This thesis presents health care organizations as heterogenic and highly complex in nature with particular normative structures underpinning their formal rational structures. It seeks to explore the evolution of organization structure as applied to a medical corporation in Qatar and to examine the nature of organizational culture and multi professional cohesiveness. In doing so it assesses a range of models on organizational design and change. The three hospitals that compose the corporation are investigated through triangulated interpretative qualitative and quantitative methodologies and the application of the Competing Values Framework. The comprehensive approach of the investigation resulted in a series of conclusions on the evolution of hospital organizational structures, the link between life cycle and structure, forms of organizing health services, characertistics of professional structures, the nature and success of change management strategies, coordination mechanisms, organizational and professional cultures, and health service, organizational and team effectiveness assessment. Findings demonstrated that autonomous and sometimes conflicting professions worked in harmony and cohesiveness as a consequence of shared core values and the human relations focus of health organizations. In examining organizational design it showed that coordination mechanisms were preferred to integration mechanisms with the former playing an important role in conflict resolution and human relations. Finally, findings indicated that when organizational design has shortcomings, the organization substitutes through other mechanisms.

Este estudo busca identificar como a integralidade em saúde, vivenciada em Programas de Residência Multiprofissional em Saúde (RMS), toma corpo e forma no cotidiano de trabalho de Cirurgiões-Dentistas na Atenção Primária à Saúde. Pretende investigar as limitações e as possibilidades encontradas pelos egressos desta modalidade de formação em serviço para implantarem uma atenção à Saúde Bucal cujo foco de atuação seja a integralidade das ações. A pesquisa utiliza uma abordagem qualitativa. Como técnica de coleta de dados foi privilegiada a entrevista semiestruturada com egressos da RMS. De forma a complementar os dados, foi realizada uma entrevista com preceptores das RMS e coletadas informações nos documentos disponíveis sobre a estrutura curricular dos cursos. Os resultados indicam que a estrutura física e os processos de ensino-aprendizagem, oferecidos pelas Unidades de Saúde/Escola, podem influenciar no perfil do egresso das RMS. Entre os saberes e práticas compartilhadas nas RMS destacam-se a interdisciplinaridade vivida na abordagem do processo saúde-doença e a possibilidade de desenhar itinerários terapêuticos que contemplem as singularidades dos sujeitos. Assim, os dados analisados permitem apontar que, se não houver uma estrutura adequada ao exercício do acolher, a realização de práticas integrais em saúde fica comprometida, bem como, se não houver no processo de trabalho espaço para escuta, se esta não for considerada como parte do itinerário terapêutico, de nada valerá uma estrutura adequada. Ainda destaca a interdependência entre os elementos descritos anteriormente e a formação dos profissionais, pois de nada valerá uma estrutura adequada e processos de trabalho cuidadores se os profissionais não estiverem preparados para trabalhar sob a óptica da integralidade. Práticas integrais em saúde propõem o encontro, o acolhimento do outro em todas as suas dimensões, respeitando o tempo e espaço vividos. / This study aims to identify how comprehensiveness of care, as experienced in Multiprofessional Health Residency Programs (RMS), takes shape and form in the daily work of dentists within primary health care. It intends to investigate the limits and the possibilities, found by those majored in this in-service education mode, to establish an oral health care focusing on the comprehensiveness of actions. The investigation has a qualitative approach, and data was collected by means of a semi-structured interview with those majored in the RMS. To supplement the data, RMS preceptors were interviewed, as well as information from available documents about the curricular structure of the courses was gathered. The results indicate that the physical infrastructure and the teaching-learning processes, provided by the Health Care Units/School, can influence on the profile of the majored dentists. Among the knowledge and practices shared within the RMS, the interdisciplinarity experienced in the approach of the health-disease process, as well as the possibility of designing therapeutic itineraries considering the uniqueness of the subjects, were highlighted. Thus, the analyzed data allows the indication that, if there is not a suitable infrastructure for the exercise of welcoming, the performance of comprehensive practices in health is compromised. Similarly, if there is not space for listening within the working process, if it is not considered as part of the therapeutic itinerary, a suitable infrastructure is not enough. It also highlights the interdependence between the previously described elements and the education of the professionals, since a suitable infrastructure and caring working processes are not enough if the providers are not prepared to work under the perspective of comprehensiveness. Comprehensive practices in health propose the encounter, the welcoming of the other one in all her/his dimensions, honoring the time and space experienced.

O atual modelo assistencial à saúde da população brasileira caracteriza-se por grande desenvolvimento científico e tecnológico, destacando a criação de procedimentos terapêuticos com grande efetividade, bem como a hegemonia de modelo de atenção à saúde, podendo influenciar em uma organização dos serviços centrada nos hospitais e na valorização de especialistas que operam essa complexidade tecnológica. Considerando que o processo de produção do cuidado em saúde envolve ações para além de rotinas, protocolos e procedimentos, torna-se necessário um movimento paralelo de investir em tecnologias que ampliem as capacidades relacionais entre os atores envolvidos, principalmente no que tange à competência de dialogar com o outro. Considerando que a literatura, em suas diversas estruturas narrativas e poéticas, provoca sempre uma relação dialética entre aquele que enuncia e o receptor, este trabalho trata de apresentar uma intervenção de aplicação da literatura com trabalhadores de equipes multiprofissionais de unidades hospitalares de um grupo hospitalar do sistema único de saúde. Tomando como referencial teórico as teses de Walter Benjamin, Mikhail Bakhtin e Paul Ricoeur, a investigação envolveu a elaboração, aplicação, validação e interpretação de uma metodologia a partir do compartilhamento de leitura literária e escrita criativa. Uma aposta de que o encontro dialógico, pela narrativa, potencializa a curiosidade e interesse pelo outro, a coragem ética para a tomada de decisão e o desejo de compreender e ser compreendido, compartilhando um sistema de valores coletivos que se materialize em ações de cuidado em saúde. Por sua capacidade de comunicar um acontecimento sem necessariamente produzir um relato informativo, cronológico, a narrativa também foi utilizada como estratégia metodológica de pesquisa. Como material de interpretação utilizou-se as notas de caderno de campo da pesquisadora e os textos produzidos pelos participantes da pesquisa que, inseridos no conceito das técnicas de pesquisa qualitativa, compõem o movimento circular de interpretação. Além da estrutura narrativa, verificou-se que os textos produzidos enunciam uma variedade de semânticas, verdades, discursos, línguas e vozes sociais que contribuem para a produção de sentido sobre o cotidiano do trabalho em saúde. Ao final, o trabalho apresenta o resultado de um processo que, apoiado e acompanhado pela literatura, possibilita novas formas de notar, narrar e compreender melhor a vida no o cotidiano do trabalho de produção do cuidado. / The current health care model in Brazil is characterized by great scientific and technological development, highlighting the creation of therapeutic procedures with great effectiveness, as well as the hegemony of a health care model, which may influence a hospital-centered organization of services and the valorization of specialists who operate this technological complexity. Considering that the process of production of health care involves actions that go beyond routines, protocols and procedures, a parallel movement of investing in technologies that enhance relational capacities among the actors involved is necessary, mainly with regard to the competence to dialogue with the other. Considering that literature, in its various narrative and poetic structures, always provokes a dialectic relationship between the one that enunciates and the receiver, this paper aims at presenting an intervention of literature application with workers of multiprofessional teams in hospital units of a Public Health System hospital group. Taking as theoretical reference the theses of Walter Benjamin, Mikhail Bakhtin and Paul Ricoeur, the research involved the elaboration, application, validation and interpretation of a methodology through the sharing of literary reading and creative writing. A bet that the dialogical encounter, through narrative, enhances curiosity and interest towards the other, the ethical courage to make a decision and the desire to understand and be understood, sharing a system of collective values that materialize in health care actions. For its potential to communicate an event without necessarily producing an informative, chronological narrative, the narrative was also used as a methodological research strategy. As interpretive material, the researcher's field notes and the texts produced by the participants were used which, inserted in the concept of qualitative research techniques, make up the circular interpretation movement. In addition to the narrative structure, it was verified that the texts produced enunciate a variety of semantics, truths, discourses, languages and social voices that contribute to the production of meaning on the daily work in health care. At the end, the work presents the result of a process that, supported and accompanied by literature, enables new ways of noting, narrating and understanding life better in the daily work of care production.

O atual modelo assistencial à saúde da população brasileira caracteriza-se por grande desenvolvimento científico e tecnológico, destacando a criação de procedimentos terapêuticos com grande efetividade, bem como a hegemonia de modelo de atenção à saúde, podendo influenciar em uma organização dos serviços centrada nos hospitais e na valorização de especialistas que operam essa complexidade tecnológica. Considerando que o processo de produção do cuidado em saúde envolve ações para além de rotinas, protocolos e procedimentos, torna-se necessário um movimento paralelo de investir em tecnologias que ampliem as capacidades relacionais entre os atores envolvidos, principalmente no que tange à competência de dialogar com o outro. Considerando que a literatura, em suas diversas estruturas narrativas e poéticas, provoca sempre uma relação dialética entre aquele que enuncia e o receptor, este trabalho trata de apresentar uma intervenção de aplicação da literatura com trabalhadores de equipes multiprofissionais de unidades hospitalares de um grupo hospitalar do sistema único de saúde. Tomando como referencial teórico as teses de Walter Benjamin, Mikhail Bakhtin e Paul Ricoeur, a investigação envolveu a elaboração, aplicação, validação e interpretação de uma metodologia a partir do compartilhamento de leitura literária e escrita criativa. Uma aposta de que o encontro dialógico, pela narrativa, potencializa a curiosidade e interesse pelo outro, a coragem ética para a tomada de decisão e o desejo de compreender e ser compreendido, compartilhando um sistema de valores coletivos que se materialize em ações de cuidado em saúde. Por sua capacidade de comunicar um acontecimento sem necessariamente produzir um relato informativo, cronológico, a narrativa também foi utilizada como estratégia metodológica de pesquisa. Como material de interpretação utilizou-se as notas de caderno de campo da pesquisadora e os textos produzidos pelos participantes da pesquisa que, inseridos no conceito das técnicas de pesquisa qualitativa, compõem o movimento circular de interpretação. Além da estrutura narrativa, verificou-se que os textos produzidos enunciam uma variedade de semânticas, verdades, discursos, línguas e vozes sociais que contribuem para a produção de sentido sobre o cotidiano do trabalho em saúde. Ao final, o trabalho apresenta o resultado de um processo que, apoiado e acompanhado pela literatura, possibilita novas formas de notar, narrar e compreender melhor a vida no o cotidiano do trabalho de produção do cuidado. / The current health care model in Brazil is characterized by great scientific and technological development, highlighting the creation of therapeutic procedures with great effectiveness, as well as the hegemony of a health care model, which may influence a hospital-centered organization of services and the valorization of specialists who operate this technological complexity. Considering that the process of production of health care involves actions that go beyond routines, protocols and procedures, a parallel movement of investing in technologies that enhance relational capacities among the actors involved is necessary, mainly with regard to the competence to dialogue with the other. Considering that literature, in its various narrative and poetic structures, always provokes a dialectic relationship between the one that enunciates and the receiver, this paper aims at presenting an intervention of literature application with workers of multiprofessional teams in hospital units of a Public Health System hospital group. Taking as theoretical reference the theses of Walter Benjamin, Mikhail Bakhtin and Paul Ricoeur, the research involved the elaboration, application, validation and interpretation of a methodology through the sharing of literary reading and creative writing. A bet that the dialogical encounter, through narrative, enhances curiosity and interest towards the other, the ethical courage to make a decision and the desire to understand and be understood, sharing a system of collective values that materialize in health care actions. For its potential to communicate an event without necessarily producing an informative, chronological narrative, the narrative was also used as a methodological research strategy. As interpretive material, the researcher's field notes and the texts produced by the participants were used which, inserted in the concept of qualitative research techniques, make up the circular interpretation movement. In addition to the narrative structure, it was verified that the texts produced enunciate a variety of semantics, truths, discourses, languages and social voices that contribute to the production of meaning on the daily work in health care. At the end, the work presents the result of a process that, supported and accompanied by literature, enables new ways of noting, narrating and understanding life better in the daily work of care production.

Este estudo busca identificar como a integralidade em saúde, vivenciada em Programas de Residência Multiprofissional em Saúde (RMS), toma corpo e forma no cotidiano de trabalho de Cirurgiões-Dentistas na Atenção Primária à Saúde. Pretende investigar as limitações e as possibilidades encontradas pelos egressos desta modalidade de formação em serviço para implantarem uma atenção à Saúde Bucal cujo foco de atuação seja a integralidade das ações. A pesquisa utiliza uma abordagem qualitativa. Como técnica de coleta de dados foi privilegiada a entrevista semiestruturada com egressos da RMS. De forma a complementar os dados, foi realizada uma entrevista com preceptores das RMS e coletadas informações nos documentos disponíveis sobre a estrutura curricular dos cursos. Os resultados indicam que a estrutura física e os processos de ensino-aprendizagem, oferecidos pelas Unidades de Saúde/Escola, podem influenciar no perfil do egresso das RMS. Entre os saberes e práticas compartilhadas nas RMS destacam-se a interdisciplinaridade vivida na abordagem do processo saúde-doença e a possibilidade de desenhar itinerários terapêuticos que contemplem as singularidades dos sujeitos. Assim, os dados analisados permitem apontar que, se não houver uma estrutura adequada ao exercício do acolher, a realização de práticas integrais em saúde fica comprometida, bem como, se não houver no processo de trabalho espaço para escuta, se esta não for considerada como parte do itinerário terapêutico, de nada valerá uma estrutura adequada. Ainda destaca a interdependência entre os elementos descritos anteriormente e a formação dos profissionais, pois de nada valerá uma estrutura adequada e processos de trabalho cuidadores se os profissionais não estiverem preparados para trabalhar sob a óptica da integralidade. Práticas integrais em saúde propõem o encontro, o acolhimento do outro em todas as suas dimensões, respeitando o tempo e espaço vividos. / This study aims to identify how comprehensiveness of care, as experienced in Multiprofessional Health Residency Programs (RMS), takes shape and form in the daily work of dentists within primary health care. It intends to investigate the limits and the possibilities, found by those majored in this in-service education mode, to establish an oral health care focusing on the comprehensiveness of actions. The investigation has a qualitative approach, and data was collected by means of a semi-structured interview with those majored in the RMS. To supplement the data, RMS preceptors were interviewed, as well as information from available documents about the curricular structure of the courses was gathered. The results indicate that the physical infrastructure and the teaching-learning processes, provided by the Health Care Units/School, can influence on the profile of the majored dentists. Among the knowledge and practices shared within the RMS, the interdisciplinarity experienced in the approach of the health-disease process, as well as the possibility of designing therapeutic itineraries considering the uniqueness of the subjects, were highlighted. Thus, the analyzed data allows the indication that, if there is not a suitable infrastructure for the exercise of welcoming, the performance of comprehensive practices in health is compromised. Similarly, if there is not space for listening within the working process, if it is not considered as part of the therapeutic itinerary, a suitable infrastructure is not enough. It also highlights the interdependence between the previously described elements and the education of the professionals, since a suitable infrastructure and caring working processes are not enough if the providers are not prepared to work under the perspective of comprehensiveness. Comprehensive practices in health propose the encounter, the welcoming of the other one in all her/his dimensions, honoring the time and space experienced.

A Reunião de Passagem de Plantão de Enfermagem (RPPE) realizada no Hospital- Dia (HD) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, possui características particulares que a diferencia das reuniões tradicionais de passagem de plantão de enfermagem. Ela reune os integrantes da equipe interdisciplinar e todos têm a oportunidade tanto de informar sobre os pacientes assistidos no HD segundo os comportamentos apresentados nas suas atividades específicas, quanto de ouvir as informações dos demais integrantes. Trata-se, portanto, de um momento ímpar, reunindo motivos suficientes para levar a RPPE a objeto do presente estudo, que se caracteriza como quanti-qualitativo e teve como objetivos fazer um levantamento das freqüências dos integrantes da equipe interdisciplinar nessa reunião, dos relatos que fazem sobre observação e evolução dos pacientes e das decisões que tomam frente às ocorrências apresentadas. Para isso, foram utilizadas 20 RPPE em um período de tempo de dois meses, gravadas, transcritas na íntegra, realizadas sínteses e análise de conteúdo com apresentação descritiva dos resultados utilizando-se também de quadros. Os resultados mostraram uma participação maior de profissionais mais experientes na RPPE, talvez por eles coordenarem a maioria das atividades terapêuticas rotineiras do HD. Mostrou ainda, que a RPPE através do enfermeiro coordenador/facilitador, ofereceu oportunidades para os integrantes da equipe interdisciplinar informar sobre comportamentos dos pacientes nas suas atividades específicas, como também ouvir as informações dos outros. Ela mostrou-se cuidadosa, examinando sempre todos os pacientes semiinternados no HD, fazendo as observações e evoluções para cada um e tomando decisões sobre condutas a serem realizadas para aqueles que tinham necessidade no momento. A RPPE favoreceu trocas de experiências entre os profissionais das diversas áreas e contribuiu no processo ensino/aprendizagem do HD, que se constitui também em uma unidade de ensino. / The meeting for nursing shift alternation which happens at the Day Hospital in the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of São Paulo University, has particular characteristics which makes it different from the traditional nursing shift alternation meetings. It gathers members of the whole interdisciplinar team and each one, during this meeting, has the opportunity of informing about the patients under assistance at the Day Hospital regarding to their behaviour towards the specifics activities, as well as to hearing from the others. Therefore it is a single moment, combining sufficient reasons for bringing the nursing shift alternation meeting to object of the present study, which has a quantitative and qualitative character and has as objective to raise the interdisicplinar members frequency to those meetings, to report about observations and evolutions of patients, and decisions taken towards the presented situation. To obtain the result were used 20 nursing shift alternation meetings in a period of two months, which were recorded, integrally written-down, prepared content syntheses and analyses for descriptive results presentation also using panels. The results show an increased participation of experienced professionals in the nursing shift alternation meetings, maybe because they coordinate most of the therapeutical routine activities at the Day Hospital. It has also shown that the nursing shift alternation meeting, through the coordinator nurse, offers opportunities for all interdisciplinar team members to inform about their patients’ behaviour towards the specific activities, as well as to hearing from the others. The coordinator was careful, always examining all semi-hospitalized patient at the Day Hospital, making observation and evolution for each one, taking decisions about procedures to be adopted for those who were in need at that moment. The nursing shift alternation meeting gives support to exchanging experiences among professionals from different areas and contributes for the teaching/learning process at Day Hospital, which is also a teaching institution.

Abstract The purpose of the study was to explore the need for and the utilisation and functionality of the specialized psychiatric health care services available to children and adolescents of comprehensive and senior secondary school age. Special-needs students' need for psychiatric treatment and the functioning of their treatment chain was described and evaluated. Data were collected from comprehensive schools and senior secondary schools, 112 (82%) with a total of 18,532 students, in Oulu Province in 1998–2002. Special schools 37 (97%) had altogether 1276 students. The data for the first and the second sub-studies were collected with a questionnaire. The data for the third sub-study were obtained from documents concerning the need for and the use and functionality of services produced and evaluated by the key groups of actors. The data sets were evaluated way using the multiple constituency method in co-operative evaluation sessions, which were video-taped. The data for the fourth sub-study consisted of tape-recorded interviews of the study subjects. Multiple constituency evaluation and content analysis were used as research methods. As evaluated by comprehensive school and senior secondary school teachers, both the incidence and the severity of students' conduct and emotional disorders have increased over the past few years. Special school students with conduct disorders and mental health problems were referred for examinations and treatment into the treatment chain of child and adolescent psychiatry similarly to other school-aged children and adolescents. Special schools had a constant need for child and adolescent psychiatric services, but there were no direct connections with specialized health care. At all schools, efforts were made by teachers and parents to help students with the assistance of school health care and social work professionals. Whenever students failed to get the requisite help from specialized health care, their problems remained the family's responsibility. The parents in these situations felt that they had been left alone, without understanding what this was all about and without knowing where to go for help. Nevertheless, the data also included many positive experiences of fluent co-operation and easy availability of help for the student. The findings showed that there is a lot of expertise and sincere desire to work for the benefit of children and adolescents. The lack of coordination of the entire treatment chain did, however, wear down the self-esteem of the students in need of help as well as the meagre resources of their parents and the help-providing key actors. It was also suggested that the key groups participating in the treatment chain should be provided joint training and mentoring. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli saada tietoa peruskoulu- ja lukioikäisten lasten ja nuorten psykiatrisen erikoissairaanhoidon palvelujen tarpeesta, käytöstä ja toimivuudesta. Tutkimuksessa kuvataan ja arvioidaan erityisoppilaan psykiatrisen hoitoketjun tarvetta ja toimintaa. Tutkimusaineisto kerättiin Oulun läänin peruskouluista ja lukioista vuosien 1998–2002 aikana. Ensimmäisessä vaiheessa mukana oli 112 (82 %) koulua, joissa oppilaita oli yhteensä 18 532. Toisessa vaiheessa tutkimusta jatkettiin 37 (97 %) erityiskoululta saadulla aineistolla. Näissä erityiskouluissa oppilaita oli yhteensä 1276. Kolmannessa vaiheessa psykiatrisen hoitoketjun tarvetta ja toimintaa arvioitiin monitahoisesti kolmella erityiskoululla. Viimeisessä vaiheessa tutkimukseen osallistui myös psykiatrisessa hoidossa olleita oppilaita ja heidän vanhempiaan. Ensimmäisen ja toisen osatutkimuksen aineistot kerättiin kyselylomakkeella. Kolmannen osatutkimuksen aineisto saatiin palvelujen tarvetta, käyttöä ja toimintaa koskevista avainryhmien tuottamista ja arvioimista kirjallisista aineistoista. Aineistot arvioitiin monitahoisesti yhteisissä arviointitilanteissa, jotka videoitiin. Neljännen osatutkimuksen aineisto koostuu tutkittavien haastatteluista, jotka nauhoitettiin. Tutkimusmetodeina käytettiin monitahoarviointia ja sisällönanalyysia. Peruskoulun ja lukion opettajien näkökulman mukaan oppilaiden käytös- ja tunne-elämän häiriöt olivat sekä lisääntyneet että vaikeutuneet viime vuosina. Käytös- ja mielenterveysongelmista kärsivät erityiskoulujen oppilaat ohjautuivat tutkimuksiin ja hoitoon lasten ja nuorten psykiatriseen hoitoketjuun, kuten muutkin kouluikäiset lapset ja nuoret. Erityiskouluilla oli jatkuva tarve saada lasten ja nuorten psykiatrisia palveluja, mutta suoraa yhteyttä erikoissairaanhoitoon ei ole ollut. Yleis- ja erityisopetuksessa oppilaita yritettiin auttaa opettajien ja vanhempien voimavarojen mukaan sekä kouluterveydenhuollon että sosiaalitoimen asiantuntijoiden avustamana. Jos oppilaalle ei saatu tarvittavaa apua erikoissairaanhoidosta, ongelmat jäivät perheen vastuulle. Näissä tilanteissa vanhemmat kokivat jääneensä yksin ymmärtämättä, mistä on kysymys ja mistä apua voi etsiä. Tutkimustulokset antavat päätöksentekijöille, koulujen johtajille ja opettajille sekä sosiaali- ja terveydenhuollon käytännön toimintaa koordinoiville asiantuntijoille tärkeää tietoa erityisoppilaan psykiatristen palvelujen tarpeesta ja moniammatillisen hoitoketjun toiminnasta.

O crescimento das doenças crônicas não-transmissíveis está relacionado ao envelhecimento da população, à rápida urbanização não planejada, e à globalização de estilos de vida insalubres, entre outros. Nessa direção, as doenças crônicas nãotransmissíveis têm sido reconhecidas como um problema de saúde pública nacional e internacional e está elencada como prioridade na agenda nacional de pesquisa em saúde no Brasil, com destaque para o cuidado em diabetes mellitus. A Enfermagem em consonância com as políticas públicas da Organização Mundial e Ministério da Saúde desenvolve atividades de atenção em saúde às populações com condições crônicas visando o gerenciamento das doenças nos diferentes níveis de atenção. Para o avanço do conhecimento com repercussões no ensino, pesquisa e assistência, um objetivo estratégico é a expansão de estudos que visem à melhoria da relação custoefetividade de forma sustentável aos cuidados e gerenciamento em condições crônicas. No entanto, constata-se que ainda há lacunas na produção e utilização do conhecimento voltado para a primeira etapa do processo de Enfermagem que é a coleta de dados. Desse modo, é preciso ampliar evidencias acerca de instrumentos que subsidiem as informações do paciente com diabetes, mas em duas óticas diferenciadas, uma sob o olhar da perspectiva multiprofissional, e a outra da perspectiva do paciente na avaliação do seu cuidado, como elemento essencial para o desenvolvimento no setor saúde. Na expectativa de fornecer evidências científicas que possam instrumentalizar profissionais e pacientes no gerenciamento das condições crônicas, esta dissertação apresenta a validação de dois instrumentos de coleta de dados do paciente com diabetes. O primeiro, realizou uma validação do Roteiro para Atendimento Multiprofissional à pessoa com Diabetes Mellitus e /ou Hipertensão Arterial segundo a análise semântica e de conteúdo. E o segundo a validação de correspondência e fatorial do instrumento Patient Assessment Chronic Illness Care (PACIC). Desta forma, torna-se disponível dois instrumentos, um o Roteiro para Atendimento Multiprofissional à pessoa com Diabetes Mellitus e /ou Hipertensão Arterial e o outro a versão brasileira do PACIC, ambos, válidos e reprodutíveis, o que pode contribuir para a assistência de pessoas com condições crônicas / The growth of nontransmissible chronic diseases is related to the population aging, fast and unplanned urbanization, globalization, and unhealthy lifestyles, among others. In this sense, nontransmissible chronic diseases have been recognized as a national and international public health problem, being classified as a priority in the Brazilian national health research agenda, in which diabetes mellitus care stands out. In consonance with public policies of the World Health Organization and the Brazilian Ministry of Health, the nursing field develops healthcare activities to the population with chronic conditions, aiming at the management of diseases at different healthcare levels. In order to broaden knowledge and impact teaching, research and care, a strategic objective is increasing studies aimed at improving the cost-effectiveness relationship of care and the management of chronic conditions in a sustainable manner. However, there are still gaps in the production and use of knowledge aimed at the first step of the nursing process, that is, data collection. Hence, it is necessary to broaden evidence on the instruments that support the information of patients with diabetes, from two different angles - one under the multiprofessional perspective, and the other from the perspective of patients in the assessment of their care, as an essential element for the development of the health sector. With the intention to provide scientific evidence that can support professionals and patients in the management of chronic diseases, this dissertation presents the validation of two data collections instruments for patients with diabetes. The first was the validation of a Multiprofessional Care Script for People with Diabetes Mellitus and/or Arterial Hypertension, according to a semantic and content analysis. And the second was the correspondence and factor validation of the instrument Patient Assessment Chronic Illness Care (PACIC). Therefore, two instruments were made available, the Multiprofessional Care Script for People with Diabetes Mellitus and/or Arterial Hypertension and the Brazilian version of the PACIC. Both instruments are valid and reproducible, and can contribute to the care of people with chronic conditions

Bakgrund: Barn identifieras som en grupp som är extra känsliga för att drabbas av vårdskador. För att minska risken för vårdskador behöver personalen kunna samarbeta i team samt ha bra redskap för att kommunicera. Simulering beskrivs som en metod där träning av detta utförs i en säker miljö som efterliknar verkligheten. Syfte: Att beskriva vårdpersonals upplevelser av simuleringsträning vid vård av akut sjuka barn på barnklinik. Metod: En kvalitativ intervjustudie genomfördes på en barnklinik på ett medelstort sjukhus i Sverige. Intervjuerna analyserades med en innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Deltagarna i studien uppgav att simuleringsträningen gav dem en större kännedom om vad som förväntas av dem i deras yrkesroll vid vård av akut sjuka barn. Denna kännedom gav dem en trygghet och skapade ett lugn i en akut situation med ett sjukt barn. Att träna i multiprofessionella team skapade en möjlighet för personalen att utveckla teamarbetet. Att kommunicera på ett tydligt sätt och att förmedla sina tankar var en stor lärdom från simuleringsträningen. Deltagarna uttryckte att det är under reflektionen, där de får se på film hur de agerat och sedan diskutera teamets arbete, som de lär sig mest. Slutsats: Att träna simulering gav deltagarna en större trygghet i de svåraste situationerna inom vården av akut sjuka barn. Genom förbättrad kommunikation och större kunskap om sina egna och andras uppgifter i ett team upplevde deltagarna att teamarbetet utvecklades efter simuleringsträning. De förbättrade kunskaperna kom efter att deltagarna hade genomfört ett scenario och sedan diskuterat och reflekterat över sitt agerande i reflektionen. / Background: Children are identified as an extra vulnerable group to be affected by mistakes in the healthcare. To be able to reduce this risk, the healthcare staff must be able to cooperate in teams and have good communication skills. Simulation based training is described as a method where teamwork and communication is trained in a safe environment that resembles reality. Aim: To describe the healthcare staff’s experiences of simulation based training when caring for acute ill children in a pediatric clinic. Method: A qualitative interview study was implemented at a pediatric clinic at a medium-sized hospital in Sweden. A content analysis according to Graneheim and Lundman (2004) was performed to analyze the interviews. Results: According to the participants simulation based training gave them more knowledge about what was anticipated of them in there profession when caring for acute ill children. This knowledge gave them a feeling of security and calmed them down in an acute event with an ill child. Training in multiprofessional team created an opportunity to develop team work. To communicate in a distinct way and to mediate thoughts was a great lesson learned from simulation based training. The participants expressed that they learned the most during the reflection, where they saw on film how they acted during the simulation, and then got to discuss how the team worked. Conclusion: Simulation based training gave the participants a greater security when caring for the most severely acute ill children. Through improved communication and a greater knowledge of their own and others tasks in a team, the participants experienced that the teamwork improved after simulation based training. The improved knowledge came after the participants had done a scenario and then discussed and reflected about their acting during the reflection.

No / In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. . The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. Methods. A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. Results. According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person¿s sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the `mechanics of nursing¿. Conclusions. The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.