Ana Maria Müller de Magalhães

Nursing workload and patient safety - a mixed method study with an ecological restorative approach

OBJETIVO: analisar a carga de trabalho da equipe de enfermagem e sua potencial relacao com a seguranca do paciente, em unidades de internacao das areas clinica e cirurgica de um hospital universitario. METODO: adotou-se um metodo misto de pesquisa com desenho sequencial explanatorio. RESULTADOS: a etapa quantitativa inicial do estudo sugere que o aumento do numero de pacientes designados para a equipe de enfermagem implica em aumento das taxas de queda do leito, infeccoes relacionadas ao cateter vascular central, rotatividade de profissionais e absenteismo. Durante a etapa qualitativa subsequente, a equipe de enfermagem destacou os cuidados relacionados a administracao de medicacao, banho de leito e transporte de pacientes, como aqueles que mais repercutem na carga de trabalho e mais representam riscos para a seguranca do paciente, dos profissionais e do ambiente. CONCLUSOES: os achados deste estudo evidenciaram associacoes significativas entre carga de trabalho e a seguranca dos pacientes. Observa-se que os quadros de pessoal com menos pacientes apresentaram os melhores indicadores de qualidade assistencial e gerencial de seguranca do paciente. Alem disso, os principios do pensamento ecologico e restaurativo contribuiram para a compreensao de alguns dos aspectos envolvidos nessa intricada relacao, a partir dos olhares dos proprios profissionais e tambem promoveram abordagem participativa para o estudo desse tema.OBJECTIVE The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital. METHOD a mixed method strategy (sequential explanatory design). RESULTS the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism. During the subsequent qualitative stage of the research, the nursing team stressed medication administration, bed baths, and patient transport as the aspects of care that have the greatest impact on workload and pose the greatest hazards to patient, provider, and environment safety. CONCLUSIONS The findings demonstrated significant associations between nursing workload and patient safety. We observed that nursing staff with fewer patients presented best results of care-related and management-related patient safety indicators. In addition, the tenets of ecological and restorative thinking contributed to the understanding of some of the aspects in this intricate relationship from the standpoint of nursing providers. They also promoted a participatory approach in this study.

Planejamento de recursos humanos de enfermagem: desafio para as lideranças

This study proposes an essay of issues involving human resources planning in nursing in the hospital sector in our current reality, discussing possible topics for future research. This is a retrospective of the evolution of research on determining the number of staff in Brazil, and the incorporation of new instruments to evaluate the work load based on the degree of dependency of the patients and actions in care. The impact of the quantity and quality of human resources on the results of care is discussed, and the role of leaders in adapting the staff composition, in order to supply safe, risk-free care to the patients and their families, seeking a management model for health practices from the perspective of complex care.Propoe-se um ensaio das questoes que envolvem o planejamento de recursos humanos de enfermagem na area hospitalar em nossa realidade, abordando possiveis temas para futuras pesquisas. Traca-se uma retrospectiva da evolucao das pesquisas sobre dimensionamento de pessoal no pais e a incorporacao de novos instrumentos para avaliacao da carga de trabalho com base no grau de dependencia dos pacientes e nas acoes de cuidado. Discute-se o impacto do quantitativo e qualitativo de recursos humanos nos resultados assistenciais e o papel das liderancas na adequacao do quadro de pessoal, com vistas a fornecer um atendimento seguro, livre de riscos aos pacientes e suas familias, buscando um modelo de gestao das praticas de saude na perspectiva do cuidado complexo.

Expectativas da equipe de enfermagem em relação à liderança

Objectives: To identify the expectations of the nursing staff in relation to the leadership of a future manager. Methods: This was an exploratory, descriptive research study, conducted in a university hospital. Data were collected by means of semi-structured interviews with 62 professionals in the field of nursing. The transcribed interviews were analyzed according to the reference of content analysis. Results: Four categories of expectations emerged from the analysis: the behavior of the future manager, working with the nursing staff, working with other teams, and the work environment. The results showed that the nursing staff is concerned with the abilities and characteristics of the future manager facing the assignments in health services. Conclusion: The nursing staff expected that the future nursing managers would have the abilities for leading a team and providing a favorable work environment.

A noção de tarefa nos grupos focais

The aim of this paper is to revisit the concept of task in light of Pichon-Riviéres referential and to discuss its application in research with focus groups. Focus groups are understood as a research technique which proposes to investigate a topic in depth, allowing the construction of new ideas and answers on the subject in focus. The presuppositions of operative groups were used to support the research practice with focus groups. In these, the notion of task has a key strategic position from which it seeks to intervene in society through dialogue and collective construction, unlike simple data collecting

Leadership in Nursing: Analysis of the Process of Choosing The Heads

The process of choosing heads can be strategic to achieve desired results in nursing care. This study presents an exploratory and descriptive research that aims to analyze the process of choosing heads for the ward, in the nursing area of a teaching hospital in Porto Alegre. Data was collected from registered nurses, technicians and nursing auxiliaries through a semi-structured interview technique and free choice of words. Three theme categories emerged from content analysis: process of choosing heads, managerial competences of the head-to-be and team articulation. Leadership was the word most frequently associated with the process of choosing heads. The consultation process for the choice of the leader also contributes to the success of the manager, as it makes the team members feel co-responsible for the results achieved and legitimizes the head-to-be in their group.O processo de escolha de dirigentes reveste-se de importância estrategica para o alcance dos resultados desejados do cuidado de enfermagem. Este estudo apresenta pesquisa exploratoria, descritiva, com o objetivo de analisar o processo de escolha de chefias de unidade, na area de enfermagem de um hospital de ensino, tendo-se coletado dados com enfermeiros, tecnicos e auxiliares de enfermagem, mediante entrevista semiestruturada e evocacao livre de palavras. Da analise de conteudo, emergiram tres categorias tematicas: processo de escolha de chefias, competencias gerenciais do futuro chefe e articulacao da equipe. Lideranca compreendeu a palavra mais frequentemente associada ao processo de escolha de chefia. O processo consultivo para a escolha dos chefes contribui para o sucesso da gestao, pois corresponsabiliza os membros da equipe pelos resultados alcancados e legitima o futuro chefe em seu grupo.Correspondencia: Gisela Maria Schebella Souto de Moura Universidade Federal do Rio Grande do Sul. Escola de Enfermagem. Departamento de Assistência e Orientação Profissional Rua São Manoel, 963 Bairro Bom Fim CEP: 90620-110 Porto Alegre, RS, Brasil E-mail: gmoura@hcpa.ufrgs.br 1 Doctor en Administración, Profesor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. Centro para el Estudio de Gestión de Enfermería, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. E-mail: giselasm@terra.com.br. 2 Enfermera, Estudiante de Doctorado y Profesor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. E-mail: amagalhaes@hcpa.ufrgs.br. 3 Doctor en Enfermería, Profesor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. Centro para el Estudio de Gestión de Enfermería, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. E-mail: clarice@adufrgs.ufrgs.br. 4 Enfermera, Hospital de Clínicas de Porto Alegre, RS, Brasil. Estudiante de Doctorado, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. Centro para el Estudio de Gestión de Enfermería, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. E-mail: bjuchem@hcpa.ufrgs.br. 5 Enfermera, Hospital de Clínicas de Porto Alegre, RS, Brasil. Estudiante de Maestría, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, RS, Brasil. E-mail: dmarona@hcpa.ufrgs.br. El proceso de elección de dirigentes se reviste de importancia estratégica para el alcance de los resultados deseados en el cuidado de enfermería. Este estudio presenta una investigación exploratoria descriptiva, con el objetivo de analizar el proceso de elección de jefes de unidad, en el área de enfermería de un hospital de enseñanza, habiendo recolectado datos con enfermeros, técnicos y auxiliares de enfermería, mediante entrevista semiestructurada y evocación libre de palabras. Del análisis de contenido, emergieron tres categorías temáticas: 1) proceso de elección de jefes, 2) competencias administrativas del futuro jefe y, 3) articulación del equipo. La palabra liderazgo fue la más frecuentemente asociada al proceso de elección de jefes. El proceso de consulta para la elección de jefes contribuye para el éxito de la administración, ya que responsabiliza a los miembros del equipo por los resultados alcanzados y otorga legitimidad al futuro jefe del grupo.

Carga de trabalho da equipe de enfermagem e segurança do paciente - estudo com método misto na abordagem ecológica restaurativa

OBJETIVO: analisar a carga de trabalho da equipe de enfermagem e sua potencial relacao com a seguranca do paciente, em unidades de internacao das areas clinica e cirurgica de um hospital universitario. METODO: adotou-se um metodo misto de pesquisa com desenho sequencial explanatorio. RESULTADOS: a etapa quantitativa inicial do estudo sugere que o aumento do numero de pacientes designados para a equipe de enfermagem implica em aumento das taxas de queda do leito, infeccoes relacionadas ao cateter vascular central, rotatividade de profissionais e absenteismo. Durante a etapa qualitativa subsequente, a equipe de enfermagem destacou os cuidados relacionados a administracao de medicacao, banho de leito e transporte de pacientes, como aqueles que mais repercutem na carga de trabalho e mais representam riscos para a seguranca do paciente, dos profissionais e do ambiente. CONCLUSOES: os achados deste estudo evidenciaram associacoes significativas entre carga de trabalho e a seguranca dos pacientes. Observa-se que os quadros de pessoal com menos pacientes apresentaram os melhores indicadores de qualidade assistencial e gerencial de seguranca do paciente. Alem disso, os principios do pensamento ecologico e restaurativo contribuiram para a compreensao de alguns dos aspectos envolvidos nessa intricada relacao, a partir dos olhares dos proprios profissionais e tambem promoveram abordagem participativa para o estudo desse tema.OBJECTIVE The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital. METHOD a mixed method strategy (sequential explanatory design). RESULTS the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism. During the subsequent qualitative stage of the research, the nursing team stressed medication administration, bed baths, and patient transport as the aspects of care that have the greatest impact on workload and pose the greatest hazards to patient, provider, and environment safety. CONCLUSIONS The findings demonstrated significant associations between nursing workload and patient safety. We observed that nursing staff with fewer patients presented best results of care-related and management-related patient safety indicators. In addition, the tenets of ecological and restorative thinking contributed to the understanding of some of the aspects in this intricate relationship from the standpoint of nursing providers. They also promoted a participatory approach in this study.

Tendências gerenciais que podem levar a enfermagem a percorrer novos caminhos

The changes in the economic and social context have led to the need of new management strategies for organizations. In the area of services, healthcare and nursing organizations have suffered the impact of these changes within their work processes. Our goal was to reflect on the new management trends and how they could influence the nursing work organization in healthcare services and the actions by managing nurses in strategies that meet the challenges of the profession in a changing social context. These new trends have pointed to the emphasis on the development or learning organizations, investment on human capital, inclusion of new knowledge and skills, searching for an open, flexible and participatory administrative practice, based on reason, creativity, sensitivity and intuition.The changes in the economic and social context have led to the need of new management strategies for organizations. In the area of services, healthcare and nursing organizations have suffered the impact of these changes within their work processes. Our goal was to reflect on the new management trends and how they could influence the nursing work organization in healthcare services and the actions by managing nurses in strategies that meet the challenges of the profession in a changing social context. These new trends have pointed to the emphasis on the development or learning organizations, investment on human capital, inclusion of new knowledge and skills, searching for an open, flexible and participatory administrative practice, based on reason, creativity, sensitivity and intuition. Descriptors: nursing; management trends; healthcare service organization Title: Management trends that may lead nursing to new paths

Constraste iodado em tomografia computadorizada: prevenção de reações adversas

Computed tomography is an X-ray exam that has been widely indicated and chosen for diagnostic purposes, especially during the last few decades. However, although it is highly revealing, in several cases the procedure presents risks associated with exposure to radiation and to the iodine contrast medium. Few publications are available in the nursing literature regarding these issues. Therefore, a review of literature is presented, emphasizing exposure to iodine contrast and adverse reactions that may arise from its use. In addition, actions are described that can be taken by the health care team professionals to reduce the occurrence of such adverse events or minimize their severity.A tomografia computadorizada tem sido um exame radiologico de ampla indicacao e escolha para fins diagnosticos, principalmente na ultima decada. No entanto, apesar de ser bastante elucidativo, em diversos casos, o procedimento oferece riscos associados a exposicao a radiacao e ao meio de contraste iodado. Sobre estas questoes e escassa a disponibilidade de publicacoes na literatura de enfermagem. Assim, apresenta-se uma revisao bibliografica, com enfase na exposicao ao contraste iodado e nas reacoes adversas que podem advir do seu uso. Alem disso, sao descritas as acoes que os profissionais da equipe de saude, alocados em servicos desta natureza, podem realizar para diminuir a ocorrencia desses eventos adversos ou minimizar sua gravidade.

Planning human resources in nursing: challenge for the leadership

This study proposes an essay of issues involving human resources planning in nursing in the hospital sector in our current reality, discussing possible topics for future research. This is a retrospective of the evolution of research on determining the number of staff in Brazil, and the incorporation of new instruments to evaluate the work load based on the degree of dependency of the patients and actions in care. The impact of the quantity and quality of human resources on the results of care is discussed, and the role of leaders in adapting the staff composition, in order to supply safe, risk-free care to the patients and their families, seeking a management model for health practices from the perspective of complex care.Propoe-se um ensaio das questoes que envolvem o planejamento de recursos humanos de enfermagem na area hospitalar em nossa realidade, abordando possiveis temas para futuras pesquisas. Traca-se uma retrospectiva da evolucao das pesquisas sobre dimensionamento de pessoal no pais e a incorporacao de novos instrumentos para avaliacao da carga de trabalho com base no grau de dependencia dos pacientes e nas acoes de cuidado. Discute-se o impacto do quantitativo e qualitativo de recursos humanos nos resultados assistenciais e o papel das liderancas na adequacao do quadro de pessoal, com vistas a fornecer um atendimento seguro, livre de riscos aos pacientes e suas familias, buscando um modelo de gestao das praticas de saude na perspectiva do cuidado complexo.

Vancomycin administration in an universitary hospital at general surgical units inpatients

To prepare and to administrate antibiotics are nursing responsibilities. Incorret use of antibiotics, like Vancomycin, very restrict drug, may influence the development of resistant bacterias.Published papers about antibiotics, focusing nursing roll are rare. Objective: to study vancomycin nursing administration by nurses. Methods: prospective observational study, in a universitary hospital, from 2001 december to 2002 april. Results:47 procedures were done by 18 professionals. Almost one kind of errors occurred in 40 (85%) of all observed infusions. They were mainly related to concentration and time of infusion in 34 (72%) infusions, residual dosis remaining in the infusion set were 27(54%) and others. There was no time of experience association and specific training with errors (p>0,01).Suggestions are made for approaches, study areas for future research are considered, and priority investigations are identified.