Janete Rodrigues da Silva Nakao

A enfermagem no processo de gestão econômica dos serviços de saúde: limites e possibilidades

Este articulo presenta algunas reflexiones sobre las posibilidades y limites de la racionalizacion y flexibilizacion del proceso de gestion en los servicios de salud bajo la perspectiva economica y enfoca la introduccion de mecanismos e instrumentos centralizados en la responsabilizacion economica y organizacional de los recursos y la participacion de la enfermeria en estos procesos. Se discute la adopcion de un sistema de control economico que pueda coordinar los intereses de los diversos sujetos arrollados; privilegie los resultados de los procesos y mejore la combinacion economica de los recursos. Con esa perspectiva dos conceptos son considerados relevantes en la elaboracion del presupuesto del Servicio de Enfermeria: la fiscalizacion de los recursos y la negociacion en los procesos de consignacion, destinacion y utilizacion de ellos. La operacionalizacion de esos conceptos en el ambito de la (re)organizacion de los servicios de salud, mas especificamente, en el area de enfermeria, crea nuevas posibilidades de participacion en los procesos de produccion de servicios y asegura mayor transparencia en los procesos decisivos y reconfigurando nuevas modalidades de gestion para los servicios de enfermeria.

O Sistema Único de Saúde e as ações do enfermeiro em uma instituição hospitalar brasileira

There are few studies on the delivery of nursing services in hospitals participating in the Brazilian universal public health system (Sistema Unico de Saúde), which was put in place in 1988. This study, which examined possible changes in the delivery of these services since universal health care was implemented, was based on interviews carried out between July and September 1995 with 31 nurses working at a teaching hospital in the city of Ribeirão Preto, in the state of São Paulo. The nurses had begun working at the hospital between May 1980 and May 1987. Thematic analysis was used to assess their answers. According to the nurses, patients treated after the universal system was implemented have had more complex medical needs and a higher socioeconomic status. In addition, nurses reported an increase in the complexity of patient demands and in the variety of medical specialties offered by the hospital, as well as a decrease in the length of inpatient stays. Forty-six percent of the interviewees reported a change in the work done by nursing staff (for example, nurses have less time available for each patient). Not all of the problems the nurses mentioned are related to the public health system (understaffing is one example). It is essential that nurses examine national health policy and that they engage in the (re)construction of the practice of health care delivery. Nurses ought to understand the reality of their institutions and carry out a management process geared towards the expectations of patients and of health care workers.Ha uma escassez de trabalhos sobre a realidade da assistencia de enfermagem nas instituicoes hospitalares brasileiras vinculadas ao Sistema Unico de Saude, instituido em 1988. Dessa forma, o objetivo do presente estudo foi examinar as possiveis modificacoes ocorridas nesta assistencia desde a implantacao do referido sistema. Partiu-se de entrevistas com 31 enfermeiros que atuam em um hospital universitario em Ribeirao Preto, Sao Paulo, admitidos pela instituicao entre maio de 1980 e maio de 1987. As entrevistas, realizadas entre julho e setembro de 1995, foram examinadas a partir de analise tematica e revelaram que, na opiniao dos enfermeiros, os pacientes atendidos apos o convenio com o Sistema Unico de Saude sao mais complexos e tem melhor nivel socioeconomico. Os entrevistados perceberam tambem um aumento na complexidade das demandas do paciente e na variedade de especialidades medicas, assim como uma diminuicao no tempo de internacao. Quanto as acoes executadas pelo enfermeiro, 46% perceberam mudancas (por exemplo, menos proximidade com o paciente). Certas dificuldades apontadas nao se relacionavam com a implantacao do Sistema Unico de Saude (por exemplo, o deficit quantitativo de recursos humanos). No atual momento, e essencial que o enfermeiro reflita sobre a politica nacional de saude e que se engaje na (re)construcao da pratica assistencial. O enfermeiro deve compreender a realidade de sua organizacao e exercer um processo de gerenciamento voltado para as expectativas dos clientes e dos trabalhadores em saude.

GESTÃO COLEGIADA NA VISÃO DOS TÉCNICOS E AUXILIARES DE ENFERMAGEM EM UM HOSPITAL PÚBLICO BRASILEIRO

ABSTRACT We presented a positive experience about implantation of sharing management in a governmental hospital of Volta Redonda in Rio de Janeiro state, Brazil. We interviewed nursery technicians and li-censed practical nurses about this management model, moreover identify the alterations occurred in the communication process, decision making and power and analyze the difficulties found in this change. It is a quality research and among many techniques suggested for data analysis, we chose the utiliza-tion of thematic analysis of contents written by Bardin (1977). We notice that the nursery technicians and assistants understand the management model; however they continue to interact with the nurses when this is necessary. It was noticed an improvement in the communication process and that there has been a decentralization of power. We pointed that the management model used in the hospital where the research has been performed brought significant improvement in attendance on people in the hospital in Volta Redonda city, which is considered a reference among other hospitals.We presented a positive experience about implantation of sharing management in a governmental hospital of Volta Redonda in Rio de Janeiro state, Brazil. We interviewed nursery technicians and licensed practical nurses about this management model, moreover identify the alterations occurred in the communication process, decision making and power and analyze the difficulties found in this change. It is a quality research and among many techniques suggested for data analysis, we chose the utilization of thematic analysis of contents written by Bardin (1977). We notice that the nursery technicians and assistants understand the management model; however they continue to interact with the nurses when this is necessary. It was noticed an improvement in the communication process and that there has been a decentralization of power. We pointed that the management model used in the hospital where the research has been performed brought significant improvement in attendance on people in the hospital in Volta Redonda city, which is considered a reference among other hospitals.

Modificações no atendimento de enfermagem hospitalar decorrentes do Sistema Único de Saúde (SUS)

Considering changes in the Health System, this survey analyses the view of 31 nurses from a hospital institution linked to the Brazilian Unified Health System (SUS) in order to learn how they face the changes and their actions in 1995. To better understand the content of the interviews, authors use a thematic analysis proposed by BARDIN (1977). This analysis shows that some nurses recognize a different action after the SUS inclusion and others do not. However, when their actions are analysed as a whole, they are mainly directed to be a physician complementary action. The inadequate management by the nurse has contributed for a not entire nursing care. Authors suggest the management improvement of nurses in order to redirect nursing actions.Considerando modificacoes ocorridas no Sistema de Saude, este estudo analisou a visao de 31 enfermeiros de instituicao hospitalar do interior paulista, inserida ao SUS frente as mudancas ocorridas em suas acoes, em 1995. Para analise destes depoimentos, obtidos atraves de entrevistas, utilizamos proposta de BARDIN (1977). Alguns enfermeiros perceberam suas acoes diferentes e outros nao mas, quando estas sao analisadas em seu conjunto, percebe-se que estao voltadas para a complementariedade do ato medico. A inadequacao do gerenciamento da assistencia realizada pelo enfermeiro, tem contribuido para a nao integralidade desta. Sugere-se o aprimoramento gerencial a fim de redirecionar as acoes de enfermagem.

Orientações ministradas à gestante durante a assistência pré-natal: atuação dos profissionais de Enfermagem

To characterize the educational nursing actions at the Prenatal Care Outpatients Clinic of the University Hospital, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, it was carried out a study based on a retrospective survey of nursing notes made on medical records and an observation of the guidance provided by the nursing professional.

GESTIóN COLEGIADA EN LA VISIóN DE LOS TéCNICOS Y AUXILIARES DE ENfERMERÍA EN UN HOSPITAL GUBERNAMENTAL BRASILEÑO

ABSTRACT We presented a positive experience about implantation of sharing management in a governmental hospital of Volta Redonda in Rio de Janeiro state, Brazil. We interviewed nursery technicians and li-censed practical nurses about this management model, moreover identify the alterations occurred in the communication process, decision making and power and analyze the difficulties found in this change. It is a quality research and among many techniques suggested for data analysis, we chose the utiliza-tion of thematic analysis of contents written by Bardin (1977). We notice that the nursery technicians and assistants understand the management model; however they continue to interact with the nurses when this is necessary. It was noticed an improvement in the communication process and that there has been a decentralization of power. We pointed that the management model used in the hospital where the research has been performed brought significant improvement in attendance on people in the hospital in Volta Redonda city, which is considered a reference among other hospitals.We presented a positive experience about implantation of sharing management in a governmental hospital of Volta Redonda in Rio de Janeiro state, Brazil. We interviewed nursery technicians and licensed practical nurses about this management model, moreover identify the alterations occurred in the communication process, decision making and power and analyze the difficulties found in this change. It is a quality research and among many techniques suggested for data analysis, we chose the utilization of thematic analysis of contents written by Bardin (1977). We notice that the nursery technicians and assistants understand the management model; however they continue to interact with the nurses when this is necessary. It was noticed an improvement in the communication process and that there has been a decentralization of power. We pointed that the management model used in the hospital where the research has been performed brought significant improvement in attendance on people in the hospital in Volta Redonda city, which is considered a reference among other hospitals.

SHARING MANAGEMENT IN THE VISIÓN OF NURSES TECHNICIANS AND LICENSED PRACTICAL NURSES IN A BRAZILIAN PUBLIC HOSPITAL

ABSTRACT We presented a positive experience about implantation of sharing management in a governmental hospital of Volta Redonda in Rio de Janeiro state, Brazil. We interviewed nursery technicians and li-censed practical nurses about this management model, moreover identify the alterations occurred in the communication process, decision making and power and analyze the difficulties found in this change. It is a quality research and among many techniques suggested for data analysis, we chose the utiliza-tion of thematic analysis of contents written by Bardin (1977). We notice that the nursery technicians and assistants understand the management model; however they continue to interact with the nurses when this is necessary. It was noticed an improvement in the communication process and that there has been a decentralization of power. We pointed that the management model used in the hospital where the research has been performed brought significant improvement in attendance on people in the hospital in Volta Redonda city, which is considered a reference among other hospitals.We presented a positive experience about implantation of sharing management in a governmental hospital of Volta Redonda in Rio de Janeiro state, Brazil. We interviewed nursery technicians and licensed practical nurses about this management model, moreover identify the alterations occurred in the communication process, decision making and power and analyze the difficulties found in this change. It is a quality research and among many techniques suggested for data analysis, we chose the utilization of thematic analysis of contents written by Bardin (1977). We notice that the nursery technicians and assistants understand the management model; however they continue to interact with the nurses when this is necessary. It was noticed an improvement in the communication process and that there has been a decentralization of power. We pointed that the management model used in the hospital where the research has been performed brought significant improvement in attendance on people in the hospital in Volta Redonda city, which is considered a reference among other hospitals.

Changes in clinical nursing care due to the brazilian Unified Health System (SUS)

Considering changes in the Health System, this survey analyses the view of 31 nurses from a hospital institution linked to the Brazilian Unified Health System (SUS) in order to learn how they face the changes and their actions in 1995. To better understand the content of the interviews, authors use a thematic analysis proposed by BARDIN (1977). This analysis shows that some nurses recognize a different action after the SUS inclusion and others do not. However, when their actions are analysed as a whole, they are mainly directed to be a physician complementary action. The inadequate management by the nurse has contributed for a not entire nursing care. Authors suggest the management improvement of nurses in order to redirect nursing actions.Considerando modificacoes ocorridas no Sistema de Saude, este estudo analisou a visao de 31 enfermeiros de instituicao hospitalar do interior paulista, inserida ao SUS frente as mudancas ocorridas em suas acoes, em 1995. Para analise destes depoimentos, obtidos atraves de entrevistas, utilizamos proposta de BARDIN (1977). Alguns enfermeiros perceberam suas acoes diferentes e outros nao mas, quando estas sao analisadas em seu conjunto, percebe-se que estao voltadas para a complementariedade do ato medico. A inadequacao do gerenciamento da assistencia realizada pelo enfermeiro, tem contribuido para a nao integralidade desta. Sugere-se o aprimoramento gerencial a fim de redirecionar as acoes de enfermagem.

Cambios en enfermería hospitalaria derivados del Sistema Único De Salud (SUS)

Considering changes in the Health System, this survey analyses the view of 31 nurses from a hospital institution linked to the Brazilian Unified Health System (SUS) in order to learn how they face the changes and their actions in 1995. To better understand the content of the interviews, authors use a thematic analysis proposed by BARDIN (1977). This analysis shows that some nurses recognize a different action after the SUS inclusion and others do not. However, when their actions are analysed as a whole, they are mainly directed to be a physician complementary action. The inadequate management by the nurse has contributed for a not entire nursing care. Authors suggest the management improvement of nurses in order to redirect nursing actions.Considerando modificacoes ocorridas no Sistema de Saude, este estudo analisou a visao de 31 enfermeiros de instituicao hospitalar do interior paulista, inserida ao SUS frente as mudancas ocorridas em suas acoes, em 1995. Para analise destes depoimentos, obtidos atraves de entrevistas, utilizamos proposta de BARDIN (1977). Alguns enfermeiros perceberam suas acoes diferentes e outros nao mas, quando estas sao analisadas em seu conjunto, percebe-se que estao voltadas para a complementariedade do ato medico. A inadequacao do gerenciamento da assistencia realizada pelo enfermeiro, tem contribuido para a nao integralidade desta. Sugere-se o aprimoramento gerencial a fim de redirecionar as acoes de enfermagem.