Lucieli Dias Pedreschi Chaves

Análise dos aspectos organizacionais de um serviço de urgências clínicas: estudo em um hospital geral do município de Ribeirão Preto, SP, Brasil

A demanda por servicos de urgencia e emergencia tem aumentado, dificultado a organizacao do trabalho. Com o objetivo de identificar e analisar caracteristicas dos atendimentos de clinica medica, no servico de urgencia de hospital geral em Ribeirao Preto, 2007, segundo variaveis organizacionais, foi realizado estudo quantitativo, descritivo, utilizando dados documentais. A populacao de estudo foi representada por todos os atendimentos clinicos, registrados no Sistema de Informacao Gestao Hospitalar. Os dados foram analisados segundo estatistica descritiva e discutidos considerando o referencial teorico de reorganizacao do SUS. No periodo, ocorreram 5285 atendimentos, que foram mais frequentes em pacientes procedentes do proprio municipio, no mes de janeiro (10%), as segundas-feiras (16%), horario das 12 as 24h (67,1%), principal motivo de alta da internacao hospitalar (63,8%) e o tempo de permanencia na unidade, predominante, foi inferior a seis horas (39,8%). Os resultados subsidiam gerenciamento de recursos humanos, materiais e equipamentos, favorecendo reorganizacao do microespaco de atencao a urgencia no hospital.Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all clinical care consultations registered in the Hospital Management Information System. Data were analyzed through descriptive statistics and discussed considering the theoretical framework of the Single Health System (SUS). A total of 5,285 consultations were registered in the period, which were more frequent in patients from the city itself, in January (10%), on Mondays (16%), from 12pm to 12am (67.1%). The main reason for discharge from the unit was hospitalization (63.8%) and the predominant length of stay in the unit was less than six hours (39.8%). The results support the management of human resources, materials and equipment, indicating the desirability of reorganizing emergency care in the hospital.

Analysis of the Organizational Aspects of a Clinical Emergency Department: A Study in a General Hospital in Ribeirao Preto, SP, Brazil

A demanda por servicos de urgencia e emergencia tem aumentado, dificultado a organizacao do trabalho. Com o objetivo de identificar e analisar caracteristicas dos atendimentos de clinica medica, no servico de urgencia de hospital geral em Ribeirao Preto, 2007, segundo variaveis organizacionais, foi realizado estudo quantitativo, descritivo, utilizando dados documentais. A populacao de estudo foi representada por todos os atendimentos clinicos, registrados no Sistema de Informacao Gestao Hospitalar. Os dados foram analisados segundo estatistica descritiva e discutidos considerando o referencial teorico de reorganizacao do SUS. No periodo, ocorreram 5285 atendimentos, que foram mais frequentes em pacientes procedentes do proprio municipio, no mes de janeiro (10%), as segundas-feiras (16%), horario das 12 as 24h (67,1%), principal motivo de alta da internacao hospitalar (63,8%) e o tempo de permanencia na unidade, predominante, foi inferior a seis horas (39,8%). Os resultados subsidiam gerenciamento de recursos humanos, materiais e equipamentos, favorecendo reorganizacao do microespaco de atencao a urgencia no hospital.Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all clinical care consultations registered in the Hospital Management Information System. Data were analyzed through descriptive statistics and discussed considering the theoretical framework of the Single Health System (SUS). A total of 5,285 consultations were registered in the period, which were more frequent in patients from the city itself, in January (10%), on Mondays (16%), from 12pm to 12am (67.1%). The main reason for discharge from the unit was hospitalization (63.8%) and the predominant length of stay in the unit was less than six hours (39.8%). The results support the management of human resources, materials and equipment, indicating the desirability of reorganizing emergency care in the hospital.

The setting of research production by nursing and management graduate programs in Brazil

This documental, descriptive study was performed using a quantitative approach with the objective to characterize the production by nursing graduates in Brazil in the 2007-2009 triennium, with emphasis on nursing management. Data was collected from the CAPES database, which allows access to the abstracts of theses and dissertations. The material was analyzed and categorized according to areas/fields and the respective lines of research, as defined in Nursing. The overall production analysis was descriptive and analytical in the field of organization, namely management. The results showed that, compared to previous studies, production underwent some changes in the triennium, with an increase in the area of health care, maintenance in the organizational area, and decrease in the professional area. Regarding the management theme, most studies addressed health assessment, the conceptions/perceptions regarding planning/organizing work-services and permanent education.This documental, descriptive study was performed using a quantitative approach with the objective to characterize the production by nursing graduates in Brazil in the 2007-2009 triennium, with emphasis on nursing management. Data was collected from the CAPES database, which allows access to the abstracts of theses and dissertations. The material was analyzed and categorized according to areas/fields and the respective lines of research, as defined in Nursing. The overall production analysis was descriptive and analytical in the field of organization, namely management. The results showed that, compared to previous studies, production underwent some changes in the triennium, with an increase in the area of health care, maintenance in the organizational area, and decrease in the professional area. Regarding the management theme, most studies addressed health assessment, the conceptions/perceptions regarding planning/organizing work-services and permanent education.

Integralidade no cuidado ao câncer do colo do útero: avaliação do acesso

OBJECTIVE To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services. METHODS The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data. RESULTS Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women. CONCLUSIONS Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies.OBJECTIVE To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services. METHODS The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data. RESULTS Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women. CONCLUSIONS Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies.

Estudo da sobrevida de pacientes submetidos a hemodiálise e estimativa de gastos no município de Ribeirão Preto-SP

Utilizando a tecnica de Tabuas de Vida de Seguimento o presente estudo estimou a sobrevida de pacientes submetidos a hemodialise, segundo grupo etario, de 1997 a 2000, em Ribeirao Preto-SP A partir das probabilidades de sobrevivencia estimou tambem, os gastos por paciente que inicie o tratamento. Cerca de 60% dos pacientes seguidos continuavam vivos ao final dos quatros anos de estudo, apontando para uma sobrevivencia elevada. Os resultados mostram ainda que o crescimento dos gastos com hemodialise deve-se ao aumento da sobrevida e nao especificamente a uma ampliacao da demanda pela terapia.Using Life Table Method the present study estimated the survival of patients gone under hemodialysis, according to age group, from 1997 to 2000, in the Ribeirão Preto County. Based in probability of survival it was also estimated the expenses referred to the sessions of hemodialysis for patients that are beginning treatment. Nearly 60% of patients followed were alive after four years of study, show high survival. The results of this study show that the high expenditure with hemodialysis refers to the increase of survival of patients and not specifically the increase of demand of the therapy.

O enfermeiro e a avaliação na gestão de Sistemas de Saúde

The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.

PERFIL PROFISSIONAL DE ENFERMEIROS ATUANTES EM UNIDADES DE TERAPIA INTENSIVA DE UM HOSPITAL DE ENSINO

The Intensive Care Unit is characterized by a scene of innovation and specialized nursing care to patients considered high complexity, increasing the need for a professional profile to harmonize service between high technology and assistance. The nurse in this context requires a profile that lets you align technical and scientific 1 Artigo extraído do Projeto “O Processo de Trabalho do enfermeiro em um Centro de Terapia Intensiva: análise das competências profissionais e estratégias de gerenciamento” com apoio financeiro FAPESP, processo 2010/11224-9. ISSN 0717-2079 CIENCIA Y ENFERMERIA XIX (3): 51-62, 2013 * Enfermeira. Professor Doutor do Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto, São Paulo, Brasil. E-mail: shcamelo@eerp.usp.br ** Enfermeira Mestranda do Programa Enfermagem Fundamental da Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto, São Paulo, Brasil. E-mail: vanealucia@uol.com.br *** Enfermeira. Professor Doutor do Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto, São Paulo, Brasil. E-mail: analaus@eerp.usp.br **** Enfermeira, Doutor em Enfermagem, Professor Doutor do Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto, São Paulo, Brasil. E-mail: dpchaves@eerp. usp.brLa Unidad de Cuidados Intensivos se caracteriza por un contexto de innovacion y atencion de enfermeria especializada para pacientes considerados de alta complejidad, lo que aumenta la necesidad de un perfil profesional para armonizar servicio entre la alta tecnologia y la asistencia. La enfermera en este contexto requiere un perfil que le permita alinear los conocimientos tecnicos y cientificos, el campo de la tecnologia y la humanizacion de la atencion. Este estudio identifico y analizo el perfil de las enfermeras que trabajan en unidades de cuidados intensivos de un hospital universitario. Se trata de un estudio de caso multiple, cualitativo, siendo la muestra de 24 enfermeras de dos unidades de criticos. Fueron utilizadas las tecnicas de observacion directa y entrevistas semiestructuradas. Los resultados mostraron que el grupo estudiado estaba conformado predominantemente por mujeres, de edad media 32 anos, con poca experiencia teorica y practica en la asistencia de alta complejidad, lo que demuestra la necesidad de una constante movilizacion de expertos con el apoyo de los conocimientos cientificos para una atencion segura y de calidad.

Produção de internações hospitalares, no sistema único de saúde, na região de Ribeirão Preto, Brasil

Este estudo objetivou caracterizar a dinâmica da producao fisica e financeira de internacoes hospitalares, em 25 municipios da regiao de Ribeirao Preto, Sao Paulo, Departamento Regional de Saude XIII (DRS-XIII). Pesquisa descritivo-exploratoria, cuja coleta de dados foi a pesquisa documental. A populacao de estudo constituiu-se pelas internacoes, processadas pelo Sistema de Informacoes Hospitalares (SIH) do Sistema Unico de Saude (SUS), segundo especialidade, ano e municipio, de 1996-2007, nos 23 hospitais conveniados/contratados SUS na regiao; os dados foram codificados em planilhas eletronicas. As internacoes em Ribeirao Preto representam 64% da producao, e na regiao, 36%. A producao financeira foi de 14,6% na regiao, e 85,4% em Ribeirao Preto. Ha possibilidades de internacoes com maior custo e complexidade em Ribeirao Preto. A producao e diferenciada entre especialidades. Os resultados subsidiam ordenacao do fluxo de usuarios, acompanhamento da producao entre hospitais, auxiliando a gestao das particularidades do sistema local de saude na atencao hospitalar.This study aimed to characterize the dynamics of the physical and financial production of hospitalizations in 25 cities in the region of Ribeirão Preto, state of São Paulo, Brazil, area of the Regional Department of Health XIII (DRS-XIII). This was a descriptive and exploratory research, with documentary research as the method of data collection. The study population was constituted by hospitalizations, processed by the Hospital Information System of the Unified Health System (SIH-SUS), according to specialty, year and municipality,from 1996 to 2007, in 23 hospitals hired or contracted by SUS in the region. The data were coded in spreadsheets. Ribeirão Preto hospitalizations represented 64% of production, and hospitalization in the nearby region, 36%. The financial output was 14.6% in the region and 85.4% in Ribeirão Preto. There are possibilities of hospitalizations with increased cost and complexity in Ribeirão Preto. The production varies across specialties. The results provide order flow of users, monitoring of production between hospitals, assisting the management of the particularities of the local health system in hospital care.

Nurses and the assessment in health system management

The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.

Cenário das pesquisas na pós-graduação na área de enfermagem e gerenciamento no Brasil

This documental, descriptive study was performed using a quantitative approach with the objective to characterize the production by nursing graduates in Brazil in the 2007-2009 triennium, with emphasis on nursing management. Data was collected from the CAPES database, which allows access to the abstracts of theses and dissertations. The material was analyzed and categorized according to areas/fields and the respective lines of research, as defined in Nursing. The overall production analysis was descriptive and analytical in the field of organization, namely management. The results showed that, compared to previous studies, production underwent some changes in the triennium, with an increase in the area of health care, maintenance in the organizational area, and decrease in the professional area. Regarding the management theme, most studies addressed health assessment, the conceptions/perceptions regarding planning/organizing work-services and permanent education.This documental, descriptive study was performed using a quantitative approach with the objective to characterize the production by nursing graduates in Brazil in the 2007-2009 triennium, with emphasis on nursing management. Data was collected from the CAPES database, which allows access to the abstracts of theses and dissertations. The material was analyzed and categorized according to areas/fields and the respective lines of research, as defined in Nursing. The overall production analysis was descriptive and analytical in the field of organization, namely management. The results showed that, compared to previous studies, production underwent some changes in the triennium, with an increase in the area of health care, maintenance in the organizational area, and decrease in the professional area. Regarding the management theme, most studies addressed health assessment, the conceptions/perceptions regarding planning/organizing work-services and permanent education.