Maria D'Innocenzo

O movimento pela qualidade nos serviços de saúde e enfermagem

Literature review about quality in healthcare and nursing services. It describes the trajectory of a worldwide movement toward quality and its insertion in the health services, based on the theoretical referential of Donabedian, approaching nursing care systematization as a basis for the quality that is delivered to the users.Revison de la literatura sobre la calidad en servicios de salud y enfermeria. Describe la trayectoria del movimiento mundial por la calidad y su insercion en los servicios de salud puntuando el referencial teorico de Donabedian, abordando como base para la calidad de la asistencia de enfermeria prestada al usuario a la sistematizacion de esta asistencia.Revisao da literatura sobre qualidade em servicos de saude e enfermagem. Descreve a trajetoria do movimento mundial pela qualidade e sua insercao nos servicos de saude, pontuando o referencial teorico de Donabedian e, abordando a Sistematizacao de Assistencia de Enfermagem como base para a qualidade dessa assistencia prestada ao usuario.(AU) Literature review about quality in healthcare and nursing services. It describes the trajectory of a worldwide movement toward quality and its insertion in the health services, based on the theoretical referential of Donabedian, approaching nursing care systematization as a basis for the quality that is delivered to the users.(AU) Revison de la literatura sobre la calidad en servicios de salud y enfermeria. Describe la trayectoria del movimiento mundial por la calidad y su insercion en los servicios de salud puntuando el referencial teorico de Donabedian, abordando como base para la calidad de la asistencia de enfermeria prestada al usuario a la sistematizacion de esta asistencia.(AU)

Avaliação da qualidade dos registros de enfermagem no prontuário por meio da auditoria

OBJETIVO: El objetivo del presente estudio fue evaluar por medio de la auditoria, la calidad de los registros de enfermeria en las historias clinicas de pacientes atendidos en unidades de un hospital universitario del municipio de Sao Paulo. METODOS: se trata de un estudio descriptivo, retrospectivo cuyo metodo fue la investigacion documental. De las 424 historias clinicas analizadas entre noviembre del 2006 a enero del 2007, en diferentes unidades clinicas y quirurgicas de un hospital universitario, el 43,9% se referian a obitos y 56,1% a altas. Se verificaron los items: Llenado del levantamiento de datos; Hoja del centro quirurgico; Evolucion de enfermeria; Diagnostico de enfermeria; Prescripcion de enfermeria; Chequeo de la prescripcion de enfermeria; Chequeo de la prescripcion medica; Notas de enfermeria; Notas del alta hospitalaria y Notas de obito. RESULTADOS: En el analisis cualitativo de las historias clinicas el 26,7% fueron considerados como malos; el 64,6% regulares y el 8,7% buenos. Se observa un compromiso de la seguridad y de la perspectiva del cuidado del paciente, ademas de la dificultad para medir los resultados asistenciales procedentes de la practica del equipo de enfermeria. CONCLUSION: La investigacion posibilito identificar varios desvios que fueron analizados con el Departamento de Enfermeria y con los Grupos de Mejoria de los Procesos del Departamento de Enfermeria del hospital en estudio, propiciando propuestas de nuevas metas y estrategias para mejoria de la calidad de la asistencia de enfermeria, asi como del registro de esa asistencia.Objective: T o evaluate the quality of nursing documentation on medical records of patients from a university hospital in Sao Paulo, Brazil. Methods: A retrospective descriptive study was used to conduct the study. Four hundred and twenty four medical records of patients from medical and surgical units were reviewed from November 2006 to January 2007. The medical records were from patients who have been discharged from the hospital (56.1%) or those who have expired (43.9%). The focus of the review was on the demographic and background information, operation room flow sheet, nursing progress notes, nursing diagnoses, nursing orders, implementation of the nursing orders, medical orders, nursing documentation, discharge documentation, and documentation of death. Results: The majority of nursing documentation was acceptable (64.7%). Only 8.7% of nursing documentation was of good quality. The remainder of nursing documentation was poor (26.7%). It is important to note that was difficult to measure nursing care outcomes reflected in nursing documentation on the medical records. This may affect patient safety and quality care. Conclusion: The findings of this study suggested deviation from recommended standards of nursing practice. They served to propose new goals and strategies to improve nursing documentation and the delivery of nursing care.OBJECTIVE: To evaluate the quality of nursing documentation on medical records of patients from a university hospital in Sao Paulo, Brazil. METHODS: A retrospective descriptive study was used to conduct the study. Four hundred and twenty four medical records of patients from medical and surgical units were reviewed from November 2006 to January 2007. The medical records were from patients who have been discharged from the hospital (56.1%) or those who have expired (43.9%). The focus of the review was on the demographic and background information, operation room flow sheet, nursing progress notes, nursing diagnoses, nursing orders, implementation of the nursing orders, medical orders, nursing documentation, discharge documentation, and documentation of death. RESULTS: The majority of nursing documentation was acceptable (64.7%). Only 8.7% of nursing documentation was of good quality. The remainder of nursing documentation was poor (26.7%). It is important to note that was difficult to measure nursing care outcomes reflected in nursing documentation on the medical records. This may affect patient safety and quality care. CONCLUSION: The findings of this study suggested deviation from recommended standards of nursing practice. They served to propose new goals and strategies to improve nursing documentation and the delivery of nursing care.

Percepção da equipe de enfermagem sobre fatores causais de erros na administração de medicamentos

The nursing staff, responsible for the last stages of the administration of medications can detect failures and avoid them. The security in the administration of medicines is essential, therefore it is necessary to identify the types of errors and the risk factors in the occurrence of failure. This study sought to identify the causes of errors in administering medication and preventive measures. This is a quantitative, descriptive and exploratory research. Fifty-two professionals participated in this research. The administration of drugs is one of the most important activities of nursing, so the awareness of all the nursing staff that there will be no punishment in the occurrence of error should be made clear.A enfermagem, responsavel pelas ultimas etapas do processo de administracao de medicamentos, pode detectar falhas e evita-las. A seguranca na administracao de medicamentos e imprescindivel, e para isto e preciso identificar os tipos de erros e os fatores de risco na ocorrencia de falha. Este estudo buscou identificar os fatores causais de erros na administracao medicamentosa e medidas de prevencao. Trata-se de uma pesquisa quantitativa, descritiva exploratoria. Cinquenta e dois profissionais participaram da pesquisa. A administracao medicamentosa e uma das atividades mais importantes da enfermagem, entao a conscientizacao de toda a equipe de enfermagem de que nao havera punicao na ocorrencia do erro deve ser feita.

Satisfação de clientes sobre cuidados de enfermagem no contexto hospitalar

Objective: To describe the methodology used to measure outpatient satisfaction with nursing care and to report their actual satisfaction scores. Methods: This was a descriptive retrospective cross-sectional study. Data were collected from December 2003 through October 2005 from a database provided by the department of marketing of a large hospital in Sao Paulo City. Results: The majority of outpatients (99%) were satisfied with nursing care. Conclusion: Outpatients satisfaction was due to their expectation, needs, and nursing care received.

Sistema informatizado para gerenciamento de indicadores da assistência de enfermagem do Hospital São Paulo

Indicators are tools that permit to define parameters that will be used to make comparisons between a result and its expected value, as well as to add a value of judgement in this regard. The purpose of this study is to describe the experience of a group of nurses in the development of a computerized system to manage nursing care indicators at Hospital São Paulo. Four stages were used to implement the indicator management system: developing a nursing care indicator handbook; performing a manually registered pilot test; developing the computerized system; and performing the pilot test of the computerized system in eleven units at the hospital.Os indicadores sao instrumentos que possibilitam definir parâmetros que serao utilizados para realizar comparacoes e agregar juizo de valor frente ao encontrado e ao ideal estabelecido. Este trabalho tem como objetivo descrever a experiencia de um grupo de enfermeiras no desenvolvimento do sistema informatizado desenvolvido no Hospital Sao Paulo para o gerenciamento de indicadores da assistencia de enfermagem. A implantacao deste sistema para o gerenciamento dos indicadores foi dividida em quatro etapas: desenvolvimento do manual de indicadores da assistencia de enfermagem; realizacao de um piloto registrado manualmente, desenvolvimento do sistema informatizado e, realizacao do piloto do sistema informatizado em onze unidades do hospital.

Satisfação do cliente na avaliação da assistência de enfermagem

O estudo destaca a importância da percepcao do cliente no processo de avaliacao da assistencia de enfermagem. Atraves da pesquisa bibliografica no periodo compreendido entre 1990 e 2004. Realizou-se uma revisao sobre satisfacao do cliente, onde foram identificados conceitos e publicacoes que abordassem a percepcao do cliente como fator importante na avaliacao da assistencia de enfermagem. Assim, concluindo que o cliente tem papel importante na obtencao do verdadeiro resultado da assistencia oferecida, pois se caracteriza como fonte de opinioes e sugestoes auxiliando no processo de avaliacao.

Evaluation of the quality of nursing documentation though the review of patient medical records

OBJETIVO: El objetivo del presente estudio fue evaluar por medio de la auditoria, la calidad de los registros de enfermeria en las historias clinicas de pacientes atendidos en unidades de un hospital universitario del municipio de Sao Paulo. METODOS: se trata de un estudio descriptivo, retrospectivo cuyo metodo fue la investigacion documental. De las 424 historias clinicas analizadas entre noviembre del 2006 a enero del 2007, en diferentes unidades clinicas y quirurgicas de un hospital universitario, el 43,9% se referian a obitos y 56,1% a altas. Se verificaron los items: Llenado del levantamiento de datos; Hoja del centro quirurgico; Evolucion de enfermeria; Diagnostico de enfermeria; Prescripcion de enfermeria; Chequeo de la prescripcion de enfermeria; Chequeo de la prescripcion medica; Notas de enfermeria; Notas del alta hospitalaria y Notas de obito. RESULTADOS: En el analisis cualitativo de las historias clinicas el 26,7% fueron considerados como malos; el 64,6% regulares y el 8,7% buenos. Se observa un compromiso de la seguridad y de la perspectiva del cuidado del paciente, ademas de la dificultad para medir los resultados asistenciales procedentes de la practica del equipo de enfermeria. CONCLUSION: La investigacion posibilito identificar varios desvios que fueron analizados con el Departamento de Enfermeria y con los Grupos de Mejoria de los Procesos del Departamento de Enfermeria del hospital en estudio, propiciando propuestas de nuevas metas y estrategias para mejoria de la calidad de la asistencia de enfermeria, asi como del registro de esa asistencia.Objective: T o evaluate the quality of nursing documentation on medical records of patients from a university hospital in Sao Paulo, Brazil. Methods: A retrospective descriptive study was used to conduct the study. Four hundred and twenty four medical records of patients from medical and surgical units were reviewed from November 2006 to January 2007. The medical records were from patients who have been discharged from the hospital (56.1%) or those who have expired (43.9%). The focus of the review was on the demographic and background information, operation room flow sheet, nursing progress notes, nursing diagnoses, nursing orders, implementation of the nursing orders, medical orders, nursing documentation, discharge documentation, and documentation of death. Results: The majority of nursing documentation was acceptable (64.7%). Only 8.7% of nursing documentation was of good quality. The remainder of nursing documentation was poor (26.7%). It is important to note that was difficult to measure nursing care outcomes reflected in nursing documentation on the medical records. This may affect patient safety and quality care. Conclusion: The findings of this study suggested deviation from recommended standards of nursing practice. They served to propose new goals and strategies to improve nursing documentation and the delivery of nursing care.OBJECTIVE: To evaluate the quality of nursing documentation on medical records of patients from a university hospital in Sao Paulo, Brazil. METHODS: A retrospective descriptive study was used to conduct the study. Four hundred and twenty four medical records of patients from medical and surgical units were reviewed from November 2006 to January 2007. The medical records were from patients who have been discharged from the hospital (56.1%) or those who have expired (43.9%). The focus of the review was on the demographic and background information, operation room flow sheet, nursing progress notes, nursing diagnoses, nursing orders, implementation of the nursing orders, medical orders, nursing documentation, discharge documentation, and documentation of death. RESULTS: The majority of nursing documentation was acceptable (64.7%). Only 8.7% of nursing documentation was of good quality. The remainder of nursing documentation was poor (26.7%). It is important to note that was difficult to measure nursing care outcomes reflected in nursing documentation on the medical records. This may affect patient safety and quality care. CONCLUSION: The findings of this study suggested deviation from recommended standards of nursing practice. They served to propose new goals and strategies to improve nursing documentation and the delivery of nursing care.

Percepção dos enfermeiros sobre os resultados dos indicadores de qualidade na melhoria da prática assistencial

The quality control strategies plays an important role to nurses as they become more involved and qualified to improve the care provided. The purpose of this study was to diagnose the perception of nurses at a private hospital on the nursing quality processes applied to care improvement. This is a descriptive-exploratory study whose sample was composed by 19 nurses from care units. Results demonstrated that nurses considered the use of results from indicators to be a strategic tool for the institution, and their perceptions have confirmed the validity of care improvement practices using quality tools and indicators, emphasizing that follow up of process flaws can be a possible suggestion towards quality improvement.As estrategias de controle da qualidade assumem um significado importante para os enfermeiros, tornando-os mais envolvidos e competentes para aperfeicoarem a qualidade do cuidado prestado. Esse estudo teve como objetivo diagnosticar a percepcao dos enfermeiros de um hospital privado sobre os processos de qualidade em enfermagem aplicados a melhoria da assistencia. E um estudo descritivo-exploratorio cuja amostra foi de19 enfermeiros. Resultados demonstraram que os mesmos consideraram a utilizacao dos resultados dos indicadores um instrumento estrategico, e que sua percepcao corrobora a pratica de melhoria assistencial por meio da utilizacao de ferramentas e indicadores de qualidade com enfase no registro de falhas no processo como possiveis sugestoes de melhoria da qualidade.

Dificuldades vivenciadas pelo enfermeiro na utilização de indicadores de processos

The research has investigated the diffi culties that nurses from “Santa Casa” Hospital in Montes Claros-MG have had in using indicators to analyze the quality of care processes results. A transversal study of quantitative approach was carried out, with a questionnaire being applied to nurses who have obeyed the inclusion criteria. As a result, it was showed that 94,9% of the participants reported diffi culties in using process indicators, considering that 50% of them got graduated less than three years ago and just 30% received information about the subject during the course. Among the diffi culties, the rise of privative activities (61,5%), lack of theoretical and practical knowledge on the subject (46,2%), little knowledge about Process Management (43,6%), little involvement of the staff on the data collection (30,8%), among others. Thus, it was concluded how important it is the refl ection on the nurse’s privative activities inside the health facilities and readjustment of their work process, besides the insertion of the subject into nursing under graduation and graduation courses.

[Coaching: a reference model for the practice of nurse-leaders in the hospital context].

The objectives of the present study was to evaluate the leadership of nurses by using the coaching strategy as a managerial tool, and identify, measure and analyze the acquisition of competencies from the view of nurse-coaches. This is a descriptive, cross-sectional, exploratory and field study that was performed using a quantitative approach. Situational Leadership was selected as the theoretical framework and the research instrument was submitted to statistical and content analyses and was applied on 11 nurse leaders of a large scale private general hospital located in Sao Paulo. The results showed that participants gained new knowledge, confirmed the Situational Leadership model as the recognized being a coach leader, with a style that is mainly aimed at tasks and people, according to the situation involved, and pointed out the following skills as determinant of coaches: communication, giving and receiving feedback, assigning and gaining power and having an influence. Finally, the attitudes reflected the practice of coaching.The objectives of the present study was to evaluate the leadership of nurses by using the coaching strategy as a managerial tool, and identify, measure and analyze the acquisition of competencies from the view of nurse-coaches. This is a descriptive, cross-sectional, exploratory and field study that was performed using a quantitative approach. Situational Leadership was selected as the theoretical framework and the research instrument was submitted to statistical and content analyses and was applied on 11 nurse leaders of a large scale private general hospital located in São Paulo. The results showed that participants gained new knowledge, confirmed the Situational Leadership model as the recognized being a coach leader, with a style that is mainly aimed at tasks and people, according to the situation involved, and pointed out the following skills as determinant of coaches: communication, giving and receiving feedback, assigning and gaining power and having an influence. Finally, the attitudes reflected the practice of coaching.