Maria Luiza Anselmi

O processo de trabalho de enfermagem: a cisão entre planejamento e execução do cuidado

Este articulo tiene tos objetivos de caracterizarei proceso de trabajo del enfermero y del auxiliar de enfermeria y de analizar contradicciones existentes en el trabajo de enfermeria. Toma como referencial teorico los estudios del proceso de trabajo en salud y en enfermeria y la teoria del actuar comunicativo. Con base en el metodo cualitativo de investigacion, el material empirico se recogio a traves de entrevista sem iestructura d a con enfermeros, auxiliares de enfermeria y medicos de un mismo equipo de trabajo, en un hospital universitario. El analisis se realizo mediante la tecnica de impregnacion y de la identificacion de nucleos tematicos interpretados con base a las categorias analiticas del cuadro teorico. Los resultados muestran contradicciones, tales como la cision entre planeamiento y ejecucion del cuidado y la ausencia de una apropiacion del saber de enfermeria, por parte de los agentes que ejecutan mayoritariamente el cuidado.This article aims at characterizing nurses and nursing assistants work process, as well as at analyzing contradictions present in nursing work. Studies on the nursing and health work process, and the communicative action theory were used as its theoretical framework. Based on qualitative research methodology, the empirical material was collected by means of semi-structured interviews with nurses, nursing assistants and physicians on the same work team in a school hospital. Analysis was conducted through the impregnation technique and the identification of thematic units, which were interpreted on basis of analytical categories from the theoretical framework. Results showed contradictions such as the separation between planning and care delivery and the absence of appropriation of nursing knowledge by the agents who are in charge of delivering care.

Dimensionamento de pessoal de enfermagem em um hospital universitário

The developed investigation in this type of case study, had as main goal to measure the nursing personnel at a university hospital. The adopted methodology comprizes the identification of some specific variables, among them the patient classification according to the nursing care category and the index of the predicted and not predicted absences. The medical clinic admission and surgical units were studied. Results demonstrated that the current nursing personnel corresponds to 50% of what was expected, whereas the nursing aides personnel has shown an overage of 29.2%. The redefinition of the nurses quantitative in the hospital will create possibilities to reorganize the work with the minimization of the working load, in such a way to assure the quality of delivered nursing care.A investigacao desenvolvida na modalidade de estudo de caso, teve como objetivo dimensionar o quadro de pessoal de enfermagem em um hospital universitario. A metodologia adotada contempla a identificacao de determinadas variaveis entre elas a classificacao de pacientes segundo categoria de cuidado de enfermagem e indice de ausencias previstas e nao previstas. Foram estudadas as unidades de internacao de clinica medica e cirurgica. Os resultados apontam: o quadro existente de enfermeiros corresponde a 50% daquele projetado, enquanto que para os auxiliares de enfermagem ha um excedente de 29,2%. A redefinicao do quantitativo de enfermeiros no hospital criara possibilidades para reorganizacao do trabalho com minimizacao da carga de trabalho de modo a assegurar qualidade a assistencia de enfermagem prestada.

Caracterização dos pacientes internados nas unidades médicas e cirúrgicas do HCFMRP-USP, segundo o grau de dependência em relação ao cuidado de enfermagem

O presente estudo caracterizou o grau de dependencia em relacao ao cuidado de enfermagem dos pacientes internados nas unidades de internacao medicas e cirurgicas do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo, no periodo de abril a junho de 2002, e identificou a taxa media de ocupacao de leitos nas unidades estudadas. Utilizou o Sistema de Classificacao de Pacientes de Perroca (2000). Foram classificados 9719 pacientes/dia nas unidades medicas e 8667 pacientes/dia nas unidades cirurgicas. Tanto nas unidades de internacao medicas como cirurgicas encontrou-se predominância de pacientes classificados no grau minimo de cuidado de enfermagem, 70,3 e 66,9%, respectivamente. A taxa media de ocupacao de leitos variou de 54,3 a 93,1% nas unidades medicas e de 43,4 a 60,2% nas unidades cirurgicas. O estudo permitiu conhecer a clientela quanto a demanda de cuidado de enfermagem e posteriormente, desenvolver o dimensionamento de pessoal de enfermagem.

Incidência de úlcera por pressão e ações de enfermagem

OBJETIVOS: Estimar a incidencia cumulativa (ICup) e a densidade de incidencia (DIup) de ulcera por pressao (UP) e descrever a ocorrencia de acoes de enfermagem em dois hospitais do Estado da Bahia, antes (fase 1) e durante (fase 2) intervencao educativa. METODOS: Estudo de coortes prospectivo com pacientes medico-cirurgicos, utilizando avaliacao da integridade cutânea, consulta a registros no prontuario, e entrevista com paciente, familia e equipe. RESULTADOS: ICup, fase 1 e fase 2 foi, respectivamente, no hospital 1 de 31,4% e 13,6%, e no hospital 2, de 21,4% e 15%; DIup aponta tempo medio de exposicao para aparecimento de UP no hospital 1 de 14,3 dias na fase 1 e de 43,5 na fase 2; no hospital 2, de 31,3 dias na fase 1 e 37 na fase 2. CONCLUSAO: Reducao estatisticamente significante da DIup no hospital 1; cuidados de enfermagem preventivos para UP comprometidos em ambos os hospitais nas duas fases.OBJECTIVES: To estimate the cumulative incidence (ICup) and density incidence (DIup) of pressure ulcer (PU) and to describe the implementation of nursing interventions in two hospitals in the State of Bahia before (phase 1) and during an educational intervention (phase 2). METHODS: A prospective design was used. The sample consisted of inpatients of medical/surgical units. Data were collected through skin integrity assessment, reviewing of medical records, interviewing patients, family members, and health care team. RESULTS: The cumulative incidence before and during the educational intervention was 31.4% and 13.6% in hospital 1, and 21.4% and 15% in hospital 2, respectively. The density incidence in hospital 1 before and during the educational intervention was 14.3 days and 43.5 days, respectively. The density incidence in hospital 2 before and during the educational intervention was 31.3 days and 37 days, respectively. CONCLUSION: There was a statistically significant reduction of density incidence in hospital 1. Preventive nursing interventions were effective in both before and during the educational intervention in both hospitals.

Qualidade no desempenho de técnicas dos trabalhadores de enfermagem de nível médio

OBJECTIVE To assess the quality of nursing care provided in inhalation, peripheral venipuncture, and administration of intra-muscular medication procedures in the context of professional training of nursing assistants. METHODS A cross-sectional study was carried out in two phases among nursing staff (nurse assistants as well as unlicensed nursing personnel), in three hospitals in the state of Bahia, Northeastern Brazil, in October and December 2001 and 2002. Data was collected by means of direct observation of task performance and analysis of the median values of performance. A convenience sample was stratified according to professional category and work unit. RESULTS There was a quality improvement or maintenance while performing the procedure of inhalation, with an overall median score equal to or above 70%. Median scores were reduced for peripheral venipuncture and administration of intra-muscular medication. Analysis of the differences in the procedures indicated that performance improved regarding basic procedural steps but worsened regarding the interaction with the patient. As to the nursing teams, those in Hospital 1, where there were better working conditions, had the best performance, and those in Hospital 2, where there were the worst working conditions, showed the worst performance. CONCLUSIONS Educational processes among nurse assistants implemented per se in poor working conditions are not able to bring about quality improvement of professional performance.

Enfermagem: realidade e perspectiva na assistência e no gerenciamento

As autoras buscam discutir as atividades desenvolvidas pela enfermagem sob duas orientacoes gerais: a da assistencia e do gerenciamento, no que diz respeito ao concreto do trabalho e as perspectivas desse mesmo trabalho e as perspectivas desse mesmo trabalho. Assim, polemizam a dicotomia criada em torno da funcao administrativa versus assistencial e chamam a atencao para a impossibilidade de se pensar o trabalho de enfermagem de forma desarticulada das diversas praticas em saude, que no conjunto complementam-se para atender as necessidades de saude da populacao a nivel social.

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.

Programa interdisciplinar de internação domiciliar de Marília-SP: custos de recursos materiais consumidos

This study estimated the mean total direct cost of some production factors (material resources), including consumption materials, diets, medication and solutions used by two patient groups during hospitalization in the Interdisciplinary Home Hospitalization Program (PROIID) of Marília-SP, Brazil. The sample consisted of 27 patients with a diagnosis of cerebral vascular accident (CVA) and 18 with Neoplasm. Data were collected from the moment of hospitalization until the patients left the program. The mean total direct cost amounted to R

Rotatividade dos trabalhadores de enfermagem nos hospitais do Município de Ribeirão Preto

52.72 for each patient with CVA and of R