Repercussões e fatores preponderantes da atuação de enfermeiras especialistas: visão de gestores / Repercussions and preponderant factors of the performance of specialist nurses: view of managers / Repercusiones y factores preponderantes de la actuación de enfermeros especialistas: visión de los directivos

Objetivo: analisar a visão dos gestores sobre as repercussões e fatores preponderantes da atuação de enfermeiras especialistas em hospitais universitários federais. Método: estudo descritivo-exploratório, com abordagem qualitativa, realizado com gestores de hospitais universitários do Nordeste brasileiro, no período de outubro a novembro de 2021, após aprovação em Comitê de Ética e Pesquisa. As análises ocorreram através do software Atlas.ti® e do referencial teórico de Bardin. Resultados: neste estudo, em entrevistas realizadas com cinco gestores, duas categorias foram identificadas e analisadas, sendo a primeira sobre as repercussões e a segunda sobre os fatores preponderantes no mercado de trabalho da atuação de enfermeiras especialistas. Conclusão: os gestores relacionam positivamente a contratação de enfermeiras especialistas, uma vez que, agregam qualidade à assistência, embora existam fatores dificultadores, como a inflexibilidade de remanejamento, adoecimento e perfil feminino da classe de enfermagem.

Objective: to analyze the view of managers on the repercussions and preponderant factors of the performance of specialist nurses in university hospitals. Method: descriptive-exploratory study, with a qualitative approach, carried out with managers of university hospitals in northeastern Brazil, from october to november 2021, after approval by the Ethics and Research Committee. Analyzes performed using the Atlas.ti® software and Bardin's theoretical framework. Results: in this study, in interviews carried out with five managers, two categories were identified and analyzed, the first on the repercussions, and the second on the preponderant factors in the labor market of the performance of specialist nurses. Conclusion: managers positively perceive the hiring of specialist nurses, as they add quality to the care, although there are complicating factors such as the inflexibility of relocation, illness and the female profile of the nursing class.

Objetivo: analizar la visión de los directivos sobre las repercusiones y factores preponderantes de la actuación de los enfermeros especialistas en hospitales federales universitarios. Método: estudio de investigación descriptivo-exploratorio, con enfoque cualitativo, realizado junto a directivos de hospitales universitarios del Nordeste de Brasil, de octubre a noviembre de 2021, previa aprobación del Comité de Ética en Investigación. Los análisis se realizaron por medio del software Atlas.ti® y del marco teórico de Bardin. Resultados: en este estudio, en entrevistas realizadas a cinco directivos, se identificaron y analizaron dos categorías: la primera sobre las repercusiones y la segunda sobre los factores preponderantes en el mercado laboral de la actuación de los enfermeros especialistas. Conclusión: los directivos perciben positivamente la contratación de enfermeras especialistas, ya que agregan calidad a la atención, aunque existen factores que complican, como la inflexibilidad de reubicación, las enfermedades y el perfil femenino de la clase de enfermería.

Estratégias de enfrentamento da COVID-19 na atenção primária: estudo de método misto / Coping strategies for COVID-19 primary care: a mixed method study

Resumo O objetivo deste artigo é analisar as estratégias de enfrentamento da COVID-19 adotadas por gestores municipais de saúde em duas regiões. Estudo de método misto do tipo explanatório sequencial, realizado com gestores municipais de saúde e coordenadores da atenção primária. A etapa quantitativa foi desenvolvida com a aplicação de instrumento a 42 gestores, para identificação de ações de enfrentamento e associação com dados demográficos e epidemiológicos da COVID-19 nos municípios. Os resultados direcionaram à definição de 15 participantes e à coleta de dados na etapa qualitativa, possibilitando aproximação das metainferências do estudo. Das ações implantadas, foram unânimes as ações de monitoramento dos casos, organização de novos fluxos de atendimento e estímulo à adoção de medidas não farmacológicas pela população. A articulação regional foi o dispositivo que permitiu ampliação e autonomia municipal para a testagem, com redução de contaminação e óbitos nos munícipes. As estratégias municipais de enfrentamento que tiveram foco na vigilância dos casos e na ampliação da testagem apresentaram desfechos positivos no que se refere a número de óbitos por COVID-19.

Abstract This article aims to analyse the COVID-19 coping strategies adopted by municipal health managers in two regions. A mixed method study of the sequential explanatory type was carried out with municipal health managers and primary care coordinators. The quantitative stage was developed with the application of an instrument to 42 managers to identify coping actions and associations with demographic and epidemiological data of COVID-19 in the municipalities. The results aimed at the definition of 15 participants and the collection of data in the qualitative stage, enabling approximation of the meta inferences of the study. Of the actions implemented, there were immediate actions to monitor cases, organize new care flows and encourage the population to adopt nonpharmacological measures. Regional articulation was the device that allowed for expansion and municipal autonomy for testing, reducing contamination and deaths among citizens. Municipal coping strategies that focused on the surveillance of cases and expansion of testing showed positive outcomes in terms of the number of infections and deaths from COVID-19.

Estratégias de enfrentamento de gestores municipaisde saúde frente à Covid-19 / Coping strategies of municipal health managersin the face of Covid-19

Objetivou-se identificar as estratégias de enfrentamento utilizadas pelos gestores da Atenção Primária à Saúde durante a pandemia da Covid-19. Trata-se de um estudo qualitativo, realizado com 10 profissionais da Atenção Primária à Saúde do município de Ibiporã, localizado no Norte do estado do Paraná. Foram realizadas entrevistas individuais, semiestruturadas, audiogravadas, transcritas na íntegra e submetidas ao Discurso do Sujeito Coletivo, adotando como referencial teórico a Teoria das Representações Sociais. As questões que permearam a identificação das estratégias de enfrentamento adotadas pelos gestores abrangeram quatro ideias centrais: questionamentos acerca dos sentimentos frente à experiência em ser gestor durante a Covid-19; tomada de decisões sobre a reorganização dos serviços frente à Covid-19; principais dificuldades e limitações durante o processo de trabalho; e estratégias pessoais e profissionais que auxiliaram no enfrentamento da Covid-19 enquanto gestor municipal de saúde. Verificou-se que a busca pelas estratégias de enfrentamento deu-se pelos sentimentos de desconhecimento acerca da Covid-19, o que desencadeou medo, cansaço e estresse nos gestores e equipes de saúde, com a necessidade de planejamento e readequações no processo de trabalho. As principais estratégias de enfrentamento utilizadas pelos gestores foram: diálogo com a equipe, escuta ativa, apoio dos familiares e momentos de oração.

The objective was to identify the management strategies used by Primary Health Care managers during the Covid-19 pandemic. This is a qualitative study, carried out with 10 professionals from Primary Health Care in the city of Ibiporã, located in the north of the State of Paraná. interviews, semi-structured audios, transcribed in full-recording and presented for individual Discourse Representations, transcribed in integral theory and presented as Social Discourse Representations were referenced. The questions that permeate the identification of the four management strategies planned by the managers cover central: questions about the feelings facing the experience of being Covid-19; decision-making on the reorganization of services in the face of Covid-19; main difficulties and guarantees during the work process; and personal and professional strategies that help face Covid-19 as a municipal health manager. It was found that fear seeks coping strategies, due to feelings of ignorance about Covid-19, which triggered fatigue and stress in managers and health teams, with the need for planning and readjustments in the work process. The main coping strategies used by the managers were: dialogue with the team, active listening, support from family members and moments of prayer.

Interactive assistance via eHealth for small- and medium-sized enterprises' employer and health care manager teams on tobacco control (eSMART-TC): protocol for a cluster randomized hybrid type II trial (N-EQUITY2101/J-SUPPORT2102).

BACKGROUND: Tobacco control should be a higher public health priority in Japan. Some workplaces provide smoking cessation support and connect employees to effective smoking cessation treatments such as outpatient clinics. However, tobacco control measures have not been sufficiently implemented in Japan, especially in small- and medium-sized enterprises (SMEs), where resources are limited. Organizational commitment and consistent leadership are crucial to facilitate implementation, but research on whether supporting organizational leaders leads to health behavior changes among employees is limited. METHODS: This hybrid type II cluster randomized effectiveness implementation trial (eSMART-TC) aims to examine the effects of interactive assistance for SME management on health and implementation outcomes. We will provide interactive assistance to employers and health managers for 6 months, aiming to promote the utilization of reimbursed smoking cessation treatments by public health insurance and to implement smoke-free workplaces. The intervention will consist of three strategies: supporting employees through campaigns, tailored ongoing facilitation, and ensuring executive engagement and support. The primary health and implementation outcomes will be salivary cotinine-validated 7-day point-prevalence abstinence rate, and the adoption of two recommended measures (promoting utilization of smoking cessation treatment and implementing smoke-free workplaces) 6 months after the initial session, respectively. Other outcomes for implementation (e.g., penetration of smoking cessation clinic visits), health (e.g., salivary cotinine-validated 7-day point-prevalence abstinence rate at 12 months), and process (e.g., adherence and potential moderating factors) will be collected via questionnaires, interviews, logbooks, and interventionists' notes at 6 and 12 months. An economic analysis will be undertaken to assess the cost-effectiveness of the implementation interventions at 12 months. DISCUSSION: This will be the first cluster randomized controlled trial to evaluate the effectiveness of an implementation intervention with interactive assistance for employers and health managers in SMEs on smoking cessation and implementation of evidence-based tobacco control measures in SMEs. The findings of this trial targeting management in SMEs have the potential to accelerate the implementation of evidence-based smoking cessation methods as well as abstinence rates among employees in SMEs across Japan. TRIAL REGISTRATION: The study protocol has been registered in the UMIN Clinical Trials Registry (UMIN-CTR; ID: UMIN000044526). Registered on 06/14/2021.

Gestores municipais de saúde da Paraíba: percepções, abordagens e práticas inerentes ao fenômeno da judicialização / Municipal health managers in the state of Paraíba, Brazil: perceptions, approaches and practices relatedto the phenomenon of judicialization / Gestores de salud municipales en el estado de Paraíba, Brasil: percepciones, enfoques y prácticas asociados conel fenómeno de la judicialización

Objetivo: analisar a percepção de gestores municipais paraibanos sobre o tema da judicialização da saúde. Metodologia: trata-se de uma pesquisa descritiva e analítica, com delimitação transversal, realizada em 2018. Foram aplicados questionários a 31 gestores de saúde municipais, que representam proporcionalmente à 75% da população do estado da Paraíba. Resultados: os resultados apontam a judicialização como fenômeno mais fortemente ligado a fatores externos à gestão do Sistema Único de Saúde (SUS). O processo de discussão da judicialização tem mais ressonância nos espaços das Comissões Intergestores, e os órgãos representativos e o Ministério Público são os maiores aliados no enfrentamento. Identifica-se fragilidades na construção dos instrumentos de gestão e, entre as soluções possíveis, estão o maior conhecimento desse fenômeno pelos órgãos e setores de gestão do SUS, bem como na qualificação das ações de regulação. Conclusão: percebe-se a complexidade da judicialização da saúde, desde a sua compreensão até a forma desafiadora de gerenciá-la. É fundamental estabelecer estratégias que promovam a comunicação e a informação, ampliando o conhecimento dos órgãos de controle e dos setores de gestão do SUS, a fim de lidar de forma mais eficaz com esse fenômeno.

Objective: to analyze the perceptions of municipal leaders in the state of Paraíba, Brazil, on the topic of health judicialization. Methodology: it is a descriptive and analytical study of a cross-sectional nature, carried out in 2018. Questionnaires were administered to 31 municipal health managers, proportionately representing 75% of the population of the state of Paraíba, Brazil. Results: judicialization is a phenomenon more associated with factors outside the management of the Brazilian Unified Health System (SUS). The discussion process about judicialization tends to take place in the Inter-institutional Commissions.The representative bodies and the Public Ministry are the main allies in the dispute. Weaknesses in the construction of administrative instruments have been identified, and solutions include better knowledge of this phenomenon by the SUS administrative bodies and sectors, and in the qualification of regulatory measures. Conclusion: the complexity of health judicializationis perceived, from its understanding to the difficulties of managing it. It is important to develop strategies that promote communication and information and improve the knowledge of regulatory bodies and SUS administrative sectors to better deal with this phenomenon.

Objetivo: analizar la percepción de los gestores municipales del estado de Paraíba, en Brasil, sobre la judicialización de la salud. Metodología: se trata de una investigación descriptiva y analítica, con delimitación transversal, realizada en 2018. Se aplicaron cuestionarios a 31 gestores municipales de salud, que representan proporcionalmente el 75% de la población del estado de Paraíba, en Brasil. Resultados: los resultados apuntan a la judicialización como un fenómeno más fuertemente ligado a factores externos a la gestión del Sistema Único de Salud (SUS) brasileño. Los órganos de representación y el Ministerio Público son los principales aliados in el enfrentamiento, y el proceso de discusión de la judicialización tiene mayor resonancia en los espacios de las Comisiones Interinstitucionales. Fue posible identificar debilidades en la construcción de instrumentos de gestióny, entre las posibles soluciones se encuentran un mayor conocimiento de este fenómeno por parte de los órganos y sectores gestores del SUS, así como en la calificación de las acciones normativas. Conclusión: se reconoce la complejidad de la judicialización de la salud, desde cómo se entiende hasta cómo se maneja. Para enfrentar con mayor eficacia este fenómeno, es necesario establecer estrategias que promuevan la comunicación y la información, ampliando el conocimiento de los órganos de control y de los sectores de gestión del SUS.

Guidance for management competency identification and development in the health context: a systematic scoping review.

BACKGROUND: Using management competency-based frameworks to guide developing and delivering training and formal education to managers has been increasingly recognized as a key strategy in building management capacity. Hence, interest in identifying and confirming the competency requirements in various contexts have been witnessed. Therefore, learnings from how competency studies were designed and conducted, how competencies were identified, and strategies in ensuring success in competency identification are of great value to researchers planning and conducting competency studies in their own country. METHODS: A scoping review was conducted guided by the Arksey and O'Malley framework and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). All papers that published empirical studies aiming at identifying and assessing manager's competencies at the peer-reviewed journals were identified from Web of sciences, PubMed, Scopus and Emerald Management between 2000 and 2021. In order to maximize learning, studies focusing on health and non-health sectors are all included. RESULTS: In total, 186 studies were included in the review including slightly more than half of the studies conducted in health sector (54.5%). 60% of the studies focused on mid to senior level managers. Surveys and Interviews were the two most commonly used methods either solely or as part of the mix-method in the studies. Half of the studies used mixed methods approach (51.1%). Large proportion of the papers failed to include all information that is necessary to contribute to learning and improvement in future study design. Based on the results of the scoping review a four steps framework was developed that can guide designing and implementing management competency studies in specific country vs. sector context and to ensure benefits of the studies are maximised. CONCLUSION: The review confirmed the increasing trend in investing in management competency studies and that the management competency identification and development process varied substantially, in the choice of methods and processes. The identification of missing information in majority of the published studies calls for the development of more rigorous guidelines for the peer-review process of journal publications. The proposed framework of improving the quality and impact of the future management competency study provides clear guidance to management competency identification and development that promotes the functional alignment of methods and strategies with intended uses and contexts.

Conhecer antes de incorporar: um retrato dos programas para alergia ao leite implementados no Brasil / Understanding before incorporating: a portrait of milk allergy programs implemented in Brazil

Este trabalho objetiva caracterizar a assistência ofertada às crianças com alergia ao leite em programas públicos, e os desafios enfrentados na sua implantação, no contexto da pré-incorporação no Sistema Único de Saúde, de três fórmulas infantis para alergia ao leite. Estudo exploratório, transversal e abordagem quantitativa. Foram avaliados 21 programas/serviços de todas as regiões brasileiras. O principal indutor da criação destes programas foi a judicialização (80,9%), e o fornecimento destas fórmulas especiais foi realizado para crianças com até 2 anos de idade. Os principais desafios para a criação e execução destes programas foram a falta de recursos humanos e financeiros, a falta da contrapartida da União, protocolo unificado para o diagnóstico (Teste de Provocação Oral), e a escolha dos tipos das fórmulas. A estratégia mais adotada para redução dos custos foi a adequação das normas e protocolos (61,9%). Não houve diferença significativa entre os programas estaduais e municipais. Este estudo apresenta uma avaliação inédita e detalhada sobre os programas, trazendo discussões que corroboram a tomada de decisões, o uso racional de recursos públicos, a melhor assistência às crianças e o fortalecimento do sistema de saúde nacional.

This paper aims to characterize the assistance offered to children with cow's milk allergy in public programs and challenges to their implementation, specifically assessing the pre-incorporation phase in the Brazilian Unified Health System of 3 formulas for infants with milk allergy. This exploratory, cross-sectional study with a quantitative approach assessed 21 programs/services from all regions of the country. The main motivation for the creation of these programs was judicialization (80.9%), and these special formulas were provided for children up to 2 years of age. The main challenges to creating and implementing these programs were a lack of human and financial resources, no counterpart federal program, no unified protocol for diagnosis (oral provocation test), and the selection of formula types. The most common strategy for reducing costs was updating norms and protocols (61.9%), which did not differ significantly between state and municipal programs. This study presents an unprecedented and detailed evaluation of the programs, raising discussion about decision-making, the rational use of public resources, better care for children, and means of strengthening of the national health system.

[Organization of healthcare systems to confront COVID-19: a scoping reviewOrganización de los sistemas de salud para hacer frente a la COVID-19: revisión del alcance]. / Organização dos sistemas de saúde no enfrentamento à covid-19: uma revisão de escopo.

Objective: To identify evidence in the literature on the response of managers regarding the organization of global healthcare systems to face the COVID-19 pandemic. Method: For this scoping review, searches were performed in 11 databases accessible through the Virtual Health Library. Eleven studies, published in 2019 and 2020, were selected based on the following guiding question: "How did managers act to organize healthcare systems to face the coronavirus pandemic?". The results were organized in terms of the categories outlined in the Pan-American Health Organization's Framework for the response of Integrated Health Service Delivery Networks to COVID-19: governance; model of care; organizational and management; financial allocations. Results: Managers in countries that invested and articulated actions in the categories of the Reference Framework, with coordination of care at the primary healthcare level, achieved better outcomes in coping with the COVID-19 pandemic. Conclusions: Situating the coordination of healthcare systems at the primary care level, preparing managers and ensuring the continued allocation of financial resources to healthcare are important factors to secure a satisfactory response to crises such as the covid-19 pandemic.

Objetivo: Hacer una búsqueda bibliográfica de la evidencia de la respuesta de los gestores en lo referente a la organización de los sistemas mundiales de salud para hacer frente a la pandemia por el nuevo coronavirus. Método: Se trata de una revisión del alcance, con búsquedas realizadas en 11 bases de datos disponibles en la Biblioteca Virtual de Salud. A partir de la pregunta orientadora sobre "¿cómo actuaron los gestores en la organización de los sistemas de salud para enfrentar la pandemia relacionada con el coronavirus?", se seleccionaron 11 estudios publicados en el período 2019­2020. Los resultados se organizaron a partir de las categorías del Marco de referencia de la red integrada de servicios de salud para la respuesta a la pandemia de COVID-19 de la Organización Panamericana de la Salud, a saber, gobernanza de la red, modelo de atención, organización y gestión, y financiamiento o recursos. Resultados: Se observó que los gestores de los países que invirtieron recursos y organizaron acciones en las categorías del marco de referencia, con la coordinación de los cuidados por medio del sistema de atención primaria de salud, obtuvieron mejores resultados en el abordaje de la pandemia. Conclusiones: La coordinación de los sistemas de salud en el nivel de atención primaria, la preparación de los gestores y el mantenimiento de la asignación continua de recursos financieros al sector de la salud son factores importantes para garantizar una respuesta satisfactoria a crisis como la causada por la pandemia de COVID-19.

How does power shape district health management team responsiveness to public feedback in low- and middle-income countries: an interpretive synthesis.

Responsiveness is a core element of World Health Organization's health system framework, considered important for ensuring inclusive and accountable health systems. System-wide responsiveness requires system-wide action, and district health management teams (DHMTs) play critical governance roles in many health systems. However, there is little evidence on how DHMTs enhance health system responsiveness. We conducted this interpretive literature review to understand how DHMTs receive and respond to public feedback and how power influences these processes. A better understanding of power dynamics could strengthen responsiveness and improve health system performance. Our interpretive synthesis drew on English language articles published between 2000 and 2021. Our search in PubMed, Google Scholar and Scopus combined terms related to responsiveness (feedback and accountability) and DHMTs (district health manager) yielding 703 articles. We retained 21 articles after screening. We applied Gaventa's power cube and Long's actor interface frameworks to synthesize insights about power. Our analysis identified complex power practices across a range of interfaces involving the public, health system and political actors. Power dynamics were rooted in social and organizational power relationships, personal characteristics (interests, attitudes and previous experiences) and world-views (values and beliefs). DHMTs' exercise of 'visible power' sometimes supported responsiveness; however, they were undermined by the 'invisible power' of public sector bureaucracy that shaped generation of responses. Invisible power, manifesting in the subconscious influence of historical marginalization, patriarchal norms and poverty, hindered vulnerable groups from providing feedback. We also identified 'hidden power' as influencing what feedback DHMTs received and from whom. Our work highlights the influence of social norms, structures and discrimination on power distribution among actors interacting with, and within, the DHMT. Responsiveness can be strengthened by recognising and building on actors' life-worlds (lived experiences) while paying attention to the broader context in which these life-worlds are embedded.

A gestão da pandemia de covid-19 e as suas repercussões para o gestor do SUS / The management of the COVID-19 pandemic and its repercussions for the SUS manager

Resumo Este artigo discute os desafios enfrentados pelos gestores estaduais do Sistema Único de Saúde (SUS) no contexto da pandemia de covid-19 e as consequências produzidas em suas vidas pessoais. A partir de entrevistas com gestores estaduais, tornou-se evidente que a pandemia demandou o replanejamento das ações e serviços de saúde, a estruturação de novos serviços e leitos hospitalares, o uso de telemedicina e a contratação e capacitação de profissionais. Também emergiu a ausência de políticas integradas e de uma coordenação nacional, que levou à adoção de diferentes estratégias por parte dos estados. Estes fatores, assim como a politização da pandemia, a negação da doença e a tentativa do governo federal de impor tratamentos ineficazes para a covid-19 foram consideradas entre as maiores dificuldades vivenciadas pelos gestores. Fazer a gestão do SUS se tornou um exercício de risco, com repercussões deletérias não apenas para si e para a sua gestão, mas também para suas famílias e amigos. Se, por um lado, o contexto extenuante afetou a saúde física e mental dos gestores, que passaram a lidar com excesso de peso, ansiedade e angústia, de outro, foi fonte de motivação por catalisar solidariedade, empatia e o compartilhamento entre os atores políticos.

Abstract This article discusses the challenges faced by the state managers of the Brazilian National Health System (SUS) in the context of the COVID-19 pandemic and the consequences for their personal lives. From interviews with state managers, it became evident that the pandemic implied the replanning of health actions and services, the structuring of new hospital services and beds, the use of telemedicine, and the hiring and training of professionals. It also exposed the lack of integrated policies and national coordination, which led to states adopting different strategies. These factors, as well as the politicization of the pandemic, the denial of the disease, and the attempt of the federal government to impose ineffective treatments for COVID-19 were considered among the greatest difficulties experienced by managers. Managing the SUS became a risky exercise, with deleterious repercussions not only for themselves and their management, but also for their families and friends. If, on the one hand, the strenuous context affected the managers' physical and mental health, who began dealing with overweight, anxiety, and anguish, on the other hand, it was a source of motivation for catalyzing solidarity, empathy, and sharing among political actors.

Educação permanente para gestores de saúde na pandemia covid-19: revisão de escopo / Educación permanente para gestores de salud en la pandemia covid-19: revisión de alcance / Permanent education for health managers in the covid-19 pandemic: scope review

Objetivos: identificar evidências documentais sobre ações de educação permanente para gestores de saúde decorrentes das necessidades de informação, decisão e ação desencadeadas pela pandemia COVID-19. Método: realizado Scoping Review segundo Joanna Briggs Institute, entre dezembro de 2019 e julho de 2022. Resultados: foram selecionados 11 estudos, classificados com base nas categorias propostas na Política e gestão da força de trabalho em saúde no contexto da resposta à pandemia da COVID-19, publicada pela Organização Mundial da Saúde/Organização Pan-Americana da Saúde. A categoria mais observada foi Intervenções para apoiar os profissionais de saúde no nível individual. Não foram encontrados estudos com intervenções voltadas ao ambiente organizacional. Considerações finais: evidenciou-se impacto positivo das ações de educação permanente na melhoria do bem-estar dos profissionais de saúde, no enfrentamento adequado dos desafios clínicos e na otimização do cuidado prestado aos pacientes durante a pandemia.

Objetivos: identificar evidencias documentales sobre acciones de educación permanente para gestores de salud derivadas de las necesidades de información, decisión y acción desencadenadas por la pandemia COVID-19. Método: realizado Scoping Review según Joanna Briggs Institute, entre diciembre de 2019 y julio de 2022. Resultados: se seleccionaron 11 estudios, clasificados en base a las categorías propuestas en la Política y gestión de la fuerza de trabajo en salud en el contexto de la respuesta a la pandemia de COVID-19, publicada por la Organización Mundial de la Salud/Organización Panamericana de la Salud. La categoría más observada fue Intervenciones para apoyar a los profesionales de la salud a nivel individual. No se encontraron estudios con intervenciones dirigidas al ambiente organizacional. Consideraciones finales: se evidenció impacto positivo de las acciones de educación permanente en la mejora del bienestar de los profesionales de salud, en el afrontamiento adecuado de los desafíos clínicos y en la optimización del cuidado prestado a los pacientes durante la pandemia.

Objective: to identify documentary evidence on permanent education actions for health managers arising from the information, decision and action needs triggered by the COVID-19 pandemic. Method: Scoping Review according to Joanna Briggs Institute, between December 2019 and July 2022. Results: 11 studies were selected, classified based on the categories proposed in the Health workforce policy and management in the context of the COVID-19 pandemic response, published by the World Health Organization/ Pan American Health Organization. The most observed category was Interventions to support health professionals at the individual level. No studies were found with interventions focused on the organizational environment. Final considerations: there was a positive impact of permanent education actions on the improvement of the well-being of health professionals, on the adequate facing of clinical challenges and on the optimization of the care provided to patients during the pandemic.

Impacto da pandemia da Covid-19 sobre o Serviço e Cuidado à Pessoa Tabagista no SUS / Impact of the Covid-19 pandemic on the Service and Care for Smokers in the SUS

Resumo Durante a pandemia da Covid-19, o serviço para tratamento do fumante foi impactado. Este artigo avaliou o impacto da pandemia sobre o serviço no SUS. Trata-se de um estudo observacional descritivo ecológico utilizando o banco de dados do Programa Nacional de Controle do Tabagismo (PNCT) anos 2019, 2020 e 2021, de cinco estados (PA, PB, GO, RJ e RS) referente ao segundo quadrimestre. Foram estimadas as diferenças relativas no número de unidades que ofereceram o serviço e no número de atendimentos para avaliação clínica, primeira e quarta sessões. Para os anos de 2019 e 2020, observou-se diferença percentual no número de unidades que ofereceram o serviço em todos os estados estudados de -51,9%. Para os anos de 2019 e 2021, a diferença relativa para as unidades de saúde foi de -20,96% e, para a avaliação clínica, primeira e quarta sessões foram: -54,19%, -55,07% e -61,31%, respectivamente. Essas diferenças foram maiores para as capitais quando comparadas com os demais municípios. Apesar do impacto negativo, principalmente no primeiro ano da pandemia, o estudo mostrou que os serviços não interromperam suas atividades e mostraram alguma recuperação em 2021.Também foi importante observar que os tabagistas, apesar das recomendações, não deixaram de procurar o tratamento.

Abstract During the Covid-19 pandemic, the smoker treatment service was impacted. This article evaluated the impact of the pandemic on the service in the SUS. This is an ecological descriptive observational study using the National Tobacco Control Program (PNCT) database for the years 2019, 2020 and 2021, from five states (PA, PB, GO, RJ and RS) for the second four months. Relative differences were estimated in the number of units that offered the service and in the number of consultations for clinical evaluation, first and fourth sessions. For the years 2019 and 2020, there was a percentage difference of -51.9% in the number of units that offered the service in all states studied. For the years 2019 and 2021, the relative difference for the health units was -20.96% and, for the clinical evaluation, the first and fourth sessions were: -54.19%, -55.07% and -61 .31%, respectively. These differences were greater for the capitals when compared to the other municipalities. Despite the negative impact, especially in the first year of the pandemic, the study showed that the services did not interrupt their activities and showed some recovery in 2021. It was also important to note that smokers, despite the recommendations, did not stop seeking treatment.

Study on the intervention effect of SMG health management in patients with ischemic stroke.

INTRODUCTION: The aim of the study was to explore the clinical effect of brain and heart health managers combined with the "SMG" health management mode on nursing intervention in ischemic stroke patients. MATERIAL AND METHODS: A total of 187 ischemic stroke patients divided into 96 patients in the observation group and 91 patients in the control group with the random number table method. The control group conducted the routine care intervention, and the observation group used the brain and heart health managers combined with the "SMG" health management model for the nursing intervention. The control of stroke risk factors was explored by comparing blood pressure, blood glucose and blood lipid and other indicators between the two groups before and after treatment. RESULTS: Compared with that before the intervention, the Stroke Self-Efficacy Questionnaire (SSEQ) score of both the observation group and the control group were significantly higher ( p < 0.05), and the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were all decreased ( p < 0.05). The proportion of patients with treatment adherence did not differ significantly before and after the intervention in the control group ( p > 0.05), and it increased significantly in the observation group after the intervention ( p < 0.05). The observation group had higher SSEQ score and lower HAMA, HAMD, NIHSS, and mRS scores after the intervention compared with the control group, with statistically significant differences. CONCLUSIONS: The combination of brain and heart health managers and "SMG" is more conducive to improving the selfefficacy of ischemic stroke patients, alleviating patient anxiety and depression, improving patient treatment compliance, controlling stroke risk factors, and promoting neurological function recovery.

Organização dos sistemas de saúde no enfrentamento à covid-19: uma revisão de escopo / Organization of healthcare systems to confront COVID-19: a scoping review / Organización de los sistemas de salud para hacer frente a la COVID-19: revisión del alcance

RESUMO Objetivo. Identificar na literatura as evidências sobre a resposta dos gestores quanto à organização dos sistemas de saúde mundiais para enfrentar a pandemia do novo coronavírus. Método. Trata-se de uma revisão de escopo, com buscas realizadas em 11 bases de dados inseridas na Biblioteca Virtual em Saúde. A partir da pergunta norteadora "Como os gestores atuaram na organização dos sistemas de saúde para enfrentar a pandemia relacionada ao coronavírus?", foram selecionados 11 estudos, publicados de 2019 a 2020. Os resultados foram organizados a partir das categorias do Marco de Referência da Rede Integrada de Serviços de Saúde em resposta da covid-19 da Organização Pan-Americana da Saúde: governança da rede; modelo de atendimento; organização e gestão; financiamento/recursos. Resultados. Identificou-se que os gestores em países que investiram e articularam ações nas categorias do Marco de Referência, com coordenação de cuidados pela atenção primária à saúde, apresentaram melhores desfechos no enfrentamento à pandemia. Conclusões. Coordenar os sistemas de saúde ao nível dos cuidados primários, preparar os gestores e manter a alocação contínua de recursos financeiros para saúde são fatores importantes para garantir uma resposta satisfatória a crises como a da pandemia de covid-19.

ABSTRACT Objective. To identify evidence in the literature on the response of managers regarding the organization of global healthcare systems to face the COVID-19 pandemic. Method. For this scoping review, searches were performed in 11 databases accessible through the Virtual Health Library. Eleven studies, published in 2019 and 2020, were selected based on the following guiding question: "How did managers act to organize healthcare systems to face the coronavirus pandemic?". The results were organized in terms of the categories outlined in the Pan-American Health Organization's Framework for the response of Integrated Health Service Delivery Networks to COVID-19: governance; model of care; organizational and management; financial allocations. Results. Managers in countries that invested and articulated actions in the categories of the Reference Framework, with coordination of care at the primary healthcare level, achieved better outcomes in coping with the COVID-19 pandemic. Conclusions. Situating the coordination of healthcare systems at the primary care level, preparing managers and ensuring the continued allocation of financial resources to healthcare are important factors to secure a satisfactory response to crises such as the covid-19 pandemic.

RESUMEN Objetivo. Hacer una búsqueda bibliográfica de la evidencia de la respuesta de los gestores en lo referente a la organización de los sistemas mundiales de salud para hacer frente a la pandemia por el nuevo coronavirus. Método. Se trata de una revisión del alcance, con búsquedas realizadas en 11 bases de datos disponibles en la Biblioteca Virtual de Salud. A partir de la pregunta orientadora sobre "¿cómo actuaron los gestores en la organización de los sistemas de salud para enfrentar la pandemia relacionada con el coronavirus?", se seleccionaron 11 estudios publicados en el período 2019-2020. Los resultados se organizaron a partir de las categorías del Marco de referencia de la red integrada de servicios de salud para la respuesta a la pandemia de COVID-19 de la Organización Panamericana de la Salud, a saber, gobernanza de la red, modelo de atención, organización y gestión, y financiamiento o recursos. Resultados. Se observó que los gestores de los países que invirtieron recursos y organizaron acciones en las categorías del marco de referencia, con la coordinación de los cuidados por medio del sistema de atención primaria de salud, obtuvieron mejores resultados en el abordaje de la pandemia. Conclusiones. La coordinación de los sistemas de salud en el nivel de atención primaria, la preparación de los gestores y el mantenimiento de la asignación continua de recursos financieros al sector de la salud son factores importantes para garantizar una respuesta satisfactoria a crisis como la causada por la pandemia de COVID-19.

Estrutura das representações sociais dos profissionais de saúde sobre doenças negligenciadas / Estructura de las representaciones sociales de los profesionales de la salud sobre enfermedades desatenidas / Structure of social representations of health professionals on neglected diseases

Objetivo: Analisar a estrutura das representações sociais dos profissionais de saúde sobre as doenças negligenciadas. Método: Estudo qualitativo sustentado pela Teoria das Representações Sociais em sua abordagem estrutural, desenvolvido em unidades de atenção primária e secundária de um município do interior da Bahia. Na primeira fase da coleta aplicou-se a técnica de evocações livres e analise pela técnica do quadrante de quatro casas, já na segunda, utilizaram-se os testes de constituição de pares pareados e os esquemas cognitivos de base. Resultados: evidenciou-se uma estrutura representacional sobre as doenças negligenciadas constituída por três dimensões: individual; social e imagética, gerenciadas por um núcleo central formado pelos termos descaso e ignorância. Conclusão: A estrutura representacional implicou na construção de práticas colaborativas dos profissionais de saúde, gestores e indivíduos no controle e nas estratégias de enfrentamento as doenças negligenciadas.(AU)

Objective: To analyze the structure of health professionals' social representations of neglected diseases. Method: Qualitative study supported by the Theory of Social Representations in its structural approach, developed in primary and secondary care units in a municipality in the interior of Bahia. In the first phase of the collection, the technique of free evocations was applied and analysis by the technique of the quadrant of four houses, in the second, the tests of constitution of paired pairs and the basic cognitive schemes were used. Results: a representational structure on neglected diseases was evidenced, consisting of three dimensions: individual; social and imagery, managed by a central nucleus formed by the terms negligence and ignorance. Conclusion: The representational structure implied the construction of collaborative practices by health professionals, managers and individuals in the control and coping strategies of neglected diseases.(AU)

Objetivo: Analizar la estructura de las representaciones sociales de los profesionales de la salud sobre las enfermedades desatendidas. Método: Estudio cualitativo sustentado en la Teoría de las Representaciones Sociales en su enfoque estructural, desarrollado en unidades de atención primaria y secundaria de un municipio del interior de Bahia. En la primera fase de la recolección se aplicó la técnica de evocaciones libres y análisis por la técnica del cuadrante de cuatro casas, en la segunda se utilizaron las pruebas de constitución de pares apareados y los esquemas cognitivos básicos. Resultados: se evidenció una estructura representacional sobre las enfermedades desatendidas, compuesta por tres dimensiones: individual; social e imaginario, gestionado por un núcleo central formado por los términos negligencia e ignorancia. Conclusión: La estructura representacional implicó la construcción de prácticas colaborativas por parte de profesionales de la salud, gestores e individuos en las estrategias de control y enfrentamiento de las enfermedades desatendidas.(AU)

Stroke health management: Novel strategies for the prevention of recurrent ischemic stroke.

Objectives: The aim of the study was to assess the effect of the stroke health management model on the prognosis and recurrence of mild to moderate ischemic stroke, guided by the stroke health manager based on the patients' needs. In addition, up-to-date evidence of healthcare resource allocation, planning, and optimization is provided. Methods: The current research was a retrospective, observational, single-center, history-controlled study with patients divided into two groups, namely, the intervention group and the control group, following the guidance of the stroke health manager. The control group patients received standard medical care during hospitalization, which consisted of advice on healthy lifestyle choices carried out by the bed nurse, but no structured education, WeChat group, or clinical consultation was included. The intervention group patients, in addition to the standard medical care, received health management and health education from the stroke health manager, and after hospital discharge, the patients were followed up over the telephone by the health manager to see if there was any recurrence or readmission. Results: From 1 January 2018 to 31 December 2020, 382 patients with acute ischemic stroke were enrolled in this study. Through the univariate regression analysis, we found that SHM intervention was associated with a significantly lower risk of recurrence (HR = 0.459). We constructed a nomogram based on the significant variables from the regression analysis and also analyzed the association between the control group and the SHM intervention group among all subgroups using the Cox proportional hazards model to assess the effect of the stroke health management model. Most patients in this study had a total risk point between 170 and 270. The C-index value was 0.76, and the time-dependent AUC for predicting recurrence was >0.7. Conclusion: The stroke health manager-guided management model based on patients' needs can better control the risk factors of stroke and significantly reduce the recurrence rate of mild to moderate ischemic stroke within 1 year.

Participação, representação e deliberação no processo decisório do Conselho Municipal de Saúde de Marabá-PA (2018-2020) / Participation, representation, and deliberation in the decision-making process of the Municipal Health Council of Marabá-PA (2018-2020)

RESUMO O objetivo deste artigo foi analisar o processo decisório do Conselho Municipal de Saúde de Marabá (CMS-M), no estado do Pará, no período de 2018 a 2020, tendo como foco os temas que foram discutidos nas reuniões ordinárias ocorridas nesse intervalo. Foi utilizado o estudo de caso como método de uma pesquisa de abordagem qualitativa que conjuga fontes primárias e secundárias. As fontes primárias foram obtidas por meio da observação participante nas reuniões realizadas no CMS-M, e as fontes secundárias, mediante análise de documentos públicos, especialmente 'pautas' e 'atas' produzidas. Tal método está vinculado a um modelo de análise próprio, concebido no escopo deste artigo. Como resultados, foram constatadas: efetiva participação dos conselheiros no processo deliberativo; regras institucionais restritivas à participação da sociedade na apresentação de demandas e denúncias; forte influência da gestão municipal no processo decisório do conselho; e baixa resposta do poder público municipal no cumprimento das deliberações produzidas no CMS-M.

ABSTRACT The objective of this article is to analyze the decision-making process of the Municipal Health Council of Marabá (CMS-M), in the state of Pará, in the period of 2018 to 2020, focusing on the themes that were discussed in the regular meetings that took place during such period. The case study was used as a research method with a qualitative approach that combines primary and secondary sources. The primary sources were obtained through participant observation in the meetings held at the CMS-M and the secondary sources through the analysis of public documents, especially 'guidelines' and 'minutes' produced. This method is linked to its analysis model, conceived within the scope of this article. As results, the following was found: effective participation of councilors in the deliberative process; institutional rules restricting society's participation in filing claims and complaints; strong influence of municipal management in the decision-making process of the council; and low response from the municipal government in complying with the deliberations produced in the CMS-M.

Competências gerenciais: conhecimento de enfermeiros / Managerial competencies: knowledge of nurses / Competencias de gestión: conocimiento de las enfermeras

Introdução: A enfermagem é considerada uma das ocupações mais versáteis dentro da força de trabalho de saúde. A gestão dos serviços de enfermagem é essencial para o sucesso da instituição de saúde e para a qualidade e segurança da assistência ao paciente. O enfermeiro gestor precisa ser apto a trabalhar e conduzir com cooperação e dinamismo a sua equipe, com respaldo em conhecimento técnico e valores éticos. Objetivo: Investigar o conhecimento dos enfermeiros quanto às competências gerenciais. Método: Estudo descritivo, exploratório, de abordagem qualitativa, realizado com enfermeiros, de um hospital universitário de pequeno porte, situado na região noroeste do estado do Paraná. As entrevistas foram pautadas na seguinte questão norteadora "Fale-me sobre as competências gerenciais executadas pelo enfermeiro?", após coleta dos dados, os mesmos foram transcritos e analisados segundo análise de conteúdo de Bardin. Resultados: Participaram do estudo sete enfermeiros, com idades entre 22 a 35 anos, a maioria desses profissionais terminaram a graduação em menos de três anos e atuavam naquela unidade de saúde, há menos de menos de um ano. A partir da análise das entrevistas emergiram três categorias, sendo elas: Habilidades para gestão; Dificuldades para gerenciar; e, Potencialidades/Facilidades para gerenciar. Principais resultados: por meio deste estudo foi possível notar que as percepções acerca das atribuições dos enfermeiros foram bem esclarecidas, demonstrando que a gerência está ligada às questões técnicas e burocráticas, e da sua relevância na condução eficiente da equipe sob sua liderança. Conclusão: Observa-se que há a necessidade de os profissionais de enfermagem compreenderem que a formação teórica e prática das atividades de educação continuada devem ser buscadas com afinco e não devem somente aguardar que os serviços de saúde as ofereçam.

Objective: To investigate nurses' knowledge of managerial skills. Method: Descriptive, exploratory study, with a qualitative approach, carried out with nurses from a small university hospital, located in the northwest region of the state of Paraná. The interviews were guided by the following guiding question "Tell me about the managerial competences performed by the nurse?", after collecting the data, they were transcribed and analyzed according to Bardin's content analysis. Results: Seven nurses participated in the study, aged between 22 and 35 years, most of these professionals finished their graduation in less than three years and worked in that health unit for less than less than a year. From the analysis of the interviews, three categories emerged, namely: Management skills; Difficulties to manage; and, Potential/Facilities to manage. Main results: through this study, it was possible to notice that the perceptions about the nurses' attributions were well clarified, demonstrating that the management is linked to technical and bureaucratic issues, and their relevance in the efficient management of the team under their leadership. Conclusion: It is observed that there is a need for nursing professionals to understand that the theoretical and practical training of continuing education activities should be pursued diligently and should not just wait for the health services to offer them.

Introducción: La enfermería se considera una de las ocupaciones más versátiles dentro del personal sanitario. La gestión de los servicios de enfermería es esencial para el éxito de la institución sanitaria y para la calidad y seguridad de la atención al paciente. El enfermero gestor debe ser capaz de trabajar y dirigir a su equipo con cooperación y dinamismo, apoyándose en conocimientos técnicos y valores éticos. Objetivo: Investigar los conocimientos de las enfermeras sobre las competencias de gestión. Método: Estudio descriptivo, exploratorio, de abordaje cualitativo, realizado con enfermeros, de un hospital universitario de pequeño porte, situado en la región noroeste del estado de Paraná. Las entrevistas se basaron en la siguiente pregunta orientadora: "Háblame de las competencias directivas que desempeñan las enfermeras". Tras la recogida de datos, se transcribieron y analizaron según el análisis de contenido de Bardin. Resultados: Participaron en el estudio siete enfermeros, con edades comprendidas entre los 22 y los 35 años, la mayoría de estos profesionales terminaron el grado en menos de tres años y permanecieron en la unidad de salud, por lo menos un año. Del análisis de las entrevistas surgieron tres categorías, a saber Habilidades para la gestión; Dificultades para la gestión; y, Potencialidades/Facilidades para la gestión. Principales resultados: a través de este estudio se ha podido constatar que las percepciones sobre las atribuciones de los enfermeros se han esclarecido, demostrando que la gerencia está ligada a las cuestiones técnicas y brocráticas, y a su relevancia en la conducción eficiente del equipo bajo su liderazgo. Conclusión: Se observa que existe la necesidad de que los profesionales de la enfermería comprendan que la formación teórica y práctica de las actividades de educación continuada debe ser buscada con afán y no debe aguantar que los servicios de salud los ofrezcan.

Perfil dos secretários municipais de Saúde do Brasil: um panorama de três décadas / Perfil de los secretarios de salud municipales en Brasil: un panorama de tres décadas / Profile of municipal managers of healthcare in Brazil: an overview of three decades

Resumo Os secretários municipais de saúde são atores estratégicos na construção e governança do SUS. Neste estudo, foi realizada uma análise comparativa do perfil dos secretários municipais ao longo de três décadas (1996, 2006 e 2017), com base em dados de três inquéritos transversais realizados em âmbito nacional, por meio de questionários estruturados direcionados para todos os secretários do país. A análise evidenciou aumento da participação feminina, maior diversidade étnica e racial e maior qualificação profissional dos gestores, além da renovação do perfil geracional, mas ainda com predomínio de homens brancos e importantes diferenças regionais. Foi observado avanço da democratização desses espaços de gestão, mas permanece o desafio de tornar a máquina pública mais representativa do conjunto da sociedade brasileira.

Resumen: Les secretarios municipales de salud son actores estratégicos en la construcción del SUS (Sistema Único de Salud) y participan activamente en la gobernanza del sistema. El análisis comparativo del perfil de los secretarios municipales a lo largo de tres décadas (1996, 2006 y 2017) se realizó utilizando la base de datos de tres encuestas transversales realizadas a nivel nacional con cuestionarios estructurados dirigidos a todos los secretarios municipales de salud del país. El aumento de la participación femenina, la mayor diversidad en términos étnicos y raciales, mayor cualificación profesional de los gestores, además de la renovación del perfil generacional, reitera el avance de la democratización de estos espacios de gestión. A pesar de la renovación del perfil durante la construcción del SUS, queda el desafío de hacer que la máquina pública sea más representativa de la sociedad brasileña en su conjunto.

Abstract Municipal health secretaries are strategic actors in the construction of the Brazilian national health system - SUS, actively participating in the system's governance. The comparative analysis of the profile of municipal secretaries over three decades (1996, 2006, and 2017) was carried out using the database of three cross-sectional surveys carried out at the national level with structured questionnaires aimed at all municipal health secretaries in the country. The increase in female participation, greater diversity in ethnic and racial terms, greater professional qualification of managers, and the renewal of the generational profile, reiterates the advance of the democratization of these management spaces. Despite the renewal of the profile during SUS's construction, the challenge remains to make the public machine more representative of Brazilian society as a whole.

Job Satisfaction Level of Safety and Health Manager in Construction Industry: Pandemic Period.

In a widespread social turmoil such as the Pandemic, job groups with high turnover rates and high job stress, such as the construction industry, will have a greater adverse impact than the general job group. This is to be used as basic data in preparing management plans by identifying the factors that hinder job stress and job satisfaction of construction workers. In this study, during the Pandemic period (1 September 2021 to 31 December 2021), a survey was conducted on job stress and job satisfaction among safety and health managers working at construction sites. The overall job satisfaction of workers in the construction industry was grasped by analyzing the level of correlation and the mutual influence on job stress, job satisfaction, general characteristics, and work-related characteristics. As a result, in terms of work characteristics, it was found that the smaller the working period in the current position, the more positive the job satisfaction was (p < 0.01). In addition, it was found that job satisfaction increased significantly when there was a promotion opportunity (p < 0.001). The construction industry is a job group with high basic job stress and low job satisfaction. In addition, it was evaluated that job stress increased during the pandemic.