Management actions for prevention and control of healthcare-associated infections: A grounded theory approach.

AIM: To understand the management actions for prevention and control of health care-associated infections (HAIs) performed by health professionals. BACKGROUND: Prevention of nosocomial infections has evidence-based practice at its essence, but not all institutions are successful in implementing prevention methodology. METHODS: Qualitative research with Grounded Theory methodological framework. The research was carried out in two southern Brazilian hospitals. Data collected were employed through open interviews with 21 health professionals and managers. This process occurred concurrently with the data analysis, through constant comparative analysis. RESULTS: The understanding of the co-responsibility of managerial actions emerged as a central phenomenon of the theoretical model. Management actions for the prevention and control of HAIs are a collective phenomenon, in which co-responsibility sustains the effectiveness of the offered assistance. The behaviours of health teams in the face of structural and human weaknesses influence the construction of a supportive relationship in the effectiveness of patient safety actions. CONCLUSIONS: The sharing of responsibilities between professionals and the actions of prevention and control of HAIs arising from this conduct positively influence the promotion of safer and improved quality care. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should consider applying the tools to prevent and control HAIs and generate in-depth discussion to promote institution's cultural changes.

Actions and interactions in clinical nursing practice in Primary Health Care. / Ações e interações na prática clínica do enfermeiro na Atenção Primária à Saúde.

OBJECTIVE: Understanding the actions and interactions required for developing clinical nursing practice in Primary Health Care. METHOD: A qualitative study anchored in the Grounded Theory. Data was collected between April and October 2016 with nurses divided into two sample groups. RESULTS: Eighteen (18) nurses participated in the study. The category "Recognizing the Systematization of Nursing Care as an essential element for clinical nursing practice" supports the "actions-interactions" component and it is composed of two subcategories: "Accomplishing clinical practice in nursing consultations", which presents the challenges encountered in performing clinical practice; and "Highlighting management tools for evidence-based clinical practice", which operates through strategies in response to the studied phenomenon. CONCLUSION: Care actions developed in clinical nursing practice are highlighted by the systematization of care in nursing consultations, a moment of direct interaction with the individual, thus contributing to improvement in the quality of care provided.

Myocardial revascularization: factors intervening in the reference and counter-reference in Primary Health Care.

OBJECTIVE: Understanding the factors that influence the reference and counter-reference process of people indicated/submitted to Myocardial Revascularization surgery in the Primary Health Care scenario. METHOD: A qualitative research anchored in the Grounded Theory, totaling 41 participants subdivided into three groups (patients, health professionals and managers) in the Metropolitan and West Region of Santa Catarina. RESULTS: Two categories elucidate the intervening factors found, contrasting the potentialities and obstacles in (creating) the bond between people affected by cardiovascular diseases and primary health care for the reference process, highlighting weaknesses in the primary health care services provided, with failures in the counter-reference for people submitted to myocardial revascularization surgery. CONCLUSION: Strengthening the potentialities presented in this study is essential for the reference process of people affected by Cardiovascular Disease, as well as strategic actions focused on solving the evidenced obstacles which contribute to deficiencies in the referral and counter-referral process, thus impeding integral care in the health care network. OBJETIVO: Compreender os fatores que influenciam o processo de referência e contrarreferência da pessoa com indicação/submetida à Cirurgia de Revascularização Miocárdica no cenário da Atenção Primária à Saúde. MÉTODO: Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados, totalizando 41 participantes subdivididos em três grupos (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina. RESULTADOS: Duas categorias elucidam os fatores interventores encontrados, Contrastando as potencialidades e entraves no vínculo da pessoa acometida por doenças cardiovasculares com a atenção primária à saúde para o processo de referência e Destacando fragilidades nos serviços disponibilizados na atenção primária à saúde, com insucessos da contrarreferência da pessoa submetida à cirurgia de revascularização miocárdica. CONCLUSÃO: Torna-se essencial o fortalecimento das potencialidades apresentadas neste estudo para o processo de referência da pessoa acometida por Doença Cardiovascular, assim como ações estratégicas com foco na resolução dos entraves apontados e que contribuem para a deficiência do processo de referência e contrarreferência, dificultando a integralidade do cuidado na rede de atenção à saúde.

[Social representations of TB patients on treatment discontinuation]. / Representações sociais das pessoas com tuberculose sobre o abandono do tratamento.

OBJECTIVE: To understand the social representations of people with TB who discontinued treatment in a Program of Tuberculosis Control. METHOD: a descriptive study of qualitative approach conducted in the city of Lima, Peru. Data were collected from October to November 2012, through semi-structured interviews with eight individuals and the method used was thematic content analysis. RESULTS: The categories led to the construction of the social representation that the disease and the treatment bring suffering. This representation influences non-adherence to treatment and may increase the rates of treatment discontinuation. CONCLUSION: Educational strategies linked to social interaction processes, to subjectivity and to the patient context are needed to reduce the rates of discontinuation of tuberculosis treatment, relapses and multi-drug resistance. The evaluations point to new challenges that must be faced to achieve the Millennium Development Goals.

[Conflict management: challenges experienced by nurse-leaders in the hospital environment]. / Gerenciamento de conflitos: desafios vivenciados pelos enfermeiros-líderes no ambiente hospitalar.

This study aimed to understand the main conflicts experienced by nurses-leaders in the hospital environment, as well as the strategies adopted to face them.The study reflects a qualitative descriptive type approach, which was used in the case study as research strategy. The study included 25 nurses who worked in three hospitals in the city of Florianopolis, Santa Catarina. Information where obtained in the months of May to December of 2010 through semi-structured interviews, non-participant observation and dialogical workshops. Data were analyzed using the Thematic Analysis. The results demonstrated the predominant of interpersonal conflicts involving the multidisciplinary team, nurses and the nursing staff Adopting a participatory leadership, based on dialogue emerges as a strategy for coping with conflicts in the hospital environment.

Practical Approach to Care Kit: Innovation for nurses' clinical practice in HIV management.

OBJECTIVE: to analyze the use of the Practical Approach to Care Kit as a technology adopted in nurses' clinical practice for HIV management in Primary Health Care. METHOD: an exploratory and descriptive research study anchored in the methodological framework of the Constructivist Grounded Theory. The participants were defined through initial sampling, with 12 nurses, and theoretical sampling, with five managers, totaling 17 participants. The data were collected by means of intensive interviews and documentary analysis, and they were analyzed in two stages: 1) Initial coding; and 2) Focused coding. RESULTS: the professionals identified the Practical Approach to Care Kit as a technological innovation that contributed to expanding the clinical practice and to empowering nurses in the clinical management of HIV infection. They also highlighted its importance as a tool for guiding the different responsibilities and duties while sharing care, contributing to the provision of evidence-based practices. CONCLUSION: The Practical Approach to Care Kit is a technological innovation that has transformed nurses' clinical practice in HIV management, expanding their scope of activities in carrying out the diagnosis, assessing the health condition and counseling, evaluating adherence to the treatment, adverse effects and prescription of exams, medications, and immunobiological.

Ethical problems in nursing teleconsultations for people living with HIV during the Covid-19 pandemic.

OBJECTIVES: to understand the ethical problems experienced by primary health care nurses in using nursing teleconsultations for people living with the human immunodeficiency virus during the coronavirus pandemic. METHODS: qualitative research, anchored in Constructivist Grounded Theory. Data was collected between July and September 2020, with 17 participants. RESULTS: the first category highlights the ethical problems in conducting teleconsultations, managing high demand, communication barriers, and risks related to data security. The second emphasizes the potential of teleconsultations in communication and access, by generating changes in the work process and the use of protocols to guide clinical practice. CONCLUSIONS: nurses' work in digital mode requires professional qualification, with a view to stimulating reflection on teleconsultation practice, ethical-moral deliberation and combating stigma, and also adopting data security-centered conduct.

[Risk and vulnerability in the practice of professional healthcare]. / Risco e vulnerabilidade nas práticas dos profissionais de saúde.

The purpose of this study is to analyze the risks and vulnerability found in professional healthcare and the safe practices adopted based on academic research in the field of healthcare and nursing, by means of an integrative review. The articles were found in the LILACS and SCIELO databases,from the years 2005-2010, in a search for the descriptors vulnerability, risk, and occupational and personal health risks, establishing a sample of 21 articles. In basic healthcare, risks and vulnerabilities are related to the lack of resources needed for work, physical violence and emotional strain. In a hospital context, the problems are related to accidents with biological materials caused by improper use and failure to adopt protective measures, as well as excessive work and self-confidence. The importance of implementing public policies in worker health to improve working conditions and provide greater satisfaction and professional awareness is emphasized.

Management in the care of people with HIV in primary health care in times of the new coronavirus.

OBJECTIVE: To understand management practices in the care of people living with the human immunodeficiency virus (HIV) in primary health care in a Brazilian capital, in times of the new coronavirus (covid-19) pandemic. METHOD: Qualitative research, anchored in the methodological-analytical framework of the grounded theory, constructivist aspect. Data were collected by using intensive online interviews with nurses from health centers and managers of the municipal health department. Data collection and analysis occurred concomitantly in two phases of analysis: initial and focused coding. RESULTS: They point to the development of best care practices, with emphasis on initiatives for coordination of care, decentralization of clinical management for primary health care services, establishment of protocols and flows, agreement of intersectoral partnerships, use of groups and social networks, use of tools such as teleconsultation and health surveillance spreadsheet and formation of support networks. CONCLUSION: The Brazilian capital restructured its network of health services with the implementation of clinical and management protocols, seeking to maintain care for people living with HIV. We highlighted the incorporation of non-face-to-face care technologies and the facilitation of routines, as strategies for expanding access.

Self-care among people with Diabetes Mellitus and quality of care in Primary Health Care.

OBJECTIVES: to verify the adherence to self-care activities among people with diabetes mellitus and its association with quality of care received in Primary Care. METHODS: a cross-sectional study with 329 people with diabetes assisted in Primary Care. Sociodemographic and self-care data were collected. To assess quality of care in Primary Care, secondary data from the Access and Quality Improvement Program were used. For comparisons between adherence to self-care activities and quality of care received in Primary Care, the Kruskal-Wallis Test was used. RESULTS: better adherence to the diet, blood glucose monitoring and medication use were observed among people with diabetes treated in Primary Care with better coordination of care, agenda organization, and equipment. Foot examination, despite the inverse relationship with quality of care, proved to be desirable. CONCLUSIONS: adherence to self-care among people with diabetes was associated with quality of care received in Primary Care.

Best leadership practices of nurses in hospital risk management: case study.

OBJECTIVE: To highlight the best leadership practices of nurses who contribute to hospital risk management. METHOD: Single case study with two integrated units of analysis, with a qualitative approach. Data collected from April to November 2018, through focused interviews with nurse managers, non-participant observation and documentary research. Analysis using the analytical technique to the explanation construction. RESULTS: Three thematic categories were evidenced, demonstrating that the best leadership practices involve technical and non-technical competencies anchored in behavioral development, scientific knowledge, guidelines for quality and patient safety and participatory management of the health team. CONCLUSION: The best leadership practices of nurses who contribute to hospital risk management pervade technical skills and/or formal positions, valuing each team professional in a unique way and emphasizing the importance of scientific knowledge and the professional reference model that the nurse exercises in hospitals.

[Parallel between permanent education and health administration complex]. / Paralelo entre educação permanente em saúde e administração complexa.

Education is a political process, in which the society operates consistently on the development of the individual, aiming to integrate it into the way of living being. The present work represents a theoretical refection, from a parallel between the guidelines of the National Politics in Continuing Education in Health and the principles of the Complex Administration. From a brief review of the literature, it is attempted to contextualize the policy and this new form of administration based on freedom, cooperation, aggregation and self-organization. Results of the study suggest that the relation between continuing education and complex administration could facilitate the implementation of nursing care and health, as well as management's activities by promoting autonomy, as well as personal, professional and organizational growth.

Integration in health: cooperation at triple international border Amazon.

OBJECTIVE: To describe the scope and limitations of the main strategies of cooperation in health, adopted between 2005 and 2017, in the context of the triple border Brazil, Colombia and Peru. METHOD: Single, explanatory, qualitative, integrated case study carried out in 2017, in the context of the triple Amazon border, Brazil, Colombia and Peru, in the city of Tabatinga, state of Amazonas, Brazil. Our sources of evidence were: documentary data; interviews with health managers of the State Health Secretariats of Amazonas and Municipal Health of Tabatinga, Municipal Health Council of Tabatinga and Consulate of Peru in Colombia; and direct observations in four health services of Tabatinga. Data were organized with MaxQDA12® software. RESULTS: Data analyzed showed that, during the study period, the Brazilian federal government made several health cooperation agreements with both Peru and Colombia and that the state government of Amazonas undertook strategies to improve the health conditions of the dwellers of Tabatinga and the region of Alto Solimões, which indirectly reached the populations of neighboring countries, supporting the interrelationships between the countries of the region. Regarding the municipal government, we verified the existence of health integration agreements, established informally, to minimize the adversities of the local health. CONCLUSION: The cooperation strategies in health adopted in the triple Amazon border have different purposes, benefits and limitations. It is noteworthy that the existence of cooperation agreements between the federal governments of Brazil, Colombia and Peru and the presence of informal cooperation agreements between the municipal governments of Tabatinga (Brazil), Leticia (Colombia) and Santa Rosa (Peru). The limitations of this study are the lack of knowledge of local managers about the cooperation agreements established between federal governments and the lack of legitimacy of the informal agreements established by the Tabatinga government.

University educational management and clinical practice applied to nursing by the faculty of a public university.

OBJECTIVE: to emphasize university educational management actions and their articulation to develop clinical practice in nursing training, designed by its faculty. METHODS: a single-case study with qualitative approach. The sources were composed of documentary research, focused interview with key informant and direct non-participant observation. Data were organized with the help of NVivo®10. Analysis followed the explanation construction technique from the perspective of complex thinking. RESULTS: three categories emerged: Characterization of university educational management actions; Articulation of university educational management with clinical practice and its repercussion; and Spaces to develop university educational management and clinical practice. Final considerations: university educational management actions are associated with the work of professors, supporting teaching, research, and extension in order to improve clinical knowledge in the general nursing training.

Demands for psychosocial support from communities vulnerable to natural disasters.

OBJECTIVE: To identify the demands for the psychosocial care of vulnerable communities in the Vale do Itajaí, Santa Catarina Methods: Qualitative research, multiple case study, through narrative interviews with health professionals in three municipalities, from January to May 2018. The analysis of the narratives followed a formal analysis of the text, structural description of the content, analytical abstraction, analysis of knowledge, and contrastive comparison. RESULTS: The described categories were: Meanings of the demands for support before the flood; Meanings of the demands during the occurrence of the disaster; Meanings of demands after the flood: psychosocial care; Meanings of the demands for monitoring the territory after the disaster. CONCLUSION: The identification of demands for mental health care after the disaster occurs through the search for health services, specific symptoms, and consequences of adapting to the recovery phase, such as migratory processes and temporary housing. The research contributes to the culture of care with a multiprofessional perspective in health care for the population affected by disasters.

Care sharing for people with HIV/AIDS: a look targeted at young adults.

OBJECTIVE: To understand the care sharing for people living with HIV/AIDS, especially young adults, as well as the structuring of the line of care in the capital of Santa Catarina. METHOD: Qualitative research, anchored by theory based on data collected in the Health Care Network of Florianópolis, totaling 19 participants distributed between two sample groups. The data collection and analysis were concomitant, with comparative analysis method. RESULTS: The municipality has been transitioning in the health care model for people with HIV/AIDS, especially young adults, whose care is shared within the Health Care Network. FINAL CONSIDERATIONS: In the municipality, there is the inclusion of management of HIV in primary health care services along with the establishment of a more resolutive care model. Thus, the care of this population is shared in different points of the health care network.

Knowledge of nursing student on the prevention of sexually transmitted infections.

OBJECTIVE: To identify the knowledge and self-care actions taken by nursing undergraduate students of a Federal University of the South of Brazil, against Sexually Transmitted Infections. METHOD: Exploratory qualitative study, conducted 40 interviews with undergraduate students at the beginning and end of the course. The analysis was thematic, resulting in three categories. RESULTS: Knowledge about the subject is a decisive factor for self-care, and the more knowledge, the greater the prevention. The dissemination of knowledge of students at the end of the course not only influences self-care but also health promotion in the social sphere. FINAL CONSIDERATIONS: Knowledge is important in self-care and caring for others. The dissemination of knowledge becomes evident according to the complexity of the course. Stable relationships may interfere with the use or disuse of condoms in sexual relationships, a misnomer present in today's society.

Contributions of the nurse's clinical practice to Primary Care.

OBJECTIVE: To understand the repercussions of the nurse's clinical practice on Primary Health Care. METHOD: Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis' Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups. RESULTS: nurses' clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional's clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice. FINAL CONSIDERATIONS: Nurses' clinical practice has positive repercussions on the health of Primary Health Care users.

Software para apoio à decisão logística no processo de captação e transplante de órgãos / Software de apoyo a la decisión logística en el proceso de obtención y trasplante de órganos / Software to support logistic decision in the process of organ acquisition and transplantation

Objetivo: desenvolver e avaliar um software para apoio à tomada de decisão dos profissionais da central de transplantes nas definições logísticas envolvidas no processo de captação e distribuição de órgãos para transplante. Método: estudo de produção tecnológica aplicada, sustentado pelo método Design Science Research Methodology. Participaram da etapa de avaliação da usabilidade dez enfermeiros da Central de Transplantes de Santa Catarina. A coleta de dados ocorreu de 1 a 20 de julho de 2021 por meio do questionário System Usability Scale. Resultados: o software utilizou linguagem JavaScript com ReactJS e PHP com Laravel, para o banco de dados PostgreSQL. A avaliação obteve escore médio de 98,25, sendo sua usabilidade considerada como melhor alcançável. Conclusão: o software demonstrou ser adequado e funcional, com fácil manuseio, reunindo informações integradas e objetivas. Representa um avanço na área, propondo uma inovação tecnológica para a gestão e apoio às decisões logísticas envolvidas no processo de captação e transplante de órgãos.

Objetivo: desenvolver e avaliar um software para apoio à tomada de decisão dos profissionais da central de transplantes nas definições logísticas envolvidas no processo de captação e distribuição de órgãos para transplante. Método: estudo de produção tecnológica aplicada, sustentado pelo método Design Science Research Methodology. Participaram da etapa de avaliação da usabilidade dez enfermeiros da Central de Transplantes de Santa Catarina. A coleta de dados ocorreu de 1 a 20 de julho de 2021 por meio do questionário System Usability Scale. Resultados: o software utilizou linguagem JavaScript com ReactJS e PHP com Laravel, para o banco de dados PostgreSQL. A avaliação obteve escore médio de 98,25, sendo sua usabilidade considerada como melhor alcançável. Conclusión: o software demonstrou ser adequado e funcional, com fácil manuseio, reunindo informações integradas e objetivas. Representa um avanço na área, propondo uma inovação tecnológica para a gestão e apoio às decisões logísticas envolvidas no processo de captação e transplante de órgãos.

Objective: to develop and evaluate a software to support the decision-making of transplant center professionals in the logistic definitions involved in the process of organ procurement and distribution for transplantation. Method: applied technological production study, supported by the Design Science Research Methodology method. Ten nurses from the Transplant Center of Santa Catarina participated in the usability evaluation stage. Data collection took place from 1 to 20 July 2021 through the System Usability Scale questionnaire. Results: the software used JavaScript language with ReactJS and PHP with Laravel, for the PostgreSQL database. The evaluation obtained a mean score of 98.25, and its usability is considered as best achievable. Conclusion: the software proved to be adequate and functional, with easy handling, gathering integrated and objective information. It represents a breakthrough in the area, proposing a technological innovation for the management and support to the logistic decisions involved in the process of organ procurement and transplantation.

A segurança do paciente e o erro sob a perspectiva do pensamento complexo: pesquisa documental / Patient safety and error from the perspective of complex thinking: documentary research

Resumo Objetivo Analisar os conceitos relacionados à Segurança do Paciente e ao Erro expressos nos documentos oficiais brasileiros, sob a perspectiva do pensamento complexo. Método Pesquisa documental nos sites: Diário Oficial da União, Ministério da Saúde e Segurança do Paciente da Agência Nacional de Vigilância Sanitária. Utilizou-se os descritores Segurança do Paciente e Erro Médico no período de 1999 até 2020. Os excertos foram tratados seguindo a técnica de Análise de Conteúdo desenvolvida em três etapas: pré-análise; exploração do material; e tratamento dos resultados. Resultados Do total de 498 documentos, foram selecionados nove e originaram as categorias: Significado de segurança do paciente e Conceitos relacionados ao significado de erro. Considerações Finais Segurança do paciente remete a proteção, minimização de riscos e prevenção de danos, melhorias contínuas, boas práticas e qualidade da assistência. Erro refere-se a incidente, evento adverso e danos. Faz-se necessário reconhecer e compreender o erro como um evento inerente aos serviços de saúde para ser possível preveni-lo. Assim, a racionalidade nos protege do erro e da ilusão, possibilita o avanço do pensamento, aceita a autocrítica, a contestação de argumentos, amplia a compreensão e o desenvolvimento do conhecimento

Abstract Objective To analyze the concepts related to Patient Safety and Error expressed in Brazilian official documents, from the perspective of complex thinking. Method Documentary research on the websites of the Federal Official Gazette, Ministry of Health, and Patient Safety of the Brazilian Health Regulatory Agency. The descriptors Patient Safety and Medical Error were used in the period from 1999 to 2020. The excerpts were treated following the Content Analysis technique, developed in three stages: pre-analysis; exploration of the material; and treatment of results. Results Of the total of 498 documents, nine were selected and originated the categories: Meaning of patient safety and Concepts related to the meaning of error. Final considerations Patient safety refers to protection, risk minimization and harm prevention, continuous improvements, good practices, and quality of care. An error refers to an incident, adverse event, and harm. To prevent an error, it is necessary to recognize and understand it as an event inherent to health services. Thus, rationality protects us from error and illusion, allows thought advancement, accepts self-criticism and argument contestation, expands understanding and development of knowledge.