Teaching and learning nursing management in the hospital context: an approach in the light of Pichon-Rivière.

OBJECTIVE: Analyze the articulation of students, professors (supervisors of the undergraduate practicum) and nursing professionals in teaching and learning nursing management at graduation in a public university hospital. METHOD: This is a study of qualitative approach, anchored in the operative group reference of Pichon-Rivière. Data collection was held between October 2013 and September 2014 and consisted of a self-administered questionnaire, participant observation and focus group. The information was submitted to thematic analysis. RESULTS: The thematic analysis of the corpus resulted in four themes: the unknown and the inevitable; in coming and going, attitudes, values and new bonding; the dialogue and ways of acting in the teaching/learning; the emergence of praxis. CONCLUSION: The articulation among students, supervisors and nursing professionals occurring in a coming and going of attitudes, values and new bonding, in which the dialogue enables ways of acting in the teaching/learning of nursing management in graduation, allowing the emergence of praxis.

Researching safety culture: deliberative dialogue with a restorative lens.

Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results. We propose a methodological approach for safety culture research, which integrates the theory and practice of restoration science with the principles and methods of deliberative dialogue to support active engagement in critical reflection and collective debate. Our aim is to describe how these two innovative approaches in health services research can be used together to provide a comprehensive effective method to study and implement change in safety culture. Restorative research in health care integrates socio-ecological theory of complex adaptive systems concepts with collaborative, place-sensitive study of local practice contexts. Deliberative dialogue brings together all stakeholders to collectively develop solutions on an issue to facilitate change. Together these approaches can be used to actively engage people in the study of safety culture to gain a better understanding of its elements. More importantly, we argue that the synergistic use of these approaches offers enhanced potential to move health care professionals towards actionable strategies to improve patient safety within today's complex health care systems.

Surgical center: challenges and strategies for nurses in managerial activities. / Centro cirúrgico: desafios e estratégias do enfermeiro nas atividades gerenciais.

Objective: Analyze the challenges and strategies of nurses performing managerial activities in a surgical center. Method: Exploratory, descriptive study with a qualitative approach, involving six nurses by means of the Focus Group Technique, between April and August 2013. Data were submitted to thematic content analysis. Results: The main challenges noted were deficiency of material resources, communication noise, adequacy of personnel downsizing, and relationships with the multidisciplinary team. Key strategies include construction of co-management spaces to promote integration among professionals, conflict resolution and exchange of knowledge. Conclusions: Managerial activities involve the promotion of dialogic moments to coordinate the different processes in the surgical center to provide inputs to expand safety and quality of services provided.

Nursing management practicum: impact to the team in medical-surgical units. / Estágio de administração em enfermagem: repercussões para a equipe em unidades clínico-cirúrgicas.

OBJECTIVE: Learn the perceptions of nursing professionals of a university hospital regarding the interactive process with nursing management practicum students. METHODS: A qualitative, exploratory, descriptive study was conducted by means of 11 semi-structured interviews with nurses, nursing technicians and nursing aides in medical-surgical units. The information, collected between December 2013 and January 2014, was submitted to a thematic analysis and discussed according to Pichon-Rivière. RESULTS: Results were grouped into three categories: Practicum students and the nursing team: interaction that can provide learning, mutual help and satisfaction; Despite the pre-task, work must go on; and Nursing team: the practicum facilitator. CONCLUSION: In the beginning, their coexistence was full of basic anxieties, but while elaborating these feelings, the group was created and shifts into teamwork. In this logic, issues like patience, empathy, communication and coherence facilitate the interactive process, and are essential for a critical (re)reading of the reality.

Contributions of the sandwich doctoral program to methodological approaches: an experience report. / Contribuições do programa de doutorado sanduíche nas abordagens metodológicas: relato de experiência.

Objective To share our experience on theoretical and methodological insights we have gained as researchers working together during the Sandwich Doctoral Program. Method This is a descriptive experience report. Results We have incorporated restoration thinking into a study on patient safety culture and will enhance knowledge translation by applying principles of deliberative dialogue to increase the uptake and implementation of research results. Conclusion Incorporating new approaches in Brazilian nursing research plays a key role in achieving international participation and visibility in different areas of nursing knowledge.

[The notion of task in focus groups]. / A noção de tarefa nos grupos focais.

The aim of this paper is to revisit the concept of task in light of Pichon-Riviére's referential and to discuss its application in research with focus groups. Focus groups are understood as a research technique which proposes to investigate a topic in depth, allowing the construction of new ideas and answers on the subject in focus. The presuppositions of operative groups were used to support the research practice with focus groups. In these, the notion of task has a key strategic position from which it seeks to intervene in society through dialogue and collective construction, unlike simple data collecting

[The social representations of the process of choosing leaders in the perspective of the nursing team]. / Representações sociais do processo de escolha de chefias na perspectiva da equipe de enfermagem.

This exploratory-descriptive, qualitative study was performed with the objective to analyze the social representation of the process of choosing leaders among nursing workers of a university hospital. The information was obtained through free word association and open interviews. For the purposes of this study, thematic content analysis was performed, guided by the Social Representations Theory. Through this focus the following category emerged: division of the nursing team - the input and output of the process of choosing leaders. The category consists of a crystallization of the social representation of the subject, anchored in elements related to leadership, impartiality, change, knowledge, trust and humanization. The idea of leadership is highlighted as inducing a movement in the division of the team as it is associated with the process of choosing leaders for an environment of communication, suitable for integrating the team and recognizing potential leaders.

[Group process: reflections of a nursing team]. / Processo grupal: reflexões de uma equipe de enfermagem.

The objective of this qualitative, exploratory-descriptive study was to analyze the group process of a nursing team at Hospital de Clínicas de Porto Alegre (HCPA), under the light of Pichon-Rivière's Operative Group Theory. Data collection took place in 2008, using a semi-structured questionnaire and focal group. The group work concept is one of the four categories that resulted from the study, and is the object of approach in the present article. It was found that the knowledge about the group process must be shared, disseminated and discussed since the undergraduate studies and developed across the professional career. As the team learns and is able to identify the main indicators of the group process, it becomes possible to improve operatively, considering not only the outcomes but mainly the course covered until achieving the goal, aiming at group learning.

Leadership in nursing: analysis of the process of choosing the heads.

The process of choosing heads can be strategic to achieve desired results in nursing care. This study presents an exploratory and descriptive research that aims to analyze the process of choosing heads for the ward, in the nursing area of a teaching hospital in Porto Alegre. Data was collected from registered nurses, technicians and nursing auxiliaries through a semi-structured interview technique and free choice of words. Three theme categories emerged from content analysis: process of choosing heads, managerial competences of the head-to-be and team articulation. Leadership was the word most frequently associated with the process of choosing heads. The consultation process for the choice of the leader also contributes to the success of the manager, as it makes the team members feel co-responsible for the results achieved and legitimizes the head-to-be in their group.

[Yellow fever: nurse counseling on travelers' health at basic health clinics]. / Febre amarela: orientações de enfermagem a saúde dos viajantes em unidades básicas de saúde.

The objective of this qualitative, exploratory and descriptive study is to investigate the nursing practices related to travelers' health counseling. Data were collected from nursing professionals who work in the immunization sector of three Basic Health Units in Porto Alegre, Rio Grande do Sul, Brazil, using the technique of semi-structured interview. Five categories emerged from content analysis: care profile, health orientation, referrals to exchange the National Immunization Card for the International Certificate of Vaccination, information source and information material. The results signal the beginning of an organization of nursing practices focused on travelers' health, going beyond the focus on yellow fever. Failures in guidelines for acquisition of International Certificate of Vaccination still occur and information materials are missing. It points out to the need of broadening the discussion on travelers' health for a review of strategies for care organization and referrals for the construction of a specific policy.

[Concepts of a multidisciplinar team on runaway patients]. / Concepções de uma equipe multidisciplinar sobre fuga de pacientes.

A qualitative study that aimed at learning the way an emergency care multidisciplinary team at a public university hospital conceives and deals with the problem of patients who run away from hospital was carried out. Data were collected using the focus groups technique, whose sample was constituted by ten individuals, approached by non-directive group dynamics. Three thematic classes resulted from content analysis: a certain ambivalence; emergency, a place of (lack of) control; fears and insecurities. The study indicates the chaotic situation encountered by emergency services and, in this context, when patients run away, the health care team is imminently subject to a triple judgment: social, legal and institutional.

[Planning human resources in nursing: challenge for the leadership]. / Planejamento de recursos humanos de enfermagem: desafio para as lideranças.

This study proposes an essay of issues involving human resources planning in nursing in the hospital sector in our current reality, discussing possible topics for future research. This is a retrospective of the evolution of research on determining the number of staff in Brazil, and the incorporation of new instruments to evaluate the work load based on the degree of dependency of the patients and actions in care. The impact of the quantity and quality of human resources on the results of care is discussed, and the role of leaders in adapting the staff composition, in order to supply safe, risk-free care to the patients and their families, seeking a management model for health practices from the perspective of complex care.

Social representations of health surveillance among workers.

This is a qualitative, exploratory-interpretative study, with the purpose of investigating the social representations of health surveillance among members of the National Health Surveillance Agency - ANVISA, in Rio Grande do Sul State. It was found that health surveillance is represented by subjects as a process that, despite the contradictions, is being constructed and lived in the job routine with signs of renovation of existing representations. Thus, health protection acquires a new understanding, deviating from the prevention limits that traditionally focus on disease in order to return to promotion itself. Also, the image of health police is displaced from punishment to health education, establishing links between normative and educative performance. Moreover, professionalism is based on responsibility and knowledge, and professional devaluation is anchored in the idea of exclusion. The results allow for an analysis of the elements that can be causing permanencies and influencing the movements of daily practice, being able to revert into a benefit for the construction of a professional profile.

[Nursing supervision: a management tool]. / Supervisão de enfermagem: um instrumento de gestão.

Supervision is a management tool in the nurse's working context. This qualitative exploratory-descriptive study aimed at understanding how the work routine of nurses in supervisory positions is organized. Data were collected by semi-structured interviews with five subjects working at Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil, and submitted to content analysis. Supervisors' work demand increased due to their administrative tasks, requiring more attention when prioritizing actions. Subjects also believed face-to-face contact with the nursing team extremely important to manage routine nursing tasks. This study also makes some contributions as to the supervisor's profile, and some reflections his/her tasks.

Immediate adverse reactions to intravenous iodinated contrast media in computed tomography.

This exploratory-descriptive, non-experimental quantitative research aimed to learn about immediate adverse reactions to intravenous iodinated contrast media in hospitalized patients submitted to computed tomography at a teaching hospital in the South of Brazil. During the study period, all adverse reactions showed mild intensity, at a frequency of 12.5% with ionic iodinated contrast media, and 1% with non-ionic contrast agent. The extravasation of contrast occurred in 2.2% of the injections in a peripheral vein without complications in any of the cases. The results are within the limits cited in international literature and suggest that tomography service professionals should know their own rates of adverse reactions to iodinated contrast agent, as well as the conditions in which they occur, in order to obtain evidence to evaluate the respective care delivery processes.

Health and self-care among garbage collectors: work experiences in a recyclable garbage cooperative.

Study performed with garbage pickers who organized a cooperative to sort recyclable garbage in Porto Alegre, Brazil, in a shed loaned by the city administration. This activity, which has attracted an increasing number of people excluded from the formal job market, presents peculiar health risks and patterns of disease. The study aimed to learn about the participants' concepts and self-care actions, proposing discussions and jointly reflection on their problems. It focuses on the working environment and on attitudes towards health risks. Through the focal group technique with ten female subjects, the expression of capacity of situational analysis of those involved was privileged, giving rise to three main themes. Each theme discussed was followed by the construction of a plan of action in order to meet compatibly the more pressing needs according to the operational feasibility of the solutions proposed.

[Group work to promote learning in health]. / O trabalho com grupos como instáncia de aprendizagem em saúde.

This article discusses group practice as a tactic to promote learning in health education, and the concept of group and its implications on learning. What type of care is needed to develop health education strategies that will generate participation, exchange of experiences, and promote positive changes in the daily life of those involved. It is proposed that groups are a care alternative that needs to be included in the professional daily life, aiming at changing one-dimensional views of health care.

[Significant situations in the space and context of hemodialysis: what do users say about?]. / Situações significativas no espaço-contexto da hemodiálise: o que dizem os usuários de um serviço?

A qualitative study performed at a hemodialysis clinic in the interior of Paraná. Semi-structured interviews were used to look at significant situations for chronic renal patients, experienced in the space and context of hemodialytic treatment. The results indicated difficulties associated with the communication process, causing discomfort and a feeling of helplessness, especially at the beginning of the treatment. It was shown that importance was assigned to the family, to the relationship with the other service users and with the members of the health care team, as a way of contributing to the recovery and adaptation process, amidst the adversities imposed by the disease and treatment. Aspects related to the presentation, esthetics and cleanliness of the environment also emerged as factors that interfere in client satisfaction.

[To wash or not to wash the hands? Reasons for a nursing team]. / Por que lavar ou não as mãos? Motivos de um grupo de enfermagem.

A qualitative study was performed by asking the nursing team at an emergency care hospital about the reasons that lead them to wash their hands or not, since this is an important measure to control cross infection in hospitals. The data, obtained by using the focus groups technique were submitted to enunciation analysis, resulting in emerging topics. It was found out that the supply of material and environmental resources is essential but does not solve all problems. The procedure is performed mainly because of visible dirt and it is a neglected and undervalued practice with predominant focus on protecting the professionals.