Valoración del liderazgo enfermero en un hospital del Sistema Sanitario Público Andaluz / Leadership in a hospital of the Andalusian Public Health System

Objetivo: Analizar, con perspectiva de género, las características y la percepción de los efectos del liderazgo de las enfermeras y enfermeros de un hospital del Sistema Sanitario Público Andaluz. Metodología: Estudio cualitativo con enfoque fenomenológico. Los/as participantes fueron enfermeras asistenciales y con cargos intermedios con contrato mayor a 6 meses. Se realizó un análisis de contenido cualitativo. Se establecieron 4 fases para el análisis de datos, de donde resultaron 5 categorías. Se utilizó el software NVivo 11 para el análisis de los diálogos. Resultados: Los discursos de los participantes dotan al líder de características que lo definen como una persona referente. La contribución de los mandos intermedios es necesaria para la consecución de los objetivos de las unidades asistenciales y cohesión del grupo, aunque este grupo la perciben solo en relación al manejo de los recursos. El acceso a cargos de gestión no tiene vinculación con el género. Conclusiones: El estilo de liderazgo predominante en los cargos intermedios del Hospital de Lebrija es reconocido como un liderazgo participativo, esencial para el mantenimiento de la gestión eficiente y favorecedor de la promoción y la igualdad entre profesionales; no identificándose sesgos de género en el acceso a dichos cargos.(AU)

Objective: To analyse, from a gender perspective, the characteristics and perception of the effects of leadership of nurses in a hospital of the Andalusian Public Health System. Methodology: Qualitative study with a phenomenological approach. The participants were nurses in care and intermediate positions with a contract of more than 6 months. A qualitative content analysis was carried out. Four phases were established for data analysis, from which 5 categories resulted. NVivo 11 software was used to analyse the dialogues. Results: The participants’ discourses endow the leader with characteristics that define him as a reference person. The contribution of middle management is necessary for the achievement of the objectives of the care units and the cohesion of the group, although this group perceives it only in relation to the management of resources. Access to management positions is not linked to gender. Conclusions: The participants’ discourses endow the leader with characteristics that define him as a reference person. The contribution of middle management is necessary for the achievement of the objectives of the care units and the cohesion of the group, although this group perceives it only in relation to the management of resources. Access to management positions is not linked to gender.(AU)

Validación de instrumentos para estudio de referenciación en enfermería oftalmológica / Validation of Instruments for the Study of Benchmarking in Ophthalmology Nursing

Introducción: El estudio de procesos que inciden en la calidad de enfermería en oftalmología con la utilización de la referenciación competitiva requiere la validación de instrumentos para el alcance de los resultados esperados. Objetivo: Describir el proceso de construcción y validación de instrumentos para el estudio de procesos relacionados con la calidad de enfermería en oftalmología. Métodos: Estudio instrumental realizado en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período de enero-julio 2020, que contó con dos fases, la construcción de los instrumentos y la validación de comprensión o de apariencia y de contenido. Para el diseño se tuvieron en cuenta las tareas que cada proceso estudiado incluye en su ficha y para la validación de comprensión y de contenido se utilizó la consulta a profesionales y expertos, así como el método Barraza que integra la valoración cuantitativa de los ítems que integran los instrumentos. Resultados: En la validación de comprensión o apariencia más del 94 % de los ítems no sufrieron cambios desde su primera ronda de consulta, en tanto solo cuatro ítems requirieron modificaciones en la forma de enfocar las preguntas propuestas. Los instrumentos recibieron en la valoración de los expertos una evaluación mayor a 2,6, lo que les confiere una fuerte validez de contenido. Conclusión: La validación realizada permitió constatar la pertinencia de los instrumentos diseñados para el estudio en la referencia de buenas prácticas, en la Clínica Central "Cira García", de los procesos de hospitalización, atención a urgencias y esterilización(AU)

Introduction: The use of competitive benchmarking for the study of processes that influence on ophthalmology nursing quality requires the validation of instruments for the achievement of the expected results. Objective: To describe the construction and validation of instruments for the study of processes related to nursing quality in ophthalmology. Methods: A instrumental study was carried out at Instituto Cubano de Oftalmología "Ramón Pando Ferrer" in the period January-July 2020. It had two phases: the construction of the instruments, and the validation of comprehension or appearance and content. For the design, the tasks that each studied process includes in their respective files were taken into account, while the validation of comprehension and content was performed by means of consultation with professionals and experts, as well as the Barraza method, which integrates the quantitative evaluation of the items making up the instruments. Results: In the validation of comprehension or appearance, more than 94% of the items did not have any changes since the first consultation round, while only four items required modifications in the way of approaching the proposed questions; the instruments received an evaluation of more than 2.6 according to the experts' assessment, which provides them with strong content validity. Conclusion: The performed validation allowed to confirm the relevance of the instruments designed for the study in reference to good practices, as well as the hospitalization, emergency care and sterilization processes, at Clínica Central "Cira García"(AU)

Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Impacto de la formación y aspectos legales en la aplicación de la gestión enfermera de la demanda por parte de las enfermeras de atención primaria de Cataluña / Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia

Objetivo: Conocer la experiencia de las enfermeras de atención primaria en la aplicación de la gestión enfermera de la demanda (GED). Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Atención primaria de Cataluña. Participantes: Enfermeras de atención primaria de Cataluña. Se estimó una muestra de 394 participantes alcanzando 405. La obtención de datos fue desde octubre de 2021 hasta enero de 2022. Mediciones principales: Se realizó un cuestionario ad hoc, el cual exploraba aspectos referentes a la experiencia de aplicación de la GED: definición y manejo del programa, formación y aspectos legales del programa. Resultados: Las enfermeras entienden la GED como un triaje. Además, consideran que la implantación de la prescripción enfermera no mejora la aplicación de la GED. Manifiestan una falta de formación especialmente las enfermeras más noveles. La formación ideal en GED, consideran, debería incluir fisiopatología y supuestos prácticos. Siete de cada 10 enfermeras desconocen el marco legal que ampara la GED y les provoca inseguridad no conocerlo. Seis de cada 10 han dejado de ser resolutivas por miedo a las repercusiones legales. Las enfermeras que sí conocen el marco legal son las que han dejado de resolver en menor proporción. Conclusiones: Se constata la necesidad de formación general en la GED y en los aspectos legales que dan cobertura al programa especialmente en las enfermeras más jóvenes y con menos experiencia en atención primaria. De esta manera se mejorará la aplicación y aceptación del rol autónomo enfermero en la gestión de enfermedades agudas leves.(AU)

Objective: To evaluate the experience of primary care nurses in the application of nurse demand management (NDM). Design: Observational, cross-sectional descriptive study. Location: Primary care in Catalonia. Participants: Nurses in the field of primary care in Catalonia. A sample of 394 responses was estimated and 405 were finally obtained. Data collection was from October 2021 to January 2022. Main measurements: An ad hoc questionnaire was developed which explored aspects related to the experience of applying NDM: definition and management of the program, training, and legal concerns of the program. Results: Nurses understand NDM as triage. In addition, they consider that the implementation of nurse prescription would not improve the application of NDM. They express a lack of training, especially among the younger nurses. They consider that the ideal training in NDM, should include physiopathology and practical cases. Seven out of ten nurses are unaware of the legal framework that protects NDM and feel insecure about not knowing it. Six out of ten nurses have stopped being resolutive due to fear of legal repercussions. Nurses who are aware of the legal framework are those who have stopped resolving in the lowest proportion. Conclusions: There is a need for general training in NDM and in the legal aspects that cover the program, especially for younger nurses with less experience in primary care. This will improve the application and acceptance of the autonomous nursing role in the management of acute minor illnesses.(AU)

Decreasing On-shift Stress With a Crisis Intervention Cart.

Because of the pandemic's impact on morbidity and mortality, nursing leaders have witnessed a marked increase in the number of staff who experience crisis and extreme stress during their shift. This hospital's Engagement and Resilience Council aimed to mediate this stress by implementing resilience-building interventions during moments of peaked stress. Preliminary data show these interventions may markedly improve stress levels in frontline caregivers by up to 52% in some clinical settings.

Desenvolvimento das ações da supervisão de enfermagem: ressignificando a prática diante da pandemia por COVID-19 / Desarrollo de acciones de supervisión de enfermería: resignificando la práctica frente al covid-19 / Development of nursing supervision actions: resigning the practice before COVID-19

Objetivo: descrever a experiência da Supervisão de Enfermagem em um hospital universitário no município do Rio de Janeiro, frente à pandemia da covid-19. Método: estudo qualitativo, descritivo, tipo relato de experiência, baseado na vivência dos autores e na análise de documentos entre março e dezembro de 2020. Resultados: a pandemia acrescentou desafios ao trabalho da supervisão, além daqueles inerentes a instituição. O aumento e a especificidade da demanda provocaram um refinamento na atuação do grupo no intuito de otimizar processos e servindo como elo entre pacientes, equipe e instituição. Conclusão: é fundamental dar voz ao corpo da Enfermagem e à clientela, para a construção de uma prática ética, ancorada na ciência, contextualizada nas esferas ­ social, histórica e política, com um olhar atento ao ambiente de trabalho, tratando com respeito os problemas do cotidiano hospitalar, tangenciado pela pandemia de covid-19(AU)

Objective: to describe the experience of Nursing Supervision in a university hospital in the city of Rio de Janeiro, facing the COVID-19 pandemic. Method: qualitative, descriptive study, experience report type, based on the authors' experience and on the analysis of documents between March and December 2020. Results: the pandemic added challenges to the work of supervision, in addition to those inherent to the institution. The increase and specificity of demand led to a refinement in the group's performance in order to optimize processes and serving as a link between patients, staff and institution. Conclusion: it is essential to give a voice to the Nursing body and the clientele, for the construction of an ethical practice, anchored in science, contextualized in the social, historical and political spheres, with an attentive look at the work environment, dealing with problems with respect hospital routine, affected by the COVID-19 pandemic.(AU)

Objetivo: describir la experiencia de Supervisión de Enfermería en un hospital universitario de la ciudad de Río de Janeiro, frente a la pandemia COVID-19. Método: estudio cualitativo, descriptivo, tipo relato de experiencia, basado en la experiencia de los autores y en el análisis de documentos entre marzo y diciembre de 2020. Resultados: la pandemia agregó desafíos a la supervisión, además de los inherentes a la institución. El aumento y la especificidad de la demanda han perfeccionado el desempeño del grupo para optimizar los procesos y servir de vínculo entre los pacientes, el personal y la institución. Conclusión: es fundamental dar voz al cuerpo de Enfermería y a la clientela, construyendo una práctica ética, anclada en la ciencia, contextualizada en los ámbitos social, histórico y político, con una mirada atenta al entorno laboral, abordando la problemática de la vida diaria hospitalaria con respeto, tocada por la pandemia COVID-19(AU)

Continuity of Care Challenges for Professional Nursing Practice / Desafíos en la continuidad de cuidados para la práctica profesional de enfermería / Desafios na continuidade de cuidados para a prática profissional de enfermagem

The transformation of health systems to meet the needs of chronic and multi-pathological patients has turned continuity of care into one of the mainstays of care programs and the design of new resources to care for these patients and their families. In this context, nurses' professional practice poses challenges for the three dimensions of continuity of care: relational, informational, and managerial. Faced with these challenges, nursing research is essential for the profession and necessary to promote innovative quality care.

La transformación de los sistemas sanitarios para dar respuesta a las necesidades del paciente crónico y pluripatológico ha situado la continuidad de cuidados como uno de los pilares en los que se basan los programas de atención y el diseño de nuevos recursos para atender a estos pacientes y a sus familias. En este contexto, la práctica profesional de las enfermeras presenta retos y desafíos en las tres dimensiones de la continuidad de cuidados: relacional, informativa y de gestión. Ante estos desafíos, la investigación en enfermería es fundamental para la profesión y necesaria para promover unos cuidados innovadores y de calidad.

A transformação dos sistemas sanitários para atender às necessidades do paciente crônico e pluripatológico situa a continuidade de cuidados como um dos pilares nos quais os programas de atenção e a criação de recursos para assistir esses pacientes e suas famílias estão baseados. Nesse contexto, a prática profissional dos enfermeiros apresenta desafios e obstáculos nas três dimensões da continuidade de cuidados: relacional, informativa e de gestão. Diante desses desafios, a pesquisa em enfermagem é fundamental para a profissão e necessária para promover cuidados inovadores e de qualidade.

El cuidado de Enfermería en cáncer infantil: una mirada desde los patrones sociopolítico y emancipatorio / Nursing Care in Childhood Cancer: A Look from the Sociopolitical and Emancipatory Patterns / O cuidado de Enfermagem em câncer infantil: um olhar a partir dos padrões sociopolítico e emancipatório

Introducción: en Enfermería el reconocimiento de los patrones emancipatorio y sociopolítico en la práctica no es evidente. Esta identificación permite la cualificación del cuidado en áreas de gran complejidad como la oncológica, que afecta a población infantil y a sus familias. Objetivo: conocer el significado de los patrones de conocimiento sociopolítico y emancipatorio en los profesionales de Enfermería durante el cuidado de los niños con cáncer y sus familias. Metodología: estudio cualitativo etnográfico en el que se realizaron entrevistas semiestructuradas a diez enfermeros con experiencias entre los seis meses y diecisiete años trabajando con población oncológica pediátrica. Y observaciones no participantes en dos instituciones de salud, una privada y otra pública. Los datos se estudiaron bajo el procedimiento de análisis propuesto por Michael Angrosino, que consta de las fases: gestión de datos, lectura general y clasificación de temas. Resultados: como producto del análisis de la información se establecieron tres grandes temas: contexto de cuidado; cuidado de enfermería; y expresiones de los patrones sociopolítico y emancipatorio en el cuidado. En la discusión se articularon los resultados con la teoría de Sistemas de Imogene King. Conclusiones: a partir de la interacción de los enfermeros con los pacientes y sus familias se logró identificar que estrategias como la educación, el seguimiento, la gestión de casos y de trámites administrativos son formas de fortalecer la gobernanza compartida y la equidad social, los cuales son índices de credibilidad de los patrones sociopolítico y emancipatorio.

Introduction: In Nursing, the recognition of emancipatory and sociopolitical patterns in practice is not evident. This identification allows the qualification of care in areas of great complexity such as oncology, which affects children and their families. Objective: To know the meaning of sociopolitical and emancipatory knowledge patterns in nursing professionals during the care of children with cancer and their families. Methodology: Qualitative ethnographic study in which semi-structured interviews were conducted with ten nurses with experiences between six months and seventeen years working with pediatric oncology population. And non-participant observations in two health institutions, one private and one public. The data were studied under the analysis procedure proposed by Michael Angrosino, which consists of the following phases: data management, general reading and classification of themes. Results: As a result of the analysis of the information, three major themes were established: context of care; nursing care; and expressions of sociopolitical and emancipatory patterns in care. In the discussion, the results were articulated with Imogene King's Systems theory. Conclusions: Based on the interaction of nurses with patients and their families, it was possible to identify that strategies such as education, follow-up, case management and administrative procedures are ways of strengthening shared governance and social equity, which are indices of credibility of sociopolitical and emancipatory patterns.

Análise do modelo de gestão compartilhada na perspectiva dos gestores e trabalhadores do Sistema Único de Saúde / Analysis of the shared management model from the perspective of the managers and workers of the Unified Health System

Modelos de gestão tradicionais, que apresentam estruturas formais e verticalizadas, têm várias limitações. Torna-se, portanto, necessário incentivar estratégias no interior das organizações que promovam discussões sobre as estruturas hierárquicas, movimento que tem sido observado no setor da saúde. A exemplo disso, o sistema de saúde brasileiro tem focado na descentralização da tomada de decisão e do poder investindo em gestão estratégica e democrática. Para tanto, faz-se necessária a realização de uma análise da situação atual da gestão nos diversos serviços de saúde. Assim, o objetivo deste estudo, realizado em três fases, foi analisar a adoção do modelo participativo de gestão nos Prontos Atendimentos dos municípios que compõem o Departamento Regional de Saúde XIII (DRS XIII), na perspectiva dos gestores e trabalhadores de saúde. Trata-se de estudo de métodos mistos multifásico, sendo na primeira fase realizada a análise do modelo de gestão com seis gestores municipais e 223 trabalhadores de 10 prontos atendimentos de oito municípios do DRS XIII. Os dados quantitativos foram analisados por meio de estatística descritiva. A fim de analisar a significância da associação entre categorias ocupacionais, gestores e trabalhadores, e os aspectos da gestão, foi utilizado o teste exato de Fisher, sendo adotado o nível de significância de 5%. Os dados qualitativos foram analisados com o apoio do software DSCSoft®. Os dois conjuntos de dados foram fundidos com o objetivo de se encontrar a relação entre eles e proceder à interpretação dos resultados. Na segunda fase foi planejado o desenvolvimento da intervenção educativa e na terceira fase da pesquisa foi desenvolvido um estudo quase-experimental, por meio da coleta de dados quantitativos de 30 participantes. Os dados foram analisados por meio do teste t de Student, sendo igualmente adotado o nível de significância de 5%. Dos profissionais que participaram da pesquisa, a maior parte era do sexo feminino e ocupava o cargo de auxiliar de enfermagem. Enquanto os gestores avaliam o modelo de gestão da instituição como sendo mais contemporâneo e participativo, possibilitando aos trabalhadores participarem da tomada de decisão e dando autonomia aos mesmos para decidirem sobre questões do dia a dia, na visão dos trabalhadores o modelo de gestão é tradicional, destacando-se por sua estrutura formal e verticalizada. Conclui-se que o modelo de gestão das organizações de saúde ainda é ordenado pelos princípios da administração mais tradicional e verticalizada e tem impacto direto na satisfação dos profissionais no cotidiano do trabalho. Nesse sentido, torna-se essencial o conhecimento e o envolvimento dos gestores na implantação do modelo de gestão contemporâneo, de modo a contemplar as políticas do próprio SUS, bem como de valorizar a participação de todos os profissionais na busca de melhor atendimento ao usuário dos serviços de saúde. Com a realização do estudo quase-experimental foram incorporados conhecimentos sobre gestão compartilhada pelos gestores e pelos trabalhadores após a implementação da ação educativa. Espera-se que o conhecimento adquirido durante a intervenção educativa, somado ao conhecimento anterior dos participantes da pesquisa, possam ser disseminados e gerar modificações necessárias que contribuam com a melhoria das relações no ambiente de trabalho e, consequentemente, no atendimento ao usuário do sistema de saúde.

Traditional management models, which present formal and verticalized structures, have several limitations. It is therefore necessary to encourage strategies within organizations that promote discussions about hierarchical structures, a movement that has been observed in the health sector. As an example, the Brazilian health system has focused on the decentralization of decision making and power by investing in strategic and democratic management. To this end, it is necessary to carry out an analysis of the current management situation in the various health services. Thus, the objective of this study, carried out in three phases, was to analyze the adoption of the participatory management model in the Emergency Departments of the municipalities that make up the Regional Health Department XIII (RHD XIII), from the perspective of managers and health workers. This is a multiphase mixed methods study, with the analysis of the management model being carried out in the first phase with six municipal managers and 223 workers from 10 emergency rooms in eight cities of the RHD XIII. The quantitative data were analyzed using descriptive statistics. In order to analyze the significance of the association between occupational categories, managers and workers, and management aspects, Fisher's exact test was used, adopting a significance level of 5%. The qualitative data were analyzed with the support of the DSCSoft software®. The two sets of data were merged in order to find the relationship between them and proceed to the interpretation of the results. In the second phase, the development of the educational intervention was planned and in the third phase of the research, a quasi-experimental study was developed by collecting quantitative data from 30 participants. The data was analyzed using Student's t-test, with a significance level of 5%. Of the professionals who participated in the research, most were female and held the position of nursing assistant. While managers evaluate the institution's management model as being more contemporary and participatory, allowing workers to participate in decision making and giving them autonomy to decide on day-to-day issues, in the workers' view the management model is traditional, standing out for its formal and verticalized structure. It is concluded that the management model of health organizations is still ordered by the principles of a more traditional and verticalized administration and has a direct impact on the satisfaction of professionals in their daily work. In this sense, it becomes essential the knowledge and involvement of managers in the implementation of the contemporary management model, in order to contemplate the policies of UHS itself, as well as to value the participation of all professionals in the search for better service to the user of health services. The quasi-experimental study incorporated knowledge about shared management by managers and workers after the implementation of the educational action. It is expected that the knowledge acquired during the educational intervention, added to the previous knowledge of the research participants, can be disseminated and generate necessary changes that contribute to the improvement of relationships in the workplace and, consequently, in the care of health system users

Análise do processo de implantação do serviço de atenção ao paciente com COVID-19 / Análisis del proceso de implementación del servicio de atención al paciente com COVID-19 / Analysis of the process of implementing the patient care service with COVID-19

A pandemia COVID-19 vem exigindo enorme esforço dos gestores hospitalares, desafiando-os a agir e pensar fluxos de atendimento de maneira rápida, adotando estratégias seguras de cuidar. OBJETIVO: Analisar o processo de planejamento e implantação de um serviço de atenção ao paciente com COVID-19 em um hospital universitário, através da experiência cotidiana de gestão. MÉTODO: Trata-se de um relato sistemático de experiência sobre o processo de implantação de fluxo de atendimento e tratamento em um hospital universitário de pessoas acometidas pela COVID-19. Registrou-se em diário de campo a experiência, sendo as narrativas submetidas à análise de conteúdo. RESULTADOS: a análise das narrativas permitiu organizar os dados nas seguintes categorias: necessidade de segurança dos profissionais, capacitação, empatia e gestão participativa. CONCLUSÃO: É importante utilizar os processos de trabalho e a Educação Permanente em Saúde como ferramentas para a orientação do cuidado assistencial ao paciente com COVID-19. O raciocínio clínico, o trabalho interdisciplinar e a tomada de decisão de forma participativa permitiu a adequada implantação do atendimento, apesar do temor da equipe frente aos desafios da pandemia.

La pandemia de COVID-19 ha exigido un enorme esfuerzo por parte de los administradores de los hospitales, desafiándolos a actuar y pensar en los flujos de atención rápidamente, adoptando estrategias de atención segura. OBJETIVO: Analizar el proceso de planificación e implementación de un servicio de atención al paciente con COVID-19 en un hospital universitario, a través de la experiencia de gestión diaria. MÉTODO: Este es un reporte sistemático de experiencia sobre el proceso de implementación de un flujo de atención y tratamiento en un hospital universitario para personas afectadas por COVID-19. La experiencia se registró en un diario de campo y las narrativas se sometieron a análisis de contenido. RESULTADOS: el análisis de las narrativas permitió organizar los datos en las siguientes categorías: necesidad de seguridad profesional, formación, empatía y gestión participativa. CONCLUSIÓN: Es importante utilizar los procesos de trabajo y la Educación Permanente en Salud como herramientas para orientar la atención brindada a los pacientes con COVID-19. El razonamiento clínico, el trabajo interdisciplinario y la toma de decisiones de manera participativa permitieron la adecuada implementación de la atención, a pesar del temor del equipo ante los desafíos de la pandemia.

The COVID-19 pandemic has demanded enormous effort from hospital managers, challenging them to act and think about care flows in a timely manner while adopting safe care strategies. OBJECTIVE: To analyze the planning and implementation process of a patient care service with COVID-19 in a university hospital, through the experience of daily management. METHOD: This is a systematic experience report on the care implementation and treatment flow process in a university hospital of people affected by COVID-19. The experience was recorded in a field diary, and the narratives were submitted to content analysis. RESULTS: the analysis of the narratives lead to the organization of data in the following categories: need for professional safety, training, empathy and participatory management. CONCLUSION: It is important to use work processes and Continuing Health Education as tools for guiding care to COVID-19 patients. Clinical reasoning, interdisciplinary work and decision-making in a participatory manner allowed the proper care implementation, despite the team's fear of the challenges caused by the pandemic.

Gestión enfermera durante la COVID-19: oportunidades y retos futuros / Nurse management during COVID-19: future opportunities and challenges

La pandemia COVID-19 ha representado un reto hasta ahora desconocido para nuestro sistema sanitario. Una parte significativa de la gestión de la crisis y adaptación durante este periodo ha correspondido a los mandos de enfermería. Este artículo muestra las dificultades y los éxitos de esta gestión, así como las oportunidades futuras que estos cambios pueden suponer para la profesión enfermera. Se realizó una encuesta telemática de 17 preguntas a las responsables de gestionar la adaptación de los servicios hospitalarios a la pandemia COVID-19, mediante la reestructuración de diferentes áreas: la comunicación interna con participación en la toma de decisiones, la formación para la seguridad de los pacientes, la dotación de materiales, la dotación y rotación de los profesionales y la actualización de los protocolos. Mediante el análisis de una encuesta realizada por responsables de enfermería de diversos hospitales públicos y mutuas laborales situados en Cataluña, hemos podido identificar las principales dificultades surgidas y las decisiones tomadas en un tiempo record para poder adaptar nuestros hospitales a la pandemia, preservando la seguridad del personal y dar una respuesta profesional y humana a nuestros pacientes. La crisis sanitaria vivida representa un incentivo para consolidar logros y proponer cambios que afiancen los aciertos, realizar autocrítica de los errores y devolver así a la sociedad, mediante cambios estructurales, aquello que hayamos aprendido. Defender este cambio supone impulsar perspectivas valientes en la redefinición de las enfermeras del futuro

The COVID-19 pandemic has represented a hitherto unknown challenge for our healthcare system. A significant part of management and adaptation during this period has been the responsibility of middle management nursing staff. This article shows the difficulties and successes of this management, in addition to the future opportunities that these changes, if they are known how to take advantage of, may represent for the nursing profession. An online survey was carried out with 17 questions to those responsible for managing the adaptation of various hospital services to the COVID-19 pandemic, through the internal communication redesign, the participation in the decision making process, the education for the patient's safety and the management of personnel, systems and materials. Through the analysis of a survey carried out by nursing managers from various public hospitals and labour mutual societies located in Catalonia, we have been able to identify the main difficulties encountered and the decisions taken in record time to be able to adapt our hospitals to the pandemic, preserving the safety of the staff and give a professional and humane response to our patients. The lived health crisis represents an incentive to consolidate achievements and propose changes that strengthen the successes, carry out self-criticism of mistakes and thus return to society, through structural changes, what we have learned. Defending this paradigm shift means promoting courageous perspectives in redefining the nurses of the future

El auge de la Enfermería / Nursing Rising

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The Impact of Interprofessional Shared Governance and a Caring Professional Practice Model on Staff's Self-report of Caring, Workplace Engagement, and Workplace Empowerment Over Time.

OBJECTIVE: To describe the impact of the implementation of interprofessional shared governance and a caring professional practice model (Relationship-Based Care [RBC]) on the staff's self-report of caring, work engagement, and workplace empowerment over a 4-year time frame. BACKGROUND: Shared or interprofessional governance has moved mainstream within healthcare settings, particularly within agencies seeking to sustain high reliability in the offering of quality patient care services and/or interest in meeting Magnet standards or embarking upon the Pathway to Excellence. Nurse leaders report that organizations having implemented shared governance thrive, citing professional governance as key to workplace engagement and empowerment, particularly related to quality care initiatives. Transition to interprofessional shared governance structures typically takes 2 to 3 years. It is unknown whether related outcome variables are sustainable over time. METHODS: Utilizing Watson's theory of human caring and appreciative inquiry as underlying frameworks, a longitudinal, quantitative study design was employed. Interprofessional focus groups and introductory sessions were offered to inform and engage all personnel within the medical center. Motivated units were identified, professional shared governance council members elected, and unit-specific education provided. Quality improvement initiatives were facilitated within unit councils, and formal leadership programs to enhance project guidance and to support staff empowerment skills for the managers of the units that were up-and-running were provided. Preimplementation and postimplementation measurements of staff's caring, workplace engagement and work empowerment were assessed, compared, and trended across units over time. RESULTS: Only work empowerment scores among staff working within RBC units were sustainable and increased progressively and significantly over time. Work engagement levels initially rose and then stabilized over time. Caring levels remained stable despite the implementation of a caring professional practice model. Statistically significant correlations were noted between work engagement and empowerment, followed by the relationship between work engagement and caring, followed by the relationship between empowerment and caring. CONCLUSIONS: The sustainability of work empowerment is likely related to the periodic provision of education for leaders regarding leading within an empowered work environment. A stronger focus on staff caring, particularly within quality improvement initiatives, with leadership guidance, will be paramount moving forward.

Nursing shared governance at hospitals - it's Finnish future?

PURPOSE: The purpose of this study is to describe council structure, its benefits, supportive and obstructive factors and developmental needs as a part of shared governance in a university hospital. DESIGN/METHODOLOGY/APPROACH: This is a descriptive study, where semi-structured interviews with 12 nurses was conducted in 2014 and documents from 75 council meetings from 2009 to 2014 were gathered and analyzed. Qualitative content analysis method was used on the data. FINDINGS: The study hospital has been developing nursing shared governance with unique structure and processes of councils. Professors and university researchers act as chair and members are voluntary nursing staff. The factors supporting the councils are nurse managers' support, enthusiastic personnel and neighboring university. The factors obstructing the councils are lack of time, understanding and skills. The work of the councils benefits the organization by improving patient care, harmonizing nursing practices and informing decision-making. The council's developmental needs were more visibility, concentration into everyday problems and interprofessionality. RESEARCH LIMITATIONS/IMPLICATIONS: Applying nursing shared governance structures into an organization improves the professional practice environment of nursing personnel. PRACTICAL IMPLICATIONS: The study hospital has its own, unique council structure. It did not cover the whole hospital or all of the nursing personnel, but it is already producing promising results. It should be given an official status and more support from nurse managers, and it should be developed into an inter-professional discussion. The results presented here indicate that shared governance, even, in its early stage, contributes positively to the quality of care, harmonizes nursing practices and informs decision-making. Applying shared governance structures into an organization improves the professional practice environment of nursing personnel. The study showed concrete supporting and obstructing factors that should be notified in nursing leadership. ORIGINALITY/VALUE: Despite the extensive empirical studies on nursing shared governance, there is very little research on councils in the Scandinavian countries.

Análisis de concepto: gestión enfermera de la demanda / Concept analysis: Nurse demand management

La gestión enfermera de la demanda (GED) es un concepto emergente que requiere una clarificación útil no solo para los profesionales y usuarios sino también para gestores. La GED nació en 2009 tras la necesidad de reorganizar los flujos de la demanda, pero se ha convertido en algo más que en eso. Se entiende la GED como un programa liderado por la enfermera de Atención Primaria para atender a personas con enfermedades agudas leves. La enfermera, bajo un protocolo consensuado y dentro de su ámbito competencial, puede ser autónoma en la atención al paciente y en la resolución de problemas agudos leves. Por tanto, siguiendo la filosofía de Atención Primaria, tanto el médico como la enfermera son los profesionales que darán continuidad en el proceso salud-enfermedad del usuario a lo largo de su vida. Este artículo ha sido escrito según la metodología descrita por Wilson

Nurse demand management (NDM) is an emerging concept that requires some useful clarification, not only for professionals and users but also for managers. The NDM was born in 2009 after the need to reorganize the flow of demand, but it has become more than this. NDM is understood as a program led by the primary care nurse to take care of people with acute minor illnesses. Nurses, under a consensual protocol and within their competence area, can be autonomous in patient care and in the resolution of acute minor illnesses. Therefore, following Primary Care's philosophy, both the doctor and the nurse are the professionals that will follow up the health-disease process throughout the user's life. This article was written according to the methodology described by Wilson

Confronting Challenges in Reducing Heart Failure 30-Day Readmissions: Lessons Learned With Implications for Evidence-Based Practice.

BACKGROUND: Heart failure (HF) is considered a condition in which a portion of hospital admissions are preventable if timely and appropriate outpatient care management occurs. Facility readmission rates for HF are reportable and subject to penalty. Both military and civilian healthcare systems have fiscal responsibility and are accountable for successful disease management. Therefore, best practices and evidence-based strategies to reduce readmissions are in critical demand. However, translating best evidence into practice can be challenging due to the complexities of the healthcare system. AIMS: This crosswalk paper provides strategies and considerations for nurses planning HF readmission reduction initiatives. METHODS: Insight regarding implementation strategies, challenges, successes, and lessons learned is shared through a framework-guided description of two separate but similar HF readmission reduction projects conducted in military and civilian healthcare facilities. RESULTS: Lessons learned suggest defined and attainable outcomes, multidisciplinary inclusivity, redundancy in roles, greater collaboration, and engagement with stakeholders are most beneficial when initiated before dedicating resources and continuously throughout practice change implementation, maintenance, and sustainment. LINKING EVIDENCE TO ACTION: The authors advocate for interdisciplinary evidence-based practice consortiums to share lessons learned that may promote success potential and optimize return on invested time and efforts in the same or similar initiatives-in this instance, reducing 30-day readmissions for HF patients.