Leadership Practices in Hospital Nursing: A Self of Manager Nurses.

OBJECTIVE: To assess the frequency of the leadership practices performed by the manager nurses of hospital institutions and their association with the variables of the socioprofessional profile. METHOD: Cross-sectional, descriptive, correlational study conducted in four hospitals in a city of the state of São Paulo. A sociodemographic questionnaire and the instrument Leadership Practices Inventory were used. Data collection and analysis were based on an exemplary Leadership Practices Model. RESULTS: Eighty-four manager nurses participated in the study. The mean values of the leadership practices used by the nurses were: enable others to act (50.6); encourage the heart (48.2); model the way (46.7); challenge the process (43.3); and inspire a shared vision (43.1). Data analysis also evidenced a correlation between the practice encourage the heart and the variables time of care and employment relationship. CONCLUSION: The study evidenced the presence of manager nurses exercising moderate leadership, and promoting teamwork, an environment of trust, and a horizontal vision. However, moderate values also reveal managerial aspects to be improved by the leaders by means of organizational strategies and/or tools aimed at best leadership practices. OBJETIVO: Avaliar a frequência das práticas de liderança executadas pelos enfermeiros gerentes de instituições hospitalares e sua associação às variáveis do perfil socioprofissional. MÉTODO: Estudo transversal, descritivo e correlacional, realizado em quatro hospitaisde um município do interior paulista. Utilizou-se de questionário sociodemográfico e do instrumento Leadership Practices Inventory. A coleta e a análise de dados foram fundamentadas em um Modelo de Práticas para Liderança exemplar. RESULTADOS: Participaram 84 enfermeiros gerentes. As médias das práticas de liderança utilizadas pelos enfermeiros foram: capacitar os outros a agir (50,6), encorajar o coração (48,2), traçar o caminho (46,7), desafiar o processo (43,3) e inspirar uma visão compartilhada (43,1). Na análise dos dados também se constatou correlação entre a prática encoraje o coração e as variáveis tempo de assistência e vínculo empregatício. CONCLUSÃO: O estudo constatou a presença de enfermeiros gerentes exercendo liderança moderada, promovendo o trabalho em equipe, propiciando um clima de confiança e visão horizontalizada. No entanto, os valores moderados também revelam aspectos gerenciais a serem aprimorados pelos líderes, por meio de ferramentas e/ou estratégias organizacionais em busca de melhores práticas de liderança.

Teamwork in a coronary care unit: facilitating and hindering aspects.

OBJECTIVE: To identify, within a multidisciplinary team, the facilitating and hindering aspects for teamwork in a coronary care unit. METHOD: A descriptive study, with qualitative and quantitative data, was carried out in the coronary care unit of a public hospital. The study population consisted of professionals working in the unit for at least one year. Those who were on leave or who were not located were excluded. The critical incident technique was used for data collection, by means of semi-structured interviews. For data analysis, content analysis and the critical incident technique were applied. RESULTS: Participants were 45 professionals: 29 nursing professionals; 11 physicians; 4 physical therapists; and 1 psychologist. A total of 49 situations (77.6% with negative references); 385 behaviors (54.2% with positive references); and 182 consequences emerged (71.9% with negative references). Positive references facilitate teamwork, whereas negative references hinder it. A collaborative/communicative interprofessional relationship was evidenced as a facilitator; whereas poor collaboration among agents/inadequate management was a hindering aspect. CONCLUSION: Despite the prevalence of negative situations and consequences, the emphasis on positive behaviors reveals the efforts the agents make in order to overcome obstacles and carry out teamwork. OBJETIVO: Identificar, junto à equipe multiprofissional, aspectos facilitadores e dificultadores do trabalho em equipe em Unidade Coronariana. MÉTODO: Estudo descritivo, com dados qualitativos e quantitativos, realizado em Unidade Coronariana/Hospital público. População constituída de profissionais atuantes na Unidade há, pelo menos, um ano. Excluídos os afastados do trabalho e os que não foram não localizados. Para a coleta de informações, utilizou-se da Técnica do Incidente Crítico por meio de entrevista semiestruturada. Para a análise dos dados, utilizaram-se da Análise de Conteúdo e Técnica do Incidente Crítico. RESULTADOS: Participaram 45 profissionais: 29 profissionais de enfermagem; 11 médicos; quatro fisioterapeutas e um psicólogo. Emergiram 49 situações (77,6% com referências negativas); 385 comportamentos (54,2% com referências positivas); e 182 consequências (71,9% com referências negativas). Referências positivas facilitam o trabalho em equipe, e as negativas o dificultam. Relacionamento interprofissional colaborativo/comunicativo foi evidenciado como facilitador; baixa colaboração entre agentes/gerenciamento inadequado como dificultador. CONCLUSÃO: Apesar de predominarem situações e consequências negativas, ênfase em comportamentos positivos revela esforço dos agentes para vencer obstáculos e realizar trabalho em equipe.

Aspects that facilitate access to care for viral hepatitis: An evaluative research.

BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Managerial Decision-Making of Nurses in Hospitals: creation and validation of a simulation scenario.

OBJECTIVE: to build and validate a clinical simulation scenario on hospital nurse managerial decision-making competence for undergraduate nursing students. METHOD: a descriptive and methodological study was carried out in a higher education institution, with the participation of 10 judges and five players. To do so, the conceptual simulation model proposed by Jeffries and standards of the International Nursing Association for Clinical Simulation and Learning were used to prepare the scenario and the checklist. RESULTS: the scenario was called "Managerial decision-making of nurses in the face of adverse events in a hospital". The scenario script and checklist were built for validation. The checklist was face- and content-validated. Afterward, judges used the checklist to validate the scenario, which, in its final version, was composed of Prebriefing (seven items), Scenario in Action (18 items) and Debriefing (seven items). CONCLUSION: the scenario proved to be a teaching strategy that anticipates the reality of future nurses, bringing them the self-confidence to perform their activities and helping them to act critically and reflectively during decision-making processes.

[Nurses and the assessment in health system management]. / O enfermeiro e a avaliação na gestão de Sistemas de Saúde.

The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.

Organizational climate and nurses' turnover intention: a mixed method study.

OBJECTIVES: to describe the organizational climate perceived by nurses of a hospital linked to the Brazilian Hospital Services Company and the reasons for the turnover intention. METHODS: mixed, concomitant triangulation type. Qualitative data were analyzed according to the discourse of the collective subject, in addition to quantitative data analysis, descriptive analysis, Pearson correlation, and multiple linear regression. Data collection was carried through a semi-structured interview with 116 nurses. RESULTS: the study presented the speeches in five categories: Leadership and organization support; Reward; Physical comfort; Control/pressure; and Cohesion among colleagues. It showed that, with increased Reward factor, there is a decrease in turnover intention; and, with decreased Physical comfort, there is an increase in turnover intention. CONCLUSIONS: there is a dichotomy in the organizational climate perceived by nurses, and personal reasons mainly justify the turnover intention. The reason could be the current processes of institutional reorganization and the hiring of experienced staff.

[Production of hospitalization in the Unified Health System in the region of Ribeirão Preto, Brazil]. / Produção de internações hospitalares, no Sistema Unico de Saúde, na região de Ribeirão Preto, Brasil.

This study aimed to characterize the dynamics of the physical and financial production of hospitalizations in 25 cities in the region of Ribeirão Preto, state of São Paulo, Brazil, area of the Regional Department of Health XIII (DRS-XIII). This was a descriptive and exploratory research, with documentary research as the method of data collection. The study population was constituted by hospitalizations, processed by the Hospital Information System of the Unified Health System (SIH-SUS), according to specialty, year and municipality,from 1996 to 2007, in 23 hospitals hired or contracted by SUS in the region. The data were coded in spreadsheets. Ribeirão Preto hospitalizations represented 64% of production, and hospitalization in the nearby region, 36%. The financial output was 14.6% in the region and 85.4% in Ribeirão Preto. There are possibilities of hospitalizations with increased cost and complexity in Ribeirão Preto. The production varies across specialties. The results provide order flow of users, monitoring of production between hospitals, assisting the management of the particularities of the local health system in hospital care.

The setting of research production by nursing and management graduate programs in Brazil. / Cenário das pesquisas na pós-graduação na área de enfermagem e gerenciamento no Brasil.

This documental, descriptive study was performed using a quantitative approach with the objective to characterize the production by nursing graduates in Brazil in the 2007-2009 triennium, with emphasis on nursing management. Data was collected from the CAPES database, which allows access to the abstracts of theses and dissertations. The material was analyzed and categorized according to areas/fields and the respective lines of research, as defined in Nursing. The overall production analysis was descriptive and analytical in the field of organization, namely management. The results showed that, compared to previous studies, production underwent some changes in the triennium, with an increase in the area of health care, maintenance in the organizational area, and decrease in the professional area. Regarding the management theme, most studies addressed health assessment, the conceptions/perceptions regarding planning/organizing work-services and permanent education.

Analysis of the organizational aspects of a clinical emergency department: a study in a General Hospital in Ribeirao Preto, SP, Brazil.

Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all clinical care consultations registered in the Hospital Management Information System. Data were analyzed through descriptive statistics and discussed considering the theoretical framework of the Single Health System (SUS). A total of 5,285 consultations were registered in the period, which were more frequent in patients from the city itself, in January (10%), on Mondays (16%), from 12pm to 12am (67.1%). The main reason for discharge from the unit was hospitalization (63.8%) and the predominant length of stay in the unit was less than six hours (39.8%). The results support the management of human resources, materials and equipment, indicating the desirability of reorganizing emergency care in the hospital.

Inter-unit Doctoral Program in Nursing of the University of São Paulo: characterization of graduates and theses defended in a decade.

This descriptive study aimed to characterize the graduates of the Inter-unit Doctoral Program in Nursing of the School of Nursing of the University of São Paulo, who defended their theses in the period 1998-2008, in relation to the location they developed their Masters and their pre and post-doctoral employment, also to investigate the theses defended in relation to the thematic areas and methodological approaches used. Data were collected from the Fenix-USP System and the Lattes Curriculum System. Of the 190 graduates, 178 had curricula available online. Of those, 58.4% performed teaching and research activities when they entered the doctoral program, which were activities mainly developed at Federal Universities (34.8%). This predominance was maintained after the conclusion of the doctoral studies. The thematic areas most studied were Women's Health (20.5%) and Adults/Elderly Health (13.2%). Regarding the methodological approach, 68.4% used qualitative methods. The data evidenced the contributions of this Program to research.

Private health insurance coverage-related lawsuits.

OBJECTIVES: to analyze lawsuits brought by beneficiaries of health insurance operators. METHODS: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. RESULTS: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. CONCLUSIONS: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

Critical incidents as perceived by rapid response teams in emergency services.

OBJECTIVE: To analyze two hospital emergency services, one in a public institution and another in a philanthropic one, from the perspective of rapid response team professionals in the face of positive and negative critical incidents. METHOD: Descriptive, exploratory, qualitative study carried with 62 health professionals. Critical Incident Technique was employed as the theoretical-methodological framework, along with Content Analysis for analyzing data. RESULTS: Sixty-two health professionals - including 23 nurses, 20 physiotherapists and 19 doctors - took part in this study. Clusters for 89 critical incidents were obtained; 66 of them were considered positive, whereas 23 were negative. The situations associated to the provided services were discriminated in three categories: recognition of patient clinical deterioration; rapid response team activation in the unit; and time until rapid response team arrival at the ward. CONCLUSION: In spite of the difficulties faced by such professionals while providing care to patients who become severely ill in non-critical wards, positive reports were predominant in all categories, what legitimized this service's importance as a contribution to quality and safety of hospitalized patients.

Planned organizational change to transform care to workers exposed to biological material.

OBJECTIVES: to describe the evaluation of the service offered in cases of occupational accidents involving exposure to biological material, from the perspective of the exposed workers, before and after an intervention to obtain planned organizational change. METHODS: descriptive study with a qualitative approach, carried out with workers exposed to biological material who received care at a reference service that was submitted to an intervention based on planned organizational change. Data were collected by using the critical incident technique and analyzed from the perspective of content analysis. RESULTS: twenty exposed workers participated in the study and were split into two groups in the pre- and post-intervention phase. Categories regarding improvement in the guidance they received, reduction in the time they waited once they got to the facility, organization of the process, documentation qualification, and professionalism in carrying out the assistance emerged from the workers' accounts. CONCLUSIONS: the present study allowed the exposed workers to visualize the changes that happened in the care management in case of accidents involving biological material. Additionally, there was the recognition of the adopted methodological path, which allowed the active participation of the people involved.

[Hospitalizations at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP, 1996-2003]. / Produção de internações no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USE, 1996-2003.

Hospitalizations represent an important share of healthcare, due to both the complexity of actions and the financial volume applied. This descriptive-exploratory investigation had the purpose to identify and describing the physical and financial production of hospitalizations performed in a school hospital in the state of São Paulo, from 1996 to 2003, focusing the specialties of surgical clinic, medical clinic, pediatrics and obstetrics. Data collection was performed by searching the official databanks of the studied institution. In that period, a global 8.5% reduction in the frequency of admittances and a 78.4% increase in the financial resources were observed. Surgical clinic, with more expensive procedures, increased its admittances; the production in obstetrics showed the lowest variation. The increasing incorporation of technology, the demands from regional users and the migration of users from the supplementary system to the SUS may justify the variation of production in the different specialties.

Aspects that facilitate access to care for viral hepatitis: An evaluative research

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Contributions and challenges of hospital nursing management: scientific evidence. / Contribuições e desafios do gerenciamento de enfermagem hospitalar: evidências científicas.

AIM: Analyze the scientific evidence, national and international, about contributions and challenges of nursing management in hospital care. METHOD: Integrative literature review, with guiding question: What are the scientific evidence about nursing management in hospital care? Data was collected in LILACS, PubMed, Scopus, CINAHL and EMBASE databases. The final sample of 14 articles resulted in two categories: "Contributions" and "Challenges." RESULTS: Contributions refer to aspects that facilitate the development and organization of work from a technical-political perspective, by qualifying the productive processes. The challenges were related to professional development, work satisfaction, overload, quality of service, conflict resolution and teamwork. CONCLUSION: Management and care processes are inseparable, requires adequate and up-to-date knowledge to provide a better care experience for the health services user and coordinate team actions.

Nurses' expectations about the succession of leaders in the hospital context.

OBJECTIVE: to analyze the expectation of nurses about the succession of leaders in the hospital context. METHOD: a descriptive and exploratory study of a qualitative approach carried out with 36 nurses from a public university hospital selected using the snowball technique. The data collection was done through semi-structured interviews that were recorded and analyzed based on the assumptions of the Content Analysis technique, Thematic modality. Ethical criteria were adequately met. RESULTS: the reports comprised two central categories, "Who Will Take My Place?" and "Potential and Openness to Plan the Succession of Leadership in Nursing," the latter being divided into two subcategories: "Nursing leadership in the hospital five years from now" and "Strengths for the implementation of a leadership succession plan". CONCLUSION: from the results, positive aspects of the diagnosis of the leadership profile in the institution that favor the development of succession planning were verified. In addition, it was possible to perceive the necessity of the development of this planning in the hospital and its importance for the succession of leadership in Nursing. In this context, this study presents itself with an innovative character for exposing a theme that aims to potentiate the future of Nursing.

Transcultural adaptation of the Competency Evaluation Questionnaire - Brazilian version. / Adaptação transcultural do Competency Evaluation Questionnaire - versão brasileira.

OBJECTIVE: Describe the process of translation and adaptation to Brazilian culture of the Competency Evaluation Questionnaire for hospital nurses. METHOD: Methodological study of translation and cross-cultural adaptation, including the steps translation of the original instrument into Portuguese, consensual evaluation of translated versions, back - translation, validation by judges and pilot with 29 hospital nurses. RESULTS: They presented the stages of process of cross-cultural adaptation of the instrument, with adjustments proposed by a Judges Committee, composed of 27 items distributed in five domains of competencies for hospital nurses. The instrument adapted to Portuguese presented semantic, idiomatic, experimental and conceptual equivalence with the original, and the total value of the Cronbach Alpha 0.932, in addition to the relative validation. CONCLUSIONS: The Competency Evaluation Questionnaire has been shown to be a reliable instrument that can be used but does not exclude the need for future statistical tests aiming at psychometric validity.

Competence-based performance evaluation in hospital nurses. / Avaliação de desempenho por competências em enfermeiros hospitalares.

OBJECTIVE: to evaluate the frequencies attributed to the professional competences of hospital nurses, discussing the ones that obtained higher and lower frequencies. METHOD: descriptive, cross-sectional, quantitative study with 45 nurses of a hospital of high complexity in the interior of São Paulo state. The study used the Competences Evaluation Questionnaire, translated and validated in Brazil, composed of 27 items in five domains: professionalism, communication, management, nursing process and problem solving. Data were analyzed using descriptive statistics. RESULTS: it was found that 80% of the participants were female and 20% were male. The age ranged between 25 and 63 years, with an average of 40.02 years, and the average length of professional experience was 13.39 years. The competences "Communication with the hospital's administrative staff" and "Participation in scientific research and / or application of results" had the lowest frequencies, while "Commitment to punctuality and workload" and "Commitment to the ethical principles of the profession" were evaluated with the highest frequencies. CONCLUSION: evaluating the performance by competences becomes essential for managers and training centers, since it contributes to the identification of gaps in knowledge, skills and attitudes of professionals, by promoting the elaboration and implementation of strategies for their development.

Access to viral hepatitis care: distribution of health services in the Northern region of Brazil.

OBJECTIVE: To analyze the distribution of health care services for viral hepatitis and reported cases of viral hepatitis according to the health regions of Northern Brazil. METHOD: It is an evaluative, descriptive and quantitative research considering viral hepatitis care services and reported cases in the Northern region of Brazil, using data collected from the National Registry of Health Establishments and the Notifiable Diseases Information System. Descriptive statistics and georeferencing, through software, were used to demonstrate the spatial distribution of services and reported cases. RESULTS: Viral hepatitis health services are distributed in a differentiated way; rapid tests are capillaries in the states; confirmatory tests and treatment are performed in some health regions, with a greater grouping of services in the capitals and their surroundings. Cases were reported across all regions, with areas of higher concentration near services. CONCLUSION: The availability of services can favor access to prevention, diagnosis and monitoring of cases. However, organizational peculiarities of the health system and services highlight fragilities that have repercussions on the access and entirety of viral hepatitis care.