Este estudio tuvo como objetivo analizar la actuacion del enfermero en el gerenciamiento del cuidado en un servicio hospitalario de emergencia. Investigacion cualitativa de tipo estudio de caso realizada con los enfermeros del Servicio de Emergencia de un Hospital Universitario de la Region Sur de Brasil. Los datos fueron recogidos a traves de observacion participante y entrevistas semi-estructuradas y analizados utilizando el analisis tematico. Los resultados demostraron las acciones de los enfermeros en la planificacion del cuidado, la prevision y provision de recursos, supervision, liderazgo y capacitacion del equipo de enfermeria. En la planificacion del cuidado, se ha identificado la ejecucion del proceso de enfermeria y control de la realizacion de los examenes de laboratorio y radiologicos. Las acciones de prevision y provision de recursos fueron: escala mensual del trabajo y distribucion de los profesionales de enfermeria y recursos materiales. El liderazgo favorece la planificacion del cuidado, coordinacion del equipo de enfermeria y delegacion de las actividades.

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Gerenciamiento del cuidado: acciones de los enfermeros en un servicio hospitalario de emergencia

Objective: To learn the profile and activities carried out by the Hospital Nurse Liaison for the continuity of care in Primary Health Care in Spain. Method: An exploratory study with a qualitative approach developed in five University Hospitals in Madrid and three in Barcelona, with Hospital Nurse Liaisons who work in Hospitals in Madrid (8) and Barcelona (11). An online questionnaire was applied with open and closed questions for data collection. The data were analyzed by the content analysis technique in the thematic modality. Results: Nineteen (19) Hospital Nurse Liaisons participated in the study. The liaisons’ ages ranged from 26 to 64 years old, the majority were women (94.73%) with experience between 21 and 30 years (52.63%), and had worked in this job between 6 months and 26 years. The Nurse Liasion is required to perform a clinical assessment of the patient prior to discharge and to contact the Nurse in the patient’s area of origin by telephone or e-mail. It is necessary to have experience as an educator, to work in a team and have motivation. Conclusion: Nurses in Spain perform care continuity for Primary Health Care, in which their activities encompass the availability of resources and experience in managing the care of complex patients and their families.

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The continuity of hospital nursing care for Primary Health Care in Spain.

This is a double titled thesis that aims to analyze the process of institutionalization of cesarean deliveries in Brazil and France from the perspective of institutional social-clinical. The theoretical-methodological framework, in its dialectical character between institute and instituinte, unfolds in the process of institutionalization. Therefore, birth is understood as an analyzer of "maternal and child health" and "health education" institutions. The present research comes from a larger study on births in Canada, France and Brazil. In this thesis, data were produced between 2016 and 2019, in Brazil and France, through focus groups, individual interviews with maternal and child health professionals (and the Brazilian Maternal and Child Death Surveillance Committee), with mothers and fathers who lived the experience of childbirth and the research journal. The focus groups were composed of professionals from traditional and alternative services, parents from different social backgrounds. There were 3 meetings making a total of 12 meetings. The ethical aspects regarding research with human beings were respected. A cross-analysis was carried out between the different types of data, between services, between groups and between countries, on a continuous basis, based on the materials produced. The polished thematic axes were: Birth by cesarean section: an analyzer of the female condition in face of medicalization, of professional practices and discourses, and of the institutionalization of birth. These were arranged in analytical frameworks and organized by group of interviewees and scenarios studied. Afterwards, horizontal summaries of the interviews were carried out, by groups interviewed. The analysis was also produced during the time of restitution to the participants and was based on the thematic analysis approach of the authors Mucchielli and Paille. Brazil and France demarcate distinct processes. Brazil is the champion in surgical deliveries without indication. France, on the other hand, presents another reality, in which births are mostly vaginal. It was possible to learn that although each of the countries studied has its peculiar sanitary and educational structure, they are marked by a sociohistorical-economic construction outlined by the patriarchy and female subjugation. The marks of New Public Management are present in both contexts and reveal a precariousness of offers and actions supported by a discourse of economic fragility. In terms of education and health, in any of the countries, pregnancy is understood as a physiological process and developed with numerous interventions on the female body. There is an appreciation of the technical and organizational dimensions pointed out by an intellectual and social division of work and knowledge in health. The practices and discourses of professionals (in their work process) influence the occurrence (or not) of cesarean delivery. The progression or regression of this is related to the degree of implementation of medical actions in health actions. In this way, in Brazil there is a struggle between the institutionalization of cesarean delivery in comparison with its deinstitutionalization. In France, in relation to cesarean sections, there is a discussion on "active cesarean section". Would this be the movement of institutionalization of cesarean delivery in this country?Keywords: cesarean section; childbirth; health education; health; education

https://tel.archives-ouvertes.fr/tel-02458149/document

The institutionalization of birth by cesariana in Brazil and France : educational and health components

Objective: To understand the perception of leadership in the work process and to promote its discussion within the Family Health Strategy scope. Method: A qualitative approach research, guided by the action-research referential, conducted with 15 Familiy Health Strategy nurses in the inland of the state of Sao Paulo. Data was collected in 2015 in two interdependent phases, interviews and intervention-action, and processed according to the methodological framework of content analysis and the theoretical framework on nursing management. Results: The nurses showed their conceptions of leadership and the inherent challenges of practice: leadership training, overlapping care and management, and management charges. In the discussion of common problems and peer learning, a conception of transformational leadership was constructed. Conclusions: The common and behavioral styles of leadership influenced on the conception of leadership and mobilized the attitudes of the nurses in the work process; however, there is a need for more engagement in the training/qualification of the professionals and the services about leadership.

http://www.scielo.br/pdf/rgenf/v41/1983-1447-rgenf-41-e20190106.pdf

Leadership in the perspective of Family Health Strategy nurses.

Objective: to analyze university teaching in nursing from an institutional dialectic approach. Method: a qualitative research based on Institutional Socioclinics. Eighteen nursing professors from four regions of Brazil and from six public institutions of higher education participated. For data production, interviews, observations, documentary analyses, individual and collective restitution and use of the research diary were performed. Data was organized for analysis by transcription/translation, recomposition/rearrangement, and final reconstruction/narration. Data analysis was produced from analyzers, based on Socioclinics, Institutional Analysis current of thought, and on the qualitative mode of analysis by questioning and writing. Results: two main analyzers made the institution ‘teaching in higher education and the nursing professor’ emerge: time-money relation and resistance. Teaching time, increasingly associated with money, in managerialist logic, has formatted the nursing professors as passive subjects in the production of knowledge, induced by the evaluation model of the Coordination for the Improvement of Higher Level Personnel and its link to the progression in the university career. In this model, the nursing professor is driven to devote more to research than to teaching. This interferes with teaching conceptions and practices, which are more influenced by managerialism and less grounded in pedagogical theories. Resistance against this model has not yet encountered coping mechanisms. Conclusion: from the analysis produced with the participants, the choices of the nursing professor are so much more grounded in managerialism and so much less based on pedagogical references, especially those arising from dialectical theories. In this sense, resistance is transformed into a movement of adaptation.

http://www.scielo.br/pdf/tce/v29/1980-265X-tce-29-e20180407.pdf

Nursing professor in higher education: time, money and resistance in the management vision

OBJECTIVE To analyze the interference of leprosy in women's life regarding work and daily life activities. METHOD Exploratory qualitative study developed from semi-structured interviews and with the use of field diaries. The strategy of the organization of data was a thematic analysis of content and referential of the work process in health and gender. RESULTS The themes presented are: "The leprosy pains", "Changes with the disease and adaptation at work and activities" and "Being a woman with leprosy". On them, we present the aspects that changed in women's life from the leprosy, especially regarding work and daily activities. Beyond physical limitation, there are impacts on social relations and above all on formal work, there may even be dismission. FINAL CONSIDERATIONS In women affected by leprosy, work and daily activities are directly affected; this deepens the social difficulties and requires attention of health professionals.

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Work and Leprosy: women in their pains, struggles and toils.

Objective: discuss how the social subjects (health team, nursing team, managers and users) visualize the care management practices of the nurse in the Estratégia Saúde da Família. Method: a qualitative study was undertaken, in which the data were collected through semistructured interviews (102 persons) and practical observation (11 family health services) and analyzed through thematic content analysis and an analysis flowchart. Results: the study reveals that the care management is marked by the nurse’s protagonist role, who takes charge of problem solving and, therefore, develops care strategies based on program actions and health education. This reality evidences the nurse’s multiple actions and suggests the creation of possibilities to expand the autonomy with co-accountability. Conclusion: the care management practice involves multiple actions, demanding shared activities between the health and nursing teams, based on qualified listening to the users’ needs. DESCRIPTORS: Patient care management. Nursing care. Community health nursing. Public health nursing. Unified health system. Family health strategy. ENFERMEIRA COMO PROTAGONISTA DO GERENCIAMENTO DO CUIDADO NA ESTRATÉGIA SAÚDE DA FAMÍLIA: DIFERENTES OLHARES ANALISADORES

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The nurse as the protagonist of care management in the estratégia saúde da família: different analysis perspectives

Resumo A complexidade das necessidades de saude da populacao exige cada vez mais a qualificacao para o trabalho colaborativo no Sistema Unico de Saude (SUS). Este artigo tem como objetivo refletir sobre possibilidades, limites e desafios do uso da analise institucional de praticas profissionais como dispositivo para a formacao interprofissional em um programa de residencia multiprofissional em saude. Foi realizada uma pesquisa-intervencao com apoio no referencial teorico-metodologico da analise institucional, de cunho participativo, que possibilitou o encontro de subjetividades por meio do exercicio da autoanalise, reconhecimento de nao saberes e necessidades de formacao, exercicio da escuta coletiva e analise de possibilidades de compartilhar saberes e papeis. Ainda, foi possivel evidenciar as contradicoes do contexto de trabalho e aspectos das relacoes interprofissionais que por vezes impoem limites as praticas colaborativas.

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A análise de práticas profissionais como dispositivo para a formação na residência multiprofissional

Objetivo: analizar como los sujetos sociales (equipo de salud, enfermeras, administradores y usuarios) visualizan las practicas de gestion de la atencion de enfermeria en la Estrategia Saude da Familia. Metodo: estudio cualitativo, en el que los datos se obtuvieron por medio de entrevistas semiestructuradas (102 personas) y observacion de la practica (unidades de salud 11 de la familia) y se analizaron mediante analisis de contenido tematico diagramas de flujo. Resultados: el estudio muestra que un manejo cuidadoso esta marcado por el papel de la enfermera, que asume los problemas y, por lo tanto, desarrolla estrategias de atencion con base en las actividades del programa y la educacion sanitaria. Esta realidad resalta las multiples acciones de enfermeria y sugiere la apertura de posibilidades para la expansion de la autonomia con responsabilidad. Conclusion: la practica de la gestion del cuidado implica multiples acciones, lo que requiere acciones compartidas entre la salud y el personal de enfermeria, de la escucha calificado para las necesidades de los usuarios.

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Enfermeira como protagonista do gerenciamento do cuidado na estratégia saúde da família: diferentes olhares analisadores

RESUMO Objetivo: refletir acerca das contribuicoes e limites da Socioclinica Institucional como aporte teorico metodologico em pesquisas em enfermagem e em saude. Metodo: estudo de reflexao desenvolvido a partir do delineamento das modalidades de conducao da abordagem Socioclinica Institucional: intervencao socioanalitica, analise institucional das praticas profissionais, pesquisa-acao e investigacao socioanalitica. Resultado: a Socioclinica Institucional e uma continuidade do aporte teorico metodologico da Socioanalise Louraudiana, corrente da analise institucional, linha francesa. Propoe oito principios norteadores: analise da encomenda e demanda; participacao dos sujeitos no dispositivo; trabalho dos analisadores; analise das transformacoes que ocorrem a medida que o trabalho avanca; aplicacao de modalidades de restituicao; trabalho das implicacoes primarias e secundarias; intencao de producao de conhecimentos e atencao aos contextos; e interferencias institucionais. As contribuicoes estao relacionadas com a logica de transformar para conhecer, producao coletiva do conhecimento e troca de saberes e aprenderes entre participantes e pesquisadores. Os desafios estao relacionados ao rompimento da logica dominante nas pesquisas e da inclusao da diferenca de saberes e poderes na producao de conhecimento. Conclusao: a Socioclinica Institucional pode articular transformacao de praticas e producao de conhecimento. O referencial oferta importante suporte no campo de producao de conhecimento da enfermagem e da saude por valorizar, em todo processo da pesquisa, a subjetividade dos envolvidos, bem como as instituicoes que atravessam as praticas e as relacoes.

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Simone Santana da Silva

Papers

Work and Leprosy: women in their pains, struggles and toils.

The nurse as the protagonist of care management in the estratégia saúde da família: different analysis perspectives

A análise de práticas profissionais como dispositivo para a formação na residência multiprofissional

Enfermeira como protagonista do gerenciamento do cuidado na estratégia saúde da família: diferentes olhares analisadores

A socioclínica institucional como referencial teórico e metodológico para a pesquisa em enfermagem e saúde