Lean thinking in health and nursing: an integrative literature review

Objectives:

to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing.

Method:

an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis.

Results:

the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing.

Conclusion:

this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient.

Care management and nursing governance in a maternity ward: grounded theory

ETJECTIVE

To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward.

METHOD

Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding.

RESULT

The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care.

CONCLUSION

Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards.

Multidimensional measures validated for home health needs of older persons: A systematic review

OBJECTIVE

To conduct a systematic review of the literature on valid and reliable multidimensional instruments to assess home health needs of older persons.

DESIGN

Systematic review.

DATA SOURCE

Electronic databases, PubMed/Medline, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online and the Latin American and Caribbean Health Sciences Information.

REVIEW METHODS

All English, Portuguese and Spanish literature which included studies of reliability and validity of instruments that assessed at least two dimensions: physical, psychological, social support and functional independence, self-rated health behaviors and contextual environment and if such instruments proposed interventions after evaluation and/or monitoring changes over a period of time.

PARTICIPANTS

Older persons aged 60 years or older.

RESULTS

Of the 2397 studies identified, 32 were considered eligible. Two-thirds of the instruments proposed the physical, psychological, social support and functional independence dimensions. Inter-observer and intra-observer reliability and internal consistency values were 0.7 or above. More than two-thirds of the studies included validity (n=26) and more than one validity was tested in 15% (n=4) of these. Only 7% (n=2) proposed interventions after evaluation and/or monitoring changes over a period of time.

CONCLUSION

Although the multidimensional assessment was performed, and the reliability values of the reviewed studies were satisfactory, different validity tests were not present in several studies. A gap at the instrument conception was observed related to interventions after evaluation and/or monitoring changes over a period of time. Further studies with this purpose are necessary for home health needs of the older persons.

University management: contributions for nurses who are faculty members and managers

Objective:

To comprehend how university management contributes on the performance of nurses who are professors and managers in a public university.

Method:

Qualitative research anchored on the Grounded Theory. The setting to collect the data was a public university in south Brazil and it happened between May and September of 2016. A total of 19 nurses took part in the study, all of them also faculty members and managers that were divided in two sample groups.

Results:

Two subcategories were created: the comprehension that university management improves the faculty performance; obtaining a wider view of the university.

Final considerations:

The contributions of university management for faculty nurses who are managers are mainly on the personal and professional satisfaction through the production and dissemination of knowledge, reflecting positively on the refinement of the teaching competences to train Nurses with knowledge, technical skills and cognitive abilities to answer society's needs.

Objetivo:

Compreender como a gestão universitária contribui na atuação de enfermeiros docentes gestores de uma universidade pública.

Método:

Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados. O cenário de coleta de dados foi uma universidade pública do sul do Brasil e ocorreu entre maio e setembro de 2016. Participaram do estudo 19 enfermeiros docentes gestores divididos em dois grupos amostrais.

Resultados:

Elucidam duas subcategorias: compreender que a gestão universitária aperfeiçoa a atuação docente; obter uma visão ampliada da universidade.

Considerações finais:

As contribuições da gestão universitária para os enfermeiros docentes gestores encontram-se especialmente na satisfação profissional e pessoal através da produção e disseminação do conhecimento, repercutindo de forma positiva no aperfeiçoamento de competências docentes para a formação de Enfermeiros com conhecimentos, habilidades e aptidões técnicas e cognitivas para atender às necessidades da sociedade.

PERFIL EPIDEMIOLÓGICO DA POPULAÇÃO SUBMETIDA À REVASCULARIZAÇÃO CARDÍACA E ACESSO AO SISTEMA ÚNICO DE SAÚDE

O objetivo deste estudo foi descrever o perfil epidemiológico de uma população submetida à revascularização cardíaca e compreender como esta população acessa os serviços de saúde para promoção, prevenção, tratamento e reabilitação. Estudo descritivo, transversal, amostra de 99 participantes, entre março de 2013 e fevereiro de 2014. Em relação ao perfil, 70 (70,7%) homens, 61 (61,6%) casados, 53 (53,5%) aposentados, 86 (86,9%) procedentes da região metropolitana, com idade média de 61,3 (±8,5) e média de anos de estudos de seis (±3,4), as comorbidades prevalentes foram Hipertensão Arterial Sistêmica 84 (84,8%) e Diabetes Mellitus 42 (42,4%). Referente ao Acesso aos serviços de saúde, 49 (49,4%) acessaram o hospital e 31 (31,3%) a Unidade Básica de Saúde. Observa-se a necessidade de ações estratégicas que facilitem o acesso e acompanhamento desta população aos serviços de saúde, em especial na Atenção primária à saúde, antes e após a revascularização cardíaca.

Domestic violence: repercussions for women and children

Abstract Objectives: To know the meanings attributed by women regarding the repercussions of the experience of domestic violence. Method: Qualitative study, based on the Grounded Theory method. Data were collected in two sticks of domestic and family violence against the Brazilian Northeast woman. An interview was conducted with 37 participants, who composed two sample groups. Results: The study demonstrates that the physical and mental health of women and their children are compromised, expressed through visible marks such as bruises and cuts, in addition to low self-esteem, sadness, fear and depression. There are also repercussions for the social relations of women as a consequence of social isolation and non-qualification for the labor market, and of children, related to the decrease in school performance, introspection and vulnerability to drug use. Conclusion: It is necessary to sensitize health professionals to the recognition of cases and promote educational actions, thus transcending the invisibility barrier of domestic violence.

Brazilian research groups in nursing: comparison of 2006 and 2016 profiles

Objective

To compare the profile of nursing research groups registered at the CNPq Research Groups Directory in 2006 and 2016.

Method

Descriptive and documentary analysis, The data has been collected in 2006 and in 2016, with parameterized search with the term "nursing" at the CNPq Research Groups Directory. The selected variables have been organized in a Microsoft Office Exce spreadsheetl.

Results

The research groups have increased from 251 in 2006 to 617 in 2016, with important increase of the number of participants, among students and researchers. There was a decrease of the number of groups without students. However, 22% remain without undergraduate students' participation.

Conclusions

It has been observed an important increase regarding the interest on research activities, when comparing both scenarios. The nursing research groups reflect structural and political advances in generation of science, technology and innovation, however, the undergraduate students' and the foreign researchers' participation should still be encouraged.

Establishment of lactaton rooms in public and private companies: potentialities and difficulties

Objective

To know how managers of public and private companies view lactation support rooms and their implantation.

Method

This is study is based on qualitative, exploratory, and descriptive research. Twenty managers from Greater Florianópolis participated in the research, in 2015. Data were collected by means of semi-structured/projective interviews, and subjected to content analysis associated with Atlas.ti software.

Results

Data analysis led to the following two categories: difficulties and facilities of establishing a lactation room, with a predominance of financial difficulties and the lack of physical space. Dialectically, the subjects also recognised the low cost involved, which facilitates establishment.

Conclusion

Financial, cultural, and political aspects make it difficult to set up lactation rooms, but the importance of this measure was acknowledged. Although the success of breastfeeding partly depends on these support rooms, it also requires multiple actions, especially the effective participation of nurses and other health workers.

SEGURANÇA DO PACIENTE NO PROCESSO DE DOAÇÃO E TRANSPLANTE DE ÓRGÃOS E TECIDOS

Objetivou-se apresentar aspectos inovadores para a prática profissional do enfermeiro, no que se refere ao diagnóstico de morte encefálica no processo de doação e transplante de órgãos e tecidos, abordando as interfaces entre a gerência do cuidado e a segurança do paciente. Enfatiza-se a padronização de processos, utilizada para promover agilidade, redução das perdas por parada cardíaca com aumento concomitante das doações reais, e diminuição do tempo entre o primeiro exame clínico e o explante. Permite que a equipe reconheça as anormalidades e faça as correções necessárias em tempo hábil. Assim, vislumbra-se que a segurança do paciente deve subsidiar as tomadas de decisão e intervenções de gestão, de modo a qualificar a prática de cuidado.

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

OBJECTIVE

Understanding the factors that influence the reference and counter-reference process of people indicated/submitted to Myocardial Revascularization surgery in the Primary Health Care scenario.

METHOD

A qualitative research anchored in the Grounded Theory, totaling 41 participants subdivided into three groups (patients, health professionals and managers) in the Metropolitan and West Region of Santa Catarina.

RESULTS

Two categories elucidate the intervening factors found, contrasting the potentialities and obstacles in (creating) the bond between people affected by cardiovascular diseases and primary health care for the reference process, highlighting weaknesses in the primary health care services provided, with failures in the counter-reference for people submitted to myocardial revascularization surgery.

CONCLUSION

Strengthening the potentialities presented in this study is essential for the reference process of people affected by Cardiovascular Disease, as well as strategic actions focused on solving the evidenced obstacles which contribute to deficiencies in the referral and counter-referral process, thus impeding integral care in the health care network.

OBJETIVO

Compreender os fatores que influenciam o processo de referência e contrarreferência da pessoa com indicação/submetida à Cirurgia de Revascularização Miocárdica no cenário da Atenção Primária à Saúde.

MÉTODO

Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados, totalizando 41 participantes subdivididos em três grupos (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina.

RESULTADOS

Duas categorias elucidam os fatores interventores encontrados, Contrastando as potencialidades e entraves no vínculo da pessoa acometida por doenças cardiovasculares com a atenção primária à saúde para o processo de referência e Destacando fragilidades nos serviços disponibilizados na atenção primária à saúde, com insucessos da contrarreferência da pessoa submetida à cirurgia de revascularização miocárdica.

CONCLUSÃO

Torna-se essencial o fortalecimento das potencialidades apresentadas neste estudo para o processo de referência da pessoa acometida por Doença Cardiovascular, assim como ações estratégicas com foco na resolução dos entraves apontados e que contribuem para a deficiência do processo de referência e contrarreferência, dificultando a integralidade do cuidado na rede de atenção à saúde.

Comparison between the working environment of nurse managers and nursing assistants in the hospital context

Objective Comparing the working environment of nurse managers and nursing assistants in the hospital context. Method A mixed methods research with concomitant triangulation of data developed in a university hospital in the South of Brazil. Participants in the quantitative study were 94 nursing assistants and 12 nurse managers. The data were collected using the Brazilian Nursing Work Index - Revised (B-NWI-R) and analyzed through descriptive and inferential statistics. Eight (8) nurse managers and 18 nursing assistants were interviewed for the qualitative study. The data were analyzed through thematic analysis. Results The total B-NWI-R mean score for nurse managers was 2.15±0.39, and for nursing assistants it was 2.22±0.39. No statistical significance was identified in the comparison between the groups (p=0.508). The qualitative results show the existence of collaborative relationships between nurse managers and nursing assistants. Conclusion The working environment was similarly evaluated by nurse managers and nursing assistants in the hospital context.

INTEGRAÇÃO ENTRE DADOS QUANTITATIVOS E QUALITATIVOS EM UMA PESQUISA DE MÉTODOS MISTOS

RESUMO Objetivo: descrever a experiência da integração entre dados quantitativos e qualitativos, por meio de uma pesquisa de métodos mistos. Método: trata-se de um relato de experiência da utilização dessa abordagem metodológica em um estudo de tese de doutorado em enfermagem sobre a governança da prática profissional de enfermagem no ambiente hospitalar. Resultados: o texto apresenta três tópicos principais: fundamentação teórica sobre as características e tipologias dos estudos de métodos mistos; procedimentos de coleta, análise e combinação dos dados; e benefícios e desafios da realização desse tipo de estudo. Conclusão: sustenta-se que a realização de uma pesquisa de métodos mistos permitiu a identificação de convergências e divergências entre os dados qualitativos e quantitativos, contribuindo para a produção de resultados que se complementam entre si.

Managing educational practices for qualified nursing care in cardiology

Objective:

to understand significances attributed by nurses who manage nursing care to the individual affected by cardiovascular disease to relations, interactions and associations of the educational practices in a cardiovascular reference hospital. To elaborate a theoretical explanatory model based on significances attributed in the light of the complex thinking.

Method:

qualitative study, which used Theory Based on Data (TBD) as methodological reference. Twenty-two professionals of nursing participated in the study.

Results:

the results indicate need of professional qualification to ensure the safety of patients, institutional support for the realization of educational practices, attitude of openness and availability of dialogue of the health professionals and other institutional conformations for the workers' development.

Conclusion:

the study presents a new space for the nurse's action that can be used to qualify and optimize the nursing practice, as it provides visibility to management and care in health institutions.

Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review

Objective:

to identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs.

Method:

systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed by using the classification provided by the Joanna Briggs Institute.

Results:

the studies presented care bundles including elements such as hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement of facilities in and commitment of staff to preventing infections.

Conclusions:

care bundles coupled with education and the commitment of both staff and institutions is a strategy that can contribute to decreased rates of central line-associated bloodstream infections among adult patients hospitalized in intensive care units.

Factors associated with mortality in patients undergoing coronary artery bypass grafting

OBJECTIVE

to investigate the factors associated with mortality in patients undergoing coronary artery bypass grafting in a cardiovascular referral hospital in Santa Catarina.

METHOD

quantitative, exploratory, descriptive and retrospective study. The medical records of 1447 patients, from 2005 to 2013, were analyzed for statistically related variables, these being: profile, hospitalization diagnosis, risk factors for coronary artery disease, complications recorded during the hospitalization, length of hospitalization and cause of death.

RESULTS

the mortality rate was 5.3% during the study period. Death was more common in females and those of black skin color, with a mean age of 65 years. Acute myocardial infarction was the most common hospitalization diagnosis. The majority of the complications recorded during hospitalization were characterized by changes in the cardiovascular system, with longer hospitalization periods being directly related to death from septic shock.

CONCLUSION

the data provide subsidies for nursing work with preventive measures and early detection of complications associated with coronary artery bypass grafting. This reinforces the importance of using the data as quality indicators, aiming to guarantee care guided by reliable information to guide managers in planning patient care and high complexity health services.

Strategies used by nurses to promote teamwork in an emergency room

Objective to analyze the strategies used by nurses to promote teamwork in a hospital emergency room. Method qualitative case study research with 20 nurses in the emergency unit of a university hospital in southern Brazil. Data were collected between June and September 2009 through participant observation and semi-structured interviews, and analyzed using thematic analysis. Results the strategies used by the nurses to promote teamwork in the emergency unit were articulating professional actions; establishing relationships of cooperation; building and maintaining friendly ties; and managing conflict. Conclusion nurses notably make the connections between the practices of the health teams and mediate the relationships established between health professionals to improve care practices.

[Oral health care in the health network and the regionalization process]

The scope of this article is to outline the construction of the regionalized health network, focusing on oral health care and identifying the problems and the progress in its implementation. The context was the proposed national network model in the policies that underpin the Unified Health System. This is a descriptive-exploratory study with a qualitative approach methodologically supported by Grounded Theory. Interviews were conducted with managers, health professionals and teachers graduated in Dentistry, forming three sample groups. The core category was named "Enhancing the interaction of oral health care in the health network in the regionalization process." In the proposed theoretical model, the enhancement of interaction arises from conditions such as: the characterization of oral health care in the regionalized health network; the identification of difficulties in the implementation process; and the analysis of the operation of the oral health care network. The inclusion of oral health in the network is at an early stage, sometimes detached from the set of relations that constitutes the health network, which is also being consolidated. Evidence gathered in this study indicates the structuring of the regionalized health care network as a prerequisite to raise oral health care and assistance to a new level.

Interatividade sistêmica entre os conceitos interdependentes de cuidado de enfermagem

O presente estudo tem por objetivo apresentar e discutir a interatividade sistêmica entre os conceitos interdependentes de cuidado de enfermagem na perspectiva dos pressupostos teóricos de Edgar Morin. Defende-se que o conceito sistêmico de cuidado de enfermagem pode ser concebido a partir de um conceito ampliado, antagônico, complementar, interdependente e de dinamicidade interativa de processos e contraprocessos de enfermagem, saúde, viver saudável, comunidade vulnerável e empreendedorismo social da enfermagem. A compreensão ampliada e interdependente desses conceitos possibilita, em suma, transcender a linearidade do processo saúde-doença e alcançar resultados mais efetivos de promoção e proteção da saúde.

THE OCCURRENCE OF THE CARE 'OF US' IN THE MOVEMENTS AND FLUCTUATIONS OF THE INTERACTIVE PROCESSES IN THE HOSPITAL ENVIRONMENT

This study's objective was to understand how nursing and health professionals experience and signify the relationships in the care "of us" process, using Grounded Theory as its method. A total of 25 nursing and health workers from a university hospital, distributed into four sample groups, participated in the study. Data were collected through semi-structured interviews in March-July 2011. The contextualization of the institution and management form the context. The movements of human relations/interactions and the professionals' health are causal conditions, while the advance of technology and decline of human care and social life are intervenient conditions. The processed human relations/interactions of care are the strategies that cause the care "of us" to take place in the procedural circularity of care and being-cared-for. The professionals construct the care "of us" in their practice, understood as relational and procedural, in the movements and fluctuations of processes of human interactions.

Learning Incubator: an instrument to foster entrepreneurship in Nursing

OBJECTIVE

this study aimed to know the contributions of the Learning Incubator to the process of lifelong education in health.

METHOD

this is a qualitative field research whose data was collected from August to December 2014 by the focus group technique. The research had 34 employees of a Teaching Hospital in the central region of the state of Rio Grande do Sul that participated previously in the incubation process.

RESULTS

from the data encoded by content analysis, three themes were selected: Learning Incubator - welcoming and integrating space; An instigating instrument that enhances possibilities; Continuous and lifelong education strategy.

CONCLUSION

the Learning Incubator is an important instrument to foster entrepreneurship in nursing and other health areas due to its capacity of rethinking mechanized practices, to the possibility of instigating new ways of being and acting, and to the ability of creating and developing new ideas based on individual and institutional needs.

Governance of professional nursing practice in a hospital setting: a mixed methods study

Objective:

to elaborate an interpretative model for the governance of professional nursing practice in a hospital setting.

Method:

a mixed methods study with concurrent triangulation strategy, using data from a cross-sectional study with 106 nurses and a Grounded Theory study with 63 participants. The quantitative data were collected through the Brazilian Nursing Work Index - Revised and underwent descriptive statistical analysis. Qualitative data were obtained from interviews and analyzed through initial, selective and focused coding.

Results:

based on the results obtained with the Brazilian Nursing Work Index - Revised, it is possible to state that nurses perceived that they had autonomy, control over the environment, good relationships with physicians and organizational support for nursing governance. The governance of the professional nursing practice is based on the management of nursing care and services carried out by the nurses. To perform these tasks, nurses aim to get around the constraints of the organizational support and develop management knowledge and skills.

Conclusion:

it is important to reorganize the structures and processes of nursing governance, especially the support provided by the organization for the management practices of nurses.

[Social support to women in situation of domestic violence]

Objective To understand the meanings attributed by health professionals to the social support of women in domestic violence situations. Methods We interviewed 52 professionals from five local health units of the municipality of Santa Catarina, Brazil. Data were processed based on the Grounded Theory. Results It was shown that the demands are related to the threats of companions and economic dependence, which justifies intersectorial referrals and women's inclusion in the income and employment generation program. Discussion Given the high demand and the health promotion prerogative of Primary Health Care, a greater availability of social workers within the Health Strategy is needed. Social support to women requires political interest in combining the health care sector with other resources available to combat violence.