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Kasper MS, Santos FLD, Oliveira PSD, Silva JPD, Santos KDS, Araujo PND, Souza GC, Quintão CBDS, Viana AL, Matumoto S, Mishima SM, Fermino TZ, Abrahão AL, Righi LB, Monceau G, Fortuna CM. The Work of Nurses in Primary Health Care: Crossings of the New Public Management. Healthcare (Basel) 2023; 11:healthcare11111562. [PMID: 37297702 DOI: 10.3390/healthcare11111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.
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Affiliation(s)
- Maristel Silva Kasper
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire École-Mutations-Apprentissages, CY Cergy Paris Université, 92230 Gennevilliers, France
| | - Felipe Lima Dos Santos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire École-Mutations-Apprentissages, CY Cergy Paris Université, 92230 Gennevilliers, France
| | - Poliana Silva de Oliveira
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Janaina Pereira da Silva
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Educatives et des Pratiques Sociales, Université Paris-Est-Créteil-Val-de-Marne, 94010 Créteil, France
| | - Karen da Silva Santos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire Éducation et Diversité en Espaces Francophones, 87036 Limoges, France
| | - Priscila Norié de Araujo
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Gabriella Carrijo Souza
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Cássia Bianca de Souza Quintão
- Technology and Innovation in Nursing Professional Master Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Angelina Lettiere Viana
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Silvia Matumoto
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Silvana Martins Mishima
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Tauani Zampieri Fermino
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Ana Lucia Abrahão
- Department of Medical-Surgical Nursing, Aurora de Afonso Costa College of Nursing at Fluminense Federal University, Niterói 24020-090, Rio de Janeiro, Brazil
| | - Liane Beatriz Righi
- Department of Collective Health, Health Sciences Center of the Federal University of Santa Maria, Santa Maria 97105-900, Rio Grande do Sul, Brazil
| | - Gilles Monceau
- Laboratoire École-Mutations-Apprentissages, CY Cergy Paris Université, 92230 Gennevilliers, France
| | - Cinira Magali Fortuna
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
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Nene SE. Exploring the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa. Curationis 2021; 44:e1-e7. [PMID: 34476953 PMCID: PMC8424710 DOI: 10.4102/curationis.v44i1.2196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/20/2021] [Accepted: 05/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background The challenges in leadership roles hinder the rendering of quality primary healthcare service in the mines. Mining, the heart of the South African economy, requires good health to its personnel to carry out operations. However, nurse managers, the leaders in a mining primary healthcare setting experience difficulties in their leadership roles. Objectives The aim of this study was to explore and describe the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa. Method The study was conducted in a mining primary healthcare setting in West Rand, Gauteng province, South Africa. A qualitative, exploratory, descriptive design that is contextual in nature, using a phenomenological approach, was adopted. Data from nurse managers in the mine were collected and data saturation was reached by the seventh participant. The study followed Giorgi’s four stages of the phenomenological descriptive data analysis. An expert independent coder in qualitative research coded the data, and consensus on the findings was reached with the researcher. Results Three subthemes emerged from the study: mining management and unions interfere with nurse managers’ leadership roles, incongruent mining primary healthcare policies and communication gap between nurse managers and mining management. Conclusion The triangulation of nurse managers, mining management and unions requires a collective fusion to directly tackle the challenges in leadership roles in mining primary healthcare.
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Affiliation(s)
- Sanele E Nene
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg.
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Managerial Strategies for Long-Term Care Organization Professionals: COVID-19 Pandemic Impacts. SUSTAINABILITY 2020. [DOI: 10.3390/su12229682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper aims to analyze the strategies that healthcare professionals have adopted during the coronavirus pandemic (COVID-19) in long-term care organizations in Rio de Janeiro city, Brazil, by investigating their competencies—mainly managerial ones. To reach its goals, this paper performs empirical research and theoretical research. For the empirical research, the plans of professionals during COVID-19 pandemic in long-term care organizations are observed, and a questionnaire is applied to analyze observed data integrity. The data are analyzed through the Python and IBM SPSS Statistic programming languages, and descriptive analyses use descriptive statistic proportions, rates, minimum, maximum, mean, median, standard deviation, and coefficient of variation (CV). A non-parametric approach performs repeated measure comparisons using Wilcoxon’s test, while the McNemmar test is used to repeat the categorical variables. Statistical significance is assumed at the 5% level. For the theoretical research, a literature review is developed using scientific databases. The results show that for the searched period, the number of deaths and the number of people infected by COVID-19 in these organizations are low when compared to general statistics of Rio de Janeiro city. This paper concludes that these strategical adoptions have brought significant benefits to long-term care organizations, and it might motivate researchers to develop future studies related to long-term care organizations, helping to fill the literature gap on the subject.
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Søreide H, Kyrkjebø D, Råholm M. Challenges in municipality healthcare services-The nurse leaders' perspective. Nurs Open 2019; 6:889-896. [PMID: 31367412 PMCID: PMC6650667 DOI: 10.1002/nop2.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/01/2019] [Accepted: 02/27/2019] [Indexed: 12/04/2022] Open
Abstract
AIM To examine perceptions of key challenges that nursing leadership face when organizing healthcare services in the municipality. DESIGN A qualitative study involving community nurse leaders (N = 9) in two focus group interviews. METHODS The material has been processed and interpreted in accordance with the phenomenological-hermeneutical tradition, and this process was inspired by Graneheim and Lundman. RESULTS Three themes were identified in this study: (a) Tension between organizing the daily work and future challenges; (b) Challenges with recruiting enough registered nurse (RNs) in municipal healthcare services; and (c) Competence development plan-a strategic tool for nursing leadership. The municipal healthcare services need a better knowledge base with better knowledge of both the content and quality of services, organization, leadership and management, thus improving new forms of work and professional approaches.
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Affiliation(s)
- Hilde Søreide
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFordeNorway
| | - Dagrun Kyrkjebø
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFordeNorway
| | - Maj‐Britt Råholm
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFordeNorway
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Midtbust MH, Alnes RE, Gjengedal E, Lykkeslet E. Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals' experiences. BMC Health Serv Res 2018; 18:709. [PMID: 30208872 PMCID: PMC6134769 DOI: 10.1186/s12913-018-3515-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/30/2018] [Indexed: 12/03/2022] Open
Abstract
Background Dementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals’ experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities. Methods This was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke. Results The major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care. Conclusions The findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3515-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- May Helen Midtbust
- Faculty of Medicine and Health Sciences, Department for Health Sciences in Aalesund, Norwegian University of Science and Technology, Box 1517, NO 6025, Aalesund, Norway.
| | - Rigmor Einang Alnes
- Faculty of Medicine and Health Sciences, Department for Health Sciences in Aalesund, Norwegian University of Science and Technology, Box 1517, NO 6025, Aalesund, Norway
| | - Eva Gjengedal
- University of Bergen, Global Public Health and Primary Care, Box 7804, 5020, Bergen, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Box 2110, NO 6402, Molde, Norway
| | - Else Lykkeslet
- Faculty of Health Sciences and Social Care, Molde University College, Box 2110, NO 6402, Molde, Norway
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Ghiasipour M, Mosadeghrad AM, Arab M, Jaafaripooyan E. Leadership challenges in health care organizations: The case of Iranian hospitals. Med J Islam Repub Iran 2017; 31:96. [PMID: 29951397 PMCID: PMC6014751 DOI: 10.14196/mjiri.31.96] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Effective leadership is a vital component of health care systems and has an extensive range of functions in improving organizational effectiveness and efficiency. This study aimed at exploring leadership challenges encountered by leaders in Iranian hospitals. Methods: This qualitative study was conducted on a purposeful sample of 27 members of hospital management team in Tehran using face-to-face semi-structured interviews and in-depth interviews. Thematic analysis was used to analyze and report the data. Results: In this study, 5 main themes emerged upon the challenges of leadership in health care organizations as follow: organizational structure (complexity, centralization, and bureaucracy); human resources (the number and distribution of human resources, staff empowerment, and education, motivational mechanisms, and staff diversity); work nature (sensitivity, stress and tension, customer diversity, and team- oriented); leaders (knowledge and skills, appointment, superiors and colleagues, and time); and context (regulations and programs, cultural issues, social issues, and economic issues). Conclusion: The results of this study shed some light on the leadership challenges in a culturally specific developing country. The results also proved the importance of using educated leaders who are capable of understanding, analyzing, and dealing with such complex challenges.
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Affiliation(s)
- Maryam Ghiasipour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Arab
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Nursing care needs and services utilised by home-dwelling elderly with complex health problems: observational study. BMC Health Serv Res 2017; 17:645. [PMID: 28899369 PMCID: PMC5596938 DOI: 10.1186/s12913-017-2600-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background In Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. We aimed at assessing aspects of health and function in a representative sample of the most vulnerable home-dwelling elderly, to identify their needs for nursing interventions and how these needs were met. Methods In this observational study we included patients aged 75+ living in their own homes in Oslo, who received daily home care, had three or more chronic diagnoses, received daily medication, and had been hospitalized during the last year. Focused attention and cognitive processing speed were assessed with the Trail Making Test A (TMT-A), handgrip strength was used as a measure of sarcopenia, mobility was assessed with the “Timed Up-and-Go” test, and independence in primary activities of daily living by the Barthel Index. Diagnoses and medication were collected from electronic medical records. For each diagnosis, medication and functional impairment, a consensus group defined which nursing service that the particular condition necessitated. We then assessed whether these needs were fulfilled for each participant. Results Of 150 eligible patients, 83 were included (mean age 87 years, 25% men). They had on average 6 diagnoses and used 9 daily medications. Of the 83 patients, 61 (75%) had grip strength indicating sarcopenia, 27 (33%) impaired mobility, and 69 (83%) an impaired TMT-A score. Median amount of home nursing per week was 3.6 h (interquartile range 2.6 to 23.4). Fulfilment of pre-specified needs was >60% for skin and wound care in patients with skin diseases, observation of blood glucose in patients taking antidiabetic drugs, and in supporting food intake in patients with eating difficulties. Most other needs as defined by the consensus group were fulfilled in <10% of the patients. Conclusions We identified a very frail group of home-dwelling patients. For this group, resources for home nursing should probably be used in a more flexible and pro-active way to aim for preserving functional status, minimize symptom burden, and prevent avoidable hospitalisations.
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