Deliberación pública en el marco de la respuesta a la pandemia por COVID-19: un análisis de la respuesta temprana en Colombia / Public deliberation in the context of the response to the COVID-19 pandemic: an analysis of the early response in Colombia

RESUMO La deliberación es deseable en el campo de la salud pública, incluso en escenarios de emergencia sanitaria, donde se deben tomar decisiones de manera rápida y con un alto grado de incertidumbre. Se realizó un análisis del proceso de toma de decisiones en los primeros meses de la llegada de la pandemia de COVID-19 a Colombia y en los meses alrededor del inicio de la vacunación, a la luz del concepto de deliberación pública y con énfasis en las decisiones del Gobierno Nacional relacionadas con el sector salud. Se llevó a cabo un estudio cualitativo de análisis de contenido, usando como fuente documentos de las páginas web de la Presidencia de la República de Colombia, del Ministerio de Salud y Protección Social y del Congreso de la República y páginas de organizaciones sociales, particularmente representativas de población vulnerable y organizaciones no gubernamentales. Los espacios deliberativos para la toma de decisiones relacionadas con el sector salud durante la pandemia en Colombia se limitaron a escenarios formales donde se privilegió la participación de expertos biomédicos y técnicos de entidades gubernamentales del nivel central. Es necesario incluir en los futuros planes de preparación para este tipo de emergencia escenarios con capacidad de deliberación pública.

ABSTRACT Deliberation is desirable in the public health field, even in emergency scenarios, where decisions must be made quickly and with a high uncertainty degree. An analysis of the decision-making process in the first months of the COVID-19 pandemic in Colombia and in the months around the start of vaccination was carried out, considering the concept of public deliberation and with emphasis on the decisions of the National Government related to the health sector. A qualitative study of content analysis was carried out, using as information source the documents from the web pages of the Presidency of the Republic of Colombia, the Ministry of Health, and the Congress of the Republic and pages of social organizations, particularly representative of the vulnerable population and non-governmental organizations (NGOs). The deliberative spaces for decision-making related to the health sector during the pandemic in Colombia were limited to formal settings where the participation of biomedical experts and technicians from central government entities was privileged. It is necessary to include scenarios with a greater capacity for public deliberation in future preparedness plans for this type of emergency.

Trajetória e participação política da enfermagem em Santa Catarina no período 1972-2018 / Trajectory and political participation of nursing in Santa Catarina in the period 1972-2018 / Trayectoria y participación política de la enfermería em Santa Catarina em el período 1972-2018

Objetivo: conhecer a participação política dos profissionais da enfermagem enquanto reflexo de suas entidades representativas. Métodos: pesquisa qualitativa de abordagem histórico-social. Dentro do recorte histórico de 1972 a 2018, entre março e setembro de 2019, entrevistaram-se 5 ex-presidentes das Associação Brasileira de Enfermagem - Seção Santa Catarina e do Conselho Regional de Enfermagem de Santa Catarina. A compreensão dos dados se deu por meio da análise de conteúdo de Bardin e interpretação através do marco conceitual de Denise Elvira Pires de Pires. Resultados: percebe-se uma significativa mudança de quadro da participação política da enfermagem através das décadas. Desde a criação da ABEn-SC a enfermagem transita de um corpo forte e unido para uma trajetória e participação em subsequente desarticulação. Conclusão: A desmobilização de uma categoria é multifatorial. Reflexo da desarticulação das entidades representativas da profissão, raízes histórico-culturais de sua fundação e do imaginário individual e social de uma profissão. (AU)

Objective: To Know the political participation of nursing professionals as a reflection of their representative entities. Methods: qualitative research of a historical-social nature in the history of 1975 to 2018, between March and September 2019. Interviewed 5 former presidents of the Brazilian Nursing Association - Santa Catarina Section and the Regional Nursing Council of Santa Catarina. The understanding of the data took place through the analysis of Bardin's content and interpretation through the conceptual framework of Denise Elvira Pires de Pires, profession, discipline and work. Results: there is a significant change in the framework of political participation in nursing over the decades. With a fragile articulation between the entities representing the category. Conclusion: The demobilization of the professional category is multifactorial. Reflection of the disarticulation of the entities representing the profession, the historical and cultural roots of its foundation and the individual and social imagery of the profession. (AU)

Objetivo: conocer la participación política de los profesionales de enfermería como reflejo de sus entidades representativas. Métodos: investigación cualitativa de carácter histórico-social en la historia de 1975 a 2018, entre marzo y septiembre de 2019. Se entrevistó a 5 ex presidentes de la Asociación Brasileña de Enfermería - Sección Santa Catarina y el Consejo Regional de Enfermería de Santa Catarina. La comprensión de los datos se llevó a cabo a través del análisis del contenido y la interpretación de Bardin a través del marco conceptual de Denise Elvira Pires de Pires, profesión, disciplina y trabajo. Resultados: hay un cambio significativo en el marco de participación política en enfermería a lo largo de las décadas. Con una articulación frágil entre las entidades que representan la categoría. Conclusión: La desmovilización de la categoría profesional es multifactorial. Reflejo de la desarticulación de los entes representativos de la profesión, las raíces históricas y culturales de su fundación y el imaginario individual y social de la profesión. (AU)

Characteristics of work in primary care identified in the collective exercise of application of the SWOT matrix / Características del trabajo en atención primaria identificadas en el ejercicio colectivo de aplicación de la matriz FODA / Características do trabalho na atenção primária identificadas no exercício coletivo de aplicação da matriz SWOT

ABSTRACT Objective: to understand how variables strengths, weaknesses, opportunities and threats make it possible to characterize work in Primary Health Care, to collectively propose strategies for systematizing this process with Family Health teams. Methods: methodological research, with 23 participants in direct relationship with Primary Care, including representatives of segments: care (work), management and social control. In one of the three pedagogical meetings, the SWOT matrix was used as a tool for organizational work planning. Results: applying the matrix resulted in the following thematic categories: Teamwork and regulations: key elements for interprofessionality at work; Continuing Health Education: path to autonomy and participatory management (co-management). Final considerations: the study promoted the systematization of teams' work, through the mobilization of sectors and distribution of tasks, involving professionals in the co-management of the process.

RESUMEN Objetivo: comprender cómo las variables fortalezas, debilidades, oportunidades y amenazas permiten caracterizar el trabajo en la Atención Primaria de Salud, para proponer colectivamente estrategias para sistematizar ese proceso con los equipos de Salud de la Familia. Métodos: investigación metodológica, con 23 participantes en relación directa con la Atención Primaria, incluidos representantes de los segmentos: cuidado (trabajo), gestión y control social. En uno de los tres encuentros pedagógicos se utilizó la matriz FODA como herramienta para la planificación del trabajo organizacional. Resultados: la aplicación de la matriz resultó en las siguientes categorías temáticas: Trabajo en equipo y normativa: elementos clave para la interprofesionalidad en el trabajo; Educación Permanente en Salud: camino hacia la autonomía y la gestión participativa (cogestión). Consideraciones finales: el estudio promovió la sistematización del trabajo de los equipos, a través de la movilización de sectores y la distribución de tareas, involucrando profesionales en la cogestión del proceso.

RESUMO Objetivo: compreender como as variáveis forças, fraquezas, oportunidades e ameaças possibilitam caracterizar o trabalho na Atenção Primária à Saúde, para propor coletivamente estratégias de sistematização deste processo junto às equipes de Saúde da Família. Métodos: pesquisa metodológica, com 23 participantes em relação direta com a Atenção Primária, contemplando representantes dos segmentos: atenção (trabalho), gestão e controle social. Em um dos três encontros pedagógicos, utilizou-se a matriz SWOT como ferramenta para o planejamento organizacional do trabalho. Resultados: a aplicação da matriz resultou nas seguintes categorias temáticas: Trabalho em equipe e normativas: elementos-chave para a interprofissionalidade no trabalho; Educação permanente: caminho para a autonomia e para a gestão participativa (cogestão). Considerações finais: o estudo promoveu a sistematização do trabalho das equipes, mediante a mobilização dos setores e a distribuição de tarefas, implicando os profissionais na cogestão do processo.

Checklist de cirurgias seguras: percepção da equipe de saúde / Safe surgery checklist: perception of the health team / Lista de verificación de cirugía segura: percepción del equipo de salud

Objetivo: analisar a percepção dos profissionais de saúde do centro cirúrgico acerca do uso do checklist de cirurgias seguras. Método: estudo descritivo-exploratório, com abordagem qualitativa, realizado com 29 profissionais da equipe cirúrgica de um hospital universitário do Centro-Oeste brasileiro. Dados obtidos por meio de entrevistas individuais, entre fevereiro e março de 2019, norteadas por instrumento semiestruturado. Realizada análise de conteúdo. Resultados: emergiram as categorias temáticas 'Prática e importância atribuída ao uso do checklist de cirurgias seguras pela equipe de saúde' e 'Perspectivas para o uso efetivo do checklist de cirurgias seguras na prática profissional'. Conclusão: Revelou-se uma prática incipiente do uso do checklist de cirurgias seguras, apesar de compreenderem sua importância, e verificou-se o reconhecimento de aspectos profissionais e organizacionais que precisam ser trabalhados para tornar a incorporação dessa ferramenta mais assertiva no processo de trabalho da instituição.

Objective: to analyze the perception of health professionals in the operating room regarding the use of the safe surgeries checklist. Method: descriptive-exploratory study, with a qualitative approach, carried out with 29 professionals from the surgical team of a university hospital in the Brazilian Midwest. Data obtained through individual interviews, between February and March 2019, guided by a semi-structured instrument. Content analysis performed. Results: thematic categories 'Practice and importance attributed to the use of the safe surgeries checklist by the health team' and 'Perspectives for the effective use of the safe surgeries checklist in professional practice' emerged. Conclusion: It was revealed an incipient practice of using the safe surgeries checklist, despite understanding its importance, and there was recognition of professional and organizational aspects that need to be worked on to make the incorporation of this tool more assertive in the work process of institution.

Objetivo: analizar la percepción de los profesionales de la salud en centro quirúrgico sobre el uso del checklist de cirugías seguras. Método: estudio descriptivo-exploratorio, con abordaje cualitativo, realizado con 29 profesionales del equipo quirúrgico de un hospital universitario del Medio Oeste brasileño. Datos obtenidos a través de entrevistas individuales, entre febrero y marzo de 2019, guiadas por un instrumento semiestructurado. Análisis de contenido realizado. Resultados: surgieron categorías temáticas 'Práctica e importancia atribuida al uso de la lista de verificación de cirugías seguras por parte del equipo de salud' y 'Perspectivas para el uso efectivo de la lista de verificación de cirugías seguras en la práctica profesional'. Conclusión: Se reveló una práctica incipiente de utilizar el checklist de cirugías seguras, a pesar de comprender su importancia, y se reconocieron aspectos profesionales y organizacionales que deben ser trabajados para hacer más asertiva la incorporación de esta herramienta en el proceso de trabajo de la institución.

Aplicação da Matriz Swot: tecnologia para a gestão do trabalho na atenção primária à saúde / Aplicación de la Matriz Swot: tecnología para la gestión del trabajo en la atención primaria de salud / Application of Swot Matrix: work management technology in primary health care

Objetivo: analisar, organizar e planejar o trabalho da equipe da Atenção Primária à Saúde, mediantea aplicação da Matriz Swot. Método: estudo qualitativo do tipo pesquisa-ação, realizada em uma Unidade de Saúde, cuja produção e registro das informações envolveram representantes do ensino, atenção, gestão e controle social, totalizando 15 participantes. Foram cinco rodas de conversae utilizou-se a Matriz Swot como tecnologia para a organização do trabalho. Os dados foram tratados mediante análise temática. Resultados: a aplicação da Matriz Swot permitiu mapear potencialidades: vínculo e longitudinalidade, associados ao tempo de serviço dos profissionais, infraestrutura de qualidade, bom relacionamento entre equipe e com usuários. O repensar acerca do cenário da produção de saúde permitiu identificar fragilidades: burocratização, cobrança por produção, ineficiente planejamento das ações, interferências políticas e falta de autocuidado dos usuários. Conclusão: a inserção da tecnologia foi exitosa, especialmente por ser idealizada, a partir da percepção das potencialidades e fragilidades locais.

ABSTRACT Purpose: toanalyze, organize and plan the work of a Primary Health Care team by applying Swot Matrix. Method: this is a research-action, qualitative study carried out in a Health Unit, the production and information record of which comprised 15 participants, representing the fields of teaching, caring, management and social control fields. There were five conversation sessions and the Swot Matrix tool was used as organization technology. Thematic analysis was used to assess the data. All the ethic measures were taken. Results: the application of the Swot Matrix allowed to map potentialities: bond and longitudinality, associated with the professionals' length of service, qualified infrastructure, good relationship between team members and users. Rethinking the health production scenario made it possible to identify weaknesses, such as bureaucratization, charging for production, inefficient action planning, political interference, and the users' lack of self-care. Conclusion: the insertion of the technology was successful, especially because it was conceived based on the perception of local strengths and weaknesses.

Objetivo: analizar, organizar y planificar el trabajo del equipo de Atención Primaria de Salud, aplicando la Matriz Swot. Método: investigación-acción realizada en una Unidad de Salud, cuya producción y registro de información involucró a representantes de educación, atención, gestión y control social, totalizando 15 participantes. Hubo cinco rondas de conversaciones y se utilizó la Matriz Swot como tecnología para la organización del trabajo. Los datos se procesaron mediante análisis temático. Resultados: la aplicación de la Matriz Swot permitió mapear potencialidades: vínculo y longitudinalidad, asociadas al tiempo de servicio de los profesionales, infraestructura de calidad, buena relación entre el equipo y con los usuarios. El replanteamiento del escenario de producción en salud permitió identificar debilidades: burocratización, cobro por producción, planificación ineficiente de acciones, injerencia política y falta de autocuidado por parte de los usuarios. Conclusión: la inserción de la tecnología fue exitosa, especialmente porque se concibió a partir de la percepción de fortalezas y debilidades locales.

Bem-Estar, Mal-Estar e Gerenciamento de Qualidade de Vida no Trabalho / Well-being, Malaise and Quality of Work Life Management / Bienestar, Malestar y Gestión de la Calidad de Vida en el Trabajo

The issue of quality of working life (QWL) has assumed social and corporate relevance due to the worsening of harmful indicators for the health and safety of workers and the scope of the organizational mission. The research aimed to highlight the structuring representations of well-being and malaise at work by servants of a public organization seeking to contribute to the sustainable management of QWL. A total of 1,110 civil ser-vants of an executive branch of the Federal District, in Brazil, participated in the survey. Data were collected based on two open questions from the qualitative part of the Quality of Working Life Assessment Inventory (QWL-AI) and were analyzed using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Ques-tionnaires (IRaMuTeQ) application. The results pointed to three discourse structuring thematic nuclei for work well-being (having a good relationship with colleagues, doing a job you like, and feeling useful to society) and malaise at work (work overload, lack of recognition, time pressure, and rework). Therefore, sustainable man-agement of QWL must be anchored in people management practices that foster professional development, the alignment between tasks, roles, and organizational mission, highlighting the social contributions, the recognition of the worker by their superiors, peers, and society, and the review of work organization, focusing on the reassessment of work processes, distribution of demands, and ways of setting and demanding goals

A questão da Qualidade de Vida no Trabalho (QVT) tem relevância social e corporativa em face do agravamento de indicadores nocivos para a saúde e segurança dos trabalhadores e o alcance da missão organizacional. A pesquisa objetivou evidenciar as representações estruturantes das vivências de bem-estar e mal-estar no trabalho por servidores de uma organização pública visando contribuir para o gerenciamento sustentável de QVT. Participaram da pesquisa 1.110 servidores de um órgão do poder executivo do Distrito Federal, no Brasil. Os dados foram coletados com base em duas questões abertas da parte qualitativa do Inventário de Avaliação de Qualidade de Vida no Trabalho (IA_QVT) e foram analisados com o aplicativo IRaMuTeQ. Os resultados apontaram três núcleos temáticos estruturadores do discurso para bem-estar no trabalho (relacionamento com colegas, fazer trabalho que gosta e sentir-se útil à sociedade) e mal-estar no trabalho (sobrecarga de trabalho, falta de reconhecimento e pressão temporal e retrabalho). A gestão sustentável de QVT, portanto, deve estar ancorada em práticas de gestão de pessoas que fomentem o investimento no desenvolvimento dos profissionais, o alinhamento das tarefas e papéis com a missão organizacional, evidenciando a conexão com as contribuições sociais, o reconhecimento do trabalhador por superiores, pares e sociedade, a revisão da organização do trabalho, com foco na reavaliação de processos de trabalho, distribuição de demandas e formas de pactuação e cobrança de resultados.

Clima organizacional en los procesos de mejora de la calidad universitaria / Organizational climate in the university quality improvement processes

RESUMEN La percepción de los trabajadores sobre el funcionamiento de las estructuras y procesos que ocurren en su medio laboral se denomina clima organizacional. Cada institución manifiesta un clima propio influenciado de forma positiva o negativa por factores internos y externos tanto físicos como estructurales. Aunque los estudios de clima se aplican con mayor frecuencia en el mundo empresarial, su uso se extiende a otras organizaciones complejas como las académicas por la variedad de subsistemas y el capital humano que la componen y las diversas percepciones que generan. El presente artículo tiene como objetivo: exponer algunas consideraciones acerca del uso de los estudios sobre clima organizacional en los procesos de mejora de la calidad universitaria, a través de un acercamiento a sus definiciones y la experiencia del uso de estos estudios en ámbitos académicos, de manera específica en la Universidad de Ciencias Médicas de Villa Clara.

ABSTRACT The perception of workers about the functioning of the structures and processes that occur in their work environment is called organizational climate. Each institution manifests its own climate influenced positively or negatively by internal and external factors, both physical and structural. Although climate studies are more frequently applied in the business world, its usage extends to other complex organizations such as academic ones due to the variety of subsystems and the human capital that compose it and the diverse perceptions that they generate. This article aims to: present some considerations about the use of studies on organizational climate in the processes of improvement of university quality, through approaching to its definitions and the experience of the use of these studies in the academic environment, specifically at Villa Clara University of Medical Sciences.

Practice and effect analysis of emergency cluster management / 中华医院管理杂志

Objective:To analyze the application effect of cluster management measures in improving the quality of emergency medical treatment.Methods:By analyzing the problems existing in the work of emergency department, the cluster management scheme was formulated and the intervention measures were implemented from the aspects of intelligent information system, patient management system and medical service process. The accuracy and efficiency of emergency triage, the satisfaction of patients and medical staff, the incidence of medical complaints and disputes and the rate of sudden death were compared before and after cluster management.Results:Before and after the implementation of cluster management, the accuracy of triage classification was 95.0% and 98.7% respectively, and the triage time was (68.3±12.8) s and (50.5±7.2) s respectively( P<0.001). The satisfaction of patients, doctors and nurses increased, the number of complaints decreased from 15 to 5 in half a year, and the number of sudden death decreased from 39 to 23 with a significant difference( P<0.05). Conclusions:The application of cluster management measures in emergency management can improve the medical quality, the satisfaction of medical staff and patients, and ensure the safety of patients.

Application of REDCap system in clinical study follow-up process management / 中华医学科研管理杂志

Objective:To summarize the experiences of clinical study project management in Peking University Clinical Research Institute, REDCap (Research Electronic Data Capture) data management system was proposed to improve the follow-up process management.Methods:Current clinical study follow-up process management situation were analyzed and methods for utilizing REDCap in follow-up management was proposed.Results:Using REDCap through " direct management" and " system management" data management can improve the follow-up quality and standard level of management in clinical study, at the same time, secured better protection of participants′ privacy and rights during the process.Conclusions:REDCap plays crucial roles in securing follow-up data quality from the source, timely tracking and standardization of follow-up management, it can be adopted more widely in assisting clinical study follow-up management.

Patient safety culture in the perception of health professionals: A mixed methods research study / La cultura de seguridad del paciente según la percepción de profesionales de la salud: una investigación de método mixto / Cultura de segurança do paciente na percepção dos profissionais de saúde: pesquisa de métodos mistos

ABSTRACT Objective: To analyze the patient safety culture perceived by health professionals working in a hospital and to understand the elements influencing it. Methods: A sequential explanatory mixed methods study, conducted in 2017 in two interrelated stages in a hospital. The quantitative stage was carried out by applying the questionnaire to 618 professionals and the qualitative stage, with ten, using the focus group technique. The analysis was descriptive statistics for the quantitative data and of content for the qualitative data. Subsequently, the data were submitted to integrated analysis. Results: Of the 12 dimensions, seven were considered weak, the most critical being "non-punitive response to error" with 28.5% of positive answers. Bureaucratic, poorly designed and uncoordinated processes, regional decisions, communication failures, hierarchy, overload, punishment and judicialization were related to the perception. Conclusions: The patient safety culture was considered weak, and elements related to work organization, people management and legal risk influenced this negative perception.

RESUMEN Objetivo: Analizar la cultura de seguridad del paciente percibida por los profesionales de la salud y comprender los elementos que influyen en ella. Métodos: Estudio de método mixto explicativo secuencial, realizado en dos etapas interrelacionadas en un hospital en el año 2017. La etapa cuantitativa se realizó mediante la aplicación del cuestionario a 618 profesionales y la etapa cualitativa, con diez, mediante la técnica de grupo focal. El análisis fue estadística descriptiva para los datos cuantitativos y de contenido para los datos cualitativos. Posteriormente, los datos se sometieron a análisis integrado. Resultados: De las 12 dimensiones, siete se consideraron débiles, siendo la más crítica la "respuesta no punitiva a los errores". Los procesos burocráticos, mal diseñados e descoordinados, decisiones regionales, fallas de comunicación, jerarquización, sobrecarga, castigo y judicialización se relacionaron con la percepción. Conclusiones: La cultura de seguridad del paciente se consideró débil y elementos relacionados con la organización del trabajo, la gestión de personas y el riesgo legal influyeron esta percepción negativa.

RESUMO Objetivo: Analisar a cultura de segurança do paciente percebida pelos profissionais de saúde de um hospital e compreender os elementos que a influenciam. Métodos: Misto sequencial explanatório, conduzido em duas etapas conectadas, em hospital, em 2017. A etapa quantitativa ocorreu mediante aplicação do questionário a 618 profissionais e a qualitativa, com dez, pela técnica de grupo focal. A análise foi descritiva para dados quantitativos e de conteúdo, para os qualitativos. Posteriormente, os dados foram submetidos à análise integrada. Resultados: Das 12 dimensões, sete foram consideradas frágeis, sendo a mais crítica "resposta não punitiva aos erros", com 28,5% de respostas positivas. Processos burocratizados, mal desenhados e descoordenados, decisões regionais, falhas de comunicação, hierarquia, sobrecarga, punição e judicialização foram relacionados à percepção. Conclusão: A cultura de segurança do paciente foi considerada frágil e os elementos relacionados à organização do trabalho, à gestão de pessoas e ao risco jurídico influenciaram essa percepção negativa.

Best practices in nursing and their interface with the expanded family health and basic healthcare centers / Las mejores prácticas en enfermería y su interfaz con el núcleo extendido de salud de la familia y atención primaria / Melhores práticas em enfermagem e sua interface com o núcleo ampliado de saúde da família e atenção básica

ABSTRACT Objective: to know and reflect on the best practices in nursing and their interface with the Expanded Family Health and Basic Healthcare Centers (NASF-AB). Method: this is a participatory research based on Paulo Freire's methodological framework and developed from thematic investigation, coding, decoding, and critical unveiling. The information was produced and analyzed in four Culture Circles, with an average of five nurses and duration of two hours each, between April and June 2018. The investigation revealed four generating themes, unveiled during the meetings. In this study, the theme "best nursing practices that favor relations with NASF-AB" will be discussed. Results: nurses acknowledge communication as a tool that promotes best practices in nursing. It was possible to deepen the dialogue and knowledge about NASF-AB's work process and the role of nursing. Nurses act as a link between the support team and the Family Health team, a skill resulting from their training focused on management, having leadership and dialogue as resources for conflict resolution. Conclusion: the present study contributed to improve nurses' thinking and acting in relation to the proposed theme. The reflections made during Culture Circles boosted transformative attitudes in the practice settings. Nurse approximation with NASF-AB favors autonomy and collaborative practices (understood as best practices), encouraging interprofessional and solve-problem actions within Basic Care.

RESUMEN Objetivo: conocer y reflexionar sobre las mejores prácticas en enfermería y su interfaz con el Núcleo Extendido de Salud de la Familia y Atención Primaria (NASF-AB). Método: investigación participativa basada en el marco metodológico de Paulo Freire y desarrollada a partir de las etapas de investigación temática, codificación, decodificación y develación crítica. La información fue producida y analizada en cuatro Círculos de Cultura, con un promedio de cinco enfermeros y una duración de dos horas cada uno, entre abril y junio de 2018. La investigación reveló cuatro temas generadores, develados durante los encuentros. En este estudio se discutirá el tema: mejores prácticas de enfermería que favorecen las relaciones con la NASF-AB. Resultados: las enfermeras reconocen la comunicación como una herramienta que promueve las mejores prácticas en esta interfaz. Se logró profundizar el diálogo y el conocimiento sobre el tema, sobre el proceso de trabajo NASF-AB y el papel de la enfermería en este contexto. Se perciben a sí mismos como un vínculo entre el equipo de apoyo y el equipo de Salud de la Familia, habilidad resultante de su formación enfocada al ejercicio de la gestión y al liderazgo y al diálogo como recursos para la resolución de conflictos. Conclusión: el estudio contribuyó a la mejora del pensamiento y la actuación de los enfermeros en relación con el tema propuesto, ya que las reflexiones realizadas durante los Círculos Culturales estimularon actitudes transformadoras en los escenarios de práctica. Se observa que la aproximación de enfermeras con la NASF-AB favorece la autonomía y las prácticas colaborativas (entendidas como mejores prácticas), estimulando movimientos interprofesionales y resolutivos en el ámbito de la Atención Primaria.

RESUMO Objetivo: conhecer e refletir sobre as melhores práticas em enfermagem e sua interface com o Núcleo Ampliado de Saúde da Família e Atenção Básica. Método: pesquisa participante pautada no referencial metodológico de Paulo Freire e desenvolvida a partir das etapas de investigação temática, codificação, decodificação e desvelamento crítico. As informações foram produzidas e analisadas em quatro Círculos de Cultura, com média de cinco enfermeiras e duração de duas horas cada, entre abril e junho de 2018. A investigação revelou quatro temas geradores, desvelados durante os encontros. Neste estudo será discutido o tema: melhores práticas de enfermagem que favorecem as relações com o Núcleo Ampliado. Resultados: as enfermeiras reconhecem a comunicação como ferramenta que promove as melhores práticas nessa interface. Foi possível aprofundar o diálogo e o conhecimento sobre o tema, sobre o processo de trabalho do Núcleo e o papel da enfermagem nesse contexto. Elas se percebem como elo entre a equipe apoiadora a equipe de Saúde da Família, habilidade decorrente da sua formação voltada para o exercício da gestão e tendo a liderança e o diálogo como recursos para a resolução de conflitos. Conclusão: o estudo contribuiu para o aprimoramento do pensar e do agir das enfermeiras em relação ao tema proposto, pois as reflexões tecidas durante os Círculos impulsionaram atitudes transformadoras nos cenários de prática. Nota-se que a aproximação das enfermeiras com os Núcleos favorece a autonomia e as práticas colaborativas (compreendidas como melhores práticas), estimulando movimentos interprofissionais e resolutivos no âmbito da Atenção Primária.

El análisis de la calidad asistencial desde la perspectiva de la satisfacción y la experiencia del paciente: una mirada enfermera / An analysis of assistance quality from the perspective of patience satisfaction and experience: A nursing view

Este artículo pretende describir dos grandes aspectos: la satisfacción y la experiencia del paciente, y cómo medirlos y analizarlos en los campos de la gestión sanitaria, la gestión clínica y los servicios sanitarios. Dichos elementos están inmersos en el abordaje en seguridad del paciente y permiten que la enfermería se relacione con temas como la calidad de los cuidados, la satisfacción del usuario, su experiencia dentro del sistema, los cambios y la implementación de mejoras así como sus formas de medición y análisis dentro del vasto campo de la gestión clínica y sanitaria. Aunque se trata de un tema ampliamente explorado y complejo, susceptible de ser abordado por métodos cuantitativos y cualitativos, en el que la encrucijada entre calidad total, calidad percibida, satisfacción y experiencia parece conformar la hoja de ruta, el artículo aporta conceptos de reciente aparición como Healthcare Improvement Science (mejora de la ciencia de la salud), centrado en la mejora de la calidad del cuidado de la salud y la reducción de daños a los usuarios de los servicios y sus familias; Magnet Hospital (hospital magnético), que relaciona la satisfacción de los profesionales con la calidad de los cuidados, y Patient Experience Officer (director de la experiencia del paciente), nuevo perfil laboral creado en Estados Unidos, centrado en la mejora continua de la calidad a partir de la experiencia del paciente. Todos estos conceptos han sido desarrollados por instituciones e investigadores reconocidos en la materia. En conclusión, en este artículo se resumen algunas de las cuestiones clave que se deben tener en cuenta a la hora de analizar la experiencia del paciente, que es un elemento importante para la mejora y el mantenimiento de la calidad en la atención sanitaria.

This article aims to describe two major aspects: patient satisfaction and experience and the way these are measured and analyzed within health management, clinical management, and health services. These elements are immersed within processes of patient safety and assume a motive for nursing of interweaving issues such as quality of care, user satisfaction, user experience within the system, change and the implementation of improvements, as well as ways of measuring and analyzing these issues within the vast field of clinical and health management. This is a widely explored and complex topic where total quality, perceived quality, satisfaction, and experience appear to make up a crossroad that needs to be taken into account and whose engagement is susceptible to qualitative and quantitative measurements. This article, however, contributes new concepts like Healthcare Impro-vement Science, centered on the improving the quality of health care and reducing harm to users of services and their families, Magnet Hospital, where the satisfaction of employed professionals is related with quality of care, and Patient Experience Officer, a new job profile created in the United States focused on the continuous improvement of patient experience quality. All these concepts were developed by recognized institutions and researchers in the field. In conclusion, this article summarizes some of the key issues that must be taken into account when analyzing the patient's experience, which is an important element for the improvement and maintenance of quality in health care.

Study on application effect of risk management in medical device management of hospital and its impact on management quality / 中国医学装备

Objective:To discuss application effect of risk management in medical device management of hospital and its impact on management quality.Methods:9800 medical devices of hospital were selected and divided into routine management group (the corresponding medical devices came from the term of 2014 year to 2015 year, n=4900) and risk management group (the corresponding medical devices came from the term of 2014 year to 2015 year, n=4900) according to different management method.The arrangement and placement of device, the specification and quantity of device, the placement of accessories and the intact situation of widgets of the two groups were recorded and calculated as statistics method.A self-designed questionnaire was adopted to assess these situations included classification error, incompetence, loss of device, undersupply, instrument damage, the timeliness degree of supply, the timeliness degree of withdrawing and quality of packaging in the management process for medical devices.And the management effects of two groups and the corresponding influences of them for curative effect were further compared.Results:The arrangement and placement of medical device, the different specification and quantity of device, the placement of accessories, intact rate of widgets of risk management group were significantly higher than those of■timeliness degree of supply, the timeliness degree of withdrawing and quality of packaging of risk management group post management were significantly higher than those of routine group (t=20.394, t=21.847, t=16.481, P<0.05) .Conclusion:The effect of risk management that is used in medical equipment management of hospital is significant, and it contribute to improve the management quality for medical apparatus and instruments and reduce the error rate of instruments, and it can ensure the safety usage of them in hospital.

Application of failure mode and effect analysis in safety management of digestive endoscopic specimens / 现代临床护理

Objective To explore the effect of failure mode and effect analysis (FMEA)in the safety management of digestive endoscopic specimens. Methods From April to November 2016, the specimens by biopsy from the patients in the department of gastrointestinal endoscopy were assigned as the control group, where conventional sample management was used and those from December 2016 to July 2017 were all included in the intervention group, where FMEA was used to find the failure mode and improvement plan was worked out. The FMEA team was set up to discuss and determine the high risk factors leading to the safety management defects in the digestive endoscopy center and calculate the risk priority number (RPN). According to the potential risk factors, we optimized and implemented continuous improvement of the specimen safety management process. Results After the implementation of FMEA,the RPNs in the top 6 failure modes were less than 125,the risk coefficient value dropped from 126~175 to 0~40.The specimen error rate after the implementation of FMEA was statistically significantly lower than that before the implementation (P<0.001). Conclusion The FMEA reduces the incidence of specimen failure and improves the quality of the management of digestive endoscopy.

Application and Exploration of PDCA Cycle Management in Hospital Social Evaluation / 中国医学伦理学

The First Hospital Affiliated to Xi'an Jiaotong University adopted PDCA cycle management tool and used planning,implementing,inspection,processing and other links in the specific application of promoting hospital social evaluation.After a certain stage,we summed up the work and changed the chaotic work status of social evaluation management.Comparing with the existing literature,this paper concluded that the application of this tool can promote the research of hospital quality and service management,promote the practice of building harmonious doctor -patient relationship.It is worth to promote the application of PDCA cycle management in hospital social evaluation.

Effect of Jiangsu Pharmaceutical Management Quality Control Center on Promoting the Rational Use of Antibacterial Agents in Hospitals / 中国药房

OBJECTIVE:To describe the effect of Jiangsu Pharmaceutical Management Quality Control Center(JPMQCC)on promoting the rational use of antibacterial agents in hospitals. METHODS:Measures in promoting the rational use of antibacterial agents taken by JPMQCC were introduced. Effect of quality control center on promoting the rational use of antibacterial agents was analyzed by collecting data(such as antibacterial prescription proportion,inpatients'use rate of antibacterial agents)about the clini-cal use of antibacterial agents during Jan. 2014-Jan. 2017 in"Jiangsu Pharmaceutical Management Quality Control Network Report-ing System"established by JPMQCC. RESULTS:Measures implemented and developed by quality center included strictly imple-menting classification management and filing system of antibacterial agents,and carrying out basic information survey for applying antibacterial agents,etc. Applying data of antibacterial agents in totally 65 hospitals were collected. Analysis results showed,com-pared with Jan. 2014,antibacterial prescription proportion for outpatient of sample hospitals in Jan. 2017 was decreased from 18.37% to 14.63%,and antibacterial prescription proportion for emergency was increased from 34.94% to 37.92%. Inpatients'use rate of antibacterial agents was decreased from 56.11%to 51.28%,and its intensity was decreased from 49.74 to 44.13. The preven-tive use rate for thyroid,breast and hernia surgery was decreased from 35.27% to 8.88%,and in interventional surgery diagnosis, it was decreased from 12.55% to 2.46%. Pathogenic detection rate of inpatients was increased from 48.44% to 54.60%. CONCLU-SIONS:The quality control management in JPMQCC for more than 3 years has promoted the rational use of antibacterial agents of 65 hospitals in Jiangsu province.

Analysis of effect of severe full-time nursing group on nursing intervention of neonatal respiratory distress syndrome / 中国基层医药

Objective To investigate the intervention value of intensive care team in neonatal respiratory distress syndrome.Methods 110 cases of neonatal respiratory distress syndrome were selected,by using a random number table method they were randomly divided into the observation group and the control group,55 cases in each group.The control group was treated with routine care model,the observation group dedicated care team for critically ill children.The incidence of complications,mechanical ventilation time,cost of hospitalization,duration of hospitalization were compared after the care of children.Results The incidence rates of infection,abdominal bloating and intraventricular hemorrhage in the observation group (3.64%,1.82%,0.00%) were significantly lower than those in the control group(20.00%,16.36%,5.45%),the incidence of infection,abdominal distension between the two groups had statistically significant differences (χ2=4.852,P=0.027;χ2=7.040,P=0.008).The mechanical ventilation time,hospitalization time in the observation group [(11.23±2.17)d,(23.45±5.45)d]were significantly shorter than those in the control group[(16.78±4.52)d,(26.78±6.47)d],there were statistically significant differences between the two groups(t=8.209,P=0.000;t=2.919,P=0.004).The hospitalization costs of the observation group[(20 462.78±214.45) yuan] was significantly lower than the control group [(24 975.45±312.45)yuan],there was significant difference between the two groups(t=88.311,P=0.000).The total effective rate of the observation group was 98.18%,which was higher than 87.27% of the control group,there was statistically significant difference between the two groups(χ2=4.852,P=0.027).Conclusion Full implementation of critical care nursing team intervention on neonatal respiratory distress syndrome,can effectively reduce the incidence of children with complications,mortality,shorter hospital stays,reduce hospitalization costs,the effect is significant and should be introduced.

Evolución de la ergonomía participativa: conceptos y aproximaciones metodologicas / Evolution of participatory ergonomics: concepts and methodological approaches

Se realizó una revisión descriptiva de la evolución de la ergonomía participativa como estrategia de intervención, su progreso conceptual y metodológico desde sus inicios de aplicación a la ac- tualidad. La revisión se realizó a partir de estrategias de consulta que incluyeron las siguientes: 1) consulta de seis bases de datos, 2) seis principales revistas científicas y 3) selección de cuatro libros especializados. Se seleccionaron 70 artículos potenciales clasificados como bibliografía exploratoria. Se establecieron como criterios de selección los siguientes: artículos científicos o libros especializados y tema central ergonomía participativa aplicada. De acuerdo con estos cri- terios se determinó como bibliografía pertinente y relevante 37 publicaciones, las cuales fueron analizadas a la luz de la evolución de la ergonomía participativa. Como conclusión se determinó que la ergonomía participativa puede ubicarse como una subárea de la Macroergonomía en cons- tante evolución que llega a considerarse por distintos autores como filosofía, modelo, enfoque, estrategia o metodología. Es necesario revisar la evidencia científica para desarrollar un concepto más acertado, que le permita a la ergonomía participativa ser parte integral en cada una de las dimensiones de la ergonomía.

This article is a descriptive review about the evolution of participatory ergonomics intervention strategy, its conceptual and methodological progress since its formation to its present applica- tion. The research was done throughout consultation strategies which included the following: 1) six databases, 2) six major scientific journals and 3) four specialized books. 70 potential articles were selected as exploratory literature. The selection criteria were focused on scientific articles or specialized books whose principal subject was participatory applied ergonomics. According to these criteria, 37 publications were chosen and analyzed focusing on the evolution of participa- tory ergonomics. In conclusion it was determined that participatory ergonomics can be classified as a subarea of Macroergonomics which is evolving continuously and is considered by different authors as philosophy, model, approach, strategy or methodology. It is necessary to review the scientific evidence to develop a most accurate concept that allows the participatory ergonomics to be an integral part in each of the dimensions of ergonomics.

Two methods applied to comprehensive evaluation of hospital operation management / 中华医院管理杂志

Objective Using principal components analysis and weighted TOPSIS method to make objective and accurate evaluation of hospital operation management quality.This aims at proving whether such methods are scientific and feasible for comprehensive evaluation for the quality of hospital operation management and providing the basis for hospital decision making.Methods 15 typical Hospital Performance Indicators were chosen from a cancer hospital during 2008-2012,which were subject to TOPSIS method and principal components analysis,weighted TOPSIS method for comprehensive evaluation.Results The results with principal components analysis and weighted TOPSIS method conform to the actual hospital conditions and prove the rising quality of operation management of the hospital.That is,the closer the date,the higher the ranking.Conclusion Principal components analysis and weighted TOPSIS method are proven flexible,practical,scientific and reliable and suitable for popularization and application in the quality evaluation of hospital operation management.

Structural Factors Influencing the Quality Management Activities in Nursing Homes / 간호행정학회지

PURPOSE: Nursing home quality indicators have been focused widely on result outcomes, not for the environment in that quality of service are delivered. This study aimed to examine structural factors influencing quality management activities in nursing homes. METHOD: Sample was 170 nursing homes responded to the survey questionnaire which was distributed to the 543 nursing homes nation-wide. Data were collected on structural characteristics, types of services, and quality management activities. Data were analyzed with the descriptive statistics, Pearson correlations, and multiple regression. RESULT: Most of the nursing homes were operated as free of charge by the social welfare ownership. Average number of residents was 52.1 with severe and mild dementia and bedridden status. In terms of quality management activities, 34% of the sample had CQI committee that focused their activities on services delivery process, performance appraisal, record keeping regularly. 30.6% of quality management activities were accounted for by the number of residents with dementia, the ratio of RN to residents, rehabilitation services, and social wefare services in nursing homes. CONCLUSION: We recommend that more comprehensive quality management activities should be developed as process quality indicators in conjunction with the outcome indicators.