Fatores influenciadores do processo decisório de enfermeiros em hospitais universitários ibero-americanos / Influencing factors in the nurses' decision-making process in Ibero-American university hospitals / Factores que influyen en el proceso de toma de decisiones de los enfermeros en los hospitales universitarios iberoamericanos

Resumo Objetivo: analisar os fatores que influenciam o processo decisório de enfermeiros em hospitais universitários ibero-americanos. Método: estudo de caso, com abordagem qualitativa, do tipo multicêntrico, realizado com 30 enfermeiros ibero-americanos. Os dados foram coletados por meio de entrevistas semiestruturadas, analisados por categorias temáticas e interpretados de acordo com o referencial teórico da obra Criando Organizações Eficazes. Resultados: identificou-se que o processo decisório permeia o desenvolvimento de competências próprias dos enfermeiros, sofrendo influências da formação em gestão em saúde e de experiências individuais prévias. Emergiram as categorias: Preparo técnico-científico na tomada de decisão; Hierarquização do processo decisório; e Prática profissional autônoma. Conclusão: a ausência/presença de rígida hierarquização, bem como de preparo técnico-científico, e a autonomia são fatores que limitam ou ampliam a gama de possibilidades na tomada de decisão de enfermeiros, com reflexos na gestão do cuidado. Assim, discussões acerca dessa temática devem ser fomentadas, no intuito de promover a autonomia dos enfermeiros para a tomada de decisão e favorecer a desburocratização dos processos que impedem/dificultam os avanços nesses serviços.

Abstract Objective: to analyze the factors that influence nurses' decision-making process in Ibero-American university hospitals. Method: a case study with a qualitative approach and of the multicenter type, carried out with 30 Ibero-American nurses. The data were collected through semi-structured interviews, analyzed by thematic categories and interpreted according to the theoretical framework of Creating Effective Organizations. Results: it was identified that the decision-making process permeates the development of nurses' own competencies, suffering influences from health management training and previous individual experiences. The following categories emerged: Technical-scientific preparation in decision-making; Hierarchization of the decision-making process; and Autonomous professional practice. Conclusion: the absence/presence of a rigid hierarchy, as well as technical-scientific preparation and autonomy, are factors that limit or expand the range of possibilities in nurses' decision-making, with consequences in care management. Thus, discussions about this theme should be encouraged, in order to promote nurses' autonomy for decision-making and favor a reduction of bureaucracy in the processes that prevent/hinder advances in these services.

Resumen Objetivo: analizar los factores que influyen en el proceso de toma de decisiones de los enfermeros en hospitales universitarios iberoamericanos. Método: estudio de caso, con enfoque cualitativo, de tipo multicéntrico, realizado con 30 enfermeros iberoamericanos. Los datos fueron recolectados mediante entrevistas semiestructuradas, analizados por categorías temáticas e interpretados según el marco teórico de la obra Diseño de Organizaciones Eficientes. Resultados: se identificó que el proceso de toma de decisiones permea el desarrollo de las competencias de los enfermeros, se ve influenciado por la formación en gestión en salud y las experiencias individuales previas. Surgieron las siguientes categorías: Preparación técnico-científica en la toma de decisiones; Jerarquización del proceso de toma de decisiones; y Ejercicio profesional autónomo. Conclusión: la ausencia/presencia de una jerarquización rígida, así como la preparación técnico-científica y la autonomía son factores que limitan o amplían el abanico de posibilidades en la toma de decisiones de los enfermeros, que se reflejan en la gestión del cuidado. Por lo tanto, hay que incentivar las discusiones sobre este tema, con el fin de promover la autonomía de los enfermeros para la toma de decisiones y favorecer la reducción de la burocracia en los procesos que impiden/dificultan el avance de estos servicios.

Indicadores de gestión para evaluar el desempeño de hospitales públicos: un caso de estudio en Chile y Ecuador / Assessing the performance of public hospitals using key indicators: a case study in Chile and Ecuador

Background: Continuous improvement, quality of care, and patient satisfaction demand the implementation of coordinated actions from all the healthcare personnel. They also require collaboration, management skills and attention to different dimensions to improve problems due to the lack of resources such as specialists, medical technology and infrastructure. Aim: To design and implement a model of indicators to evaluate the performance of hospitals. Material and Methods: The methodology used in this research included a review of the literature, data collection, conducting interviews, defining objectives and indicators, proposing a model of indicators, validating the set of indicators, implementing the indicators in a hospital, and analyzing the results. Results: The proposed model of 95 indicators was implemented in a hospital in Ecuador. The results indicate that 37 indicators meet the standard, 19 need to be reviewed, 10 show non-compliance and need serious improvements, and the remaining 29 were not informed by the hospital under study. Conclusions: The defined indicators are aimed to improve the performance of a hospital, are easily interpreted, can be measured without spending large amounts of money, and do not need excessive efforts to collect data, mainly if they are supported by information systems.

An investigation on the resource status of mental health service organizations in Hangzhou / 预防医学

Objective To learn the current status of the resources of mental health organizations in Hangzhou,and to provide evidence for the government departments to formulate plans and to allocate mental health service resources reasonably.Methods The investigation was conducted by Hangzhou Mental Health Office,which compiled and issued "Hangzhou Mental Health Services Questionnaire",and reported by the District Mental Health Office.Data was statistically analyzed on mental health service organizations,beds,outpatient visits,hospitalization visits and spiritual practitioners in 2015.Results Totally 29 organizations,11 rehabilitation centers and 128 community occupation therapy institutions carried out mental health services,and 24 medical organizations and all the rehabilitation centers were located in the main city.A total of 3,079 beds in these organizations were recorded,that is to say,each 10,000 people own 3.54 beds with 3.86 beds per 10,000 people in the main city and 2.24 beds per 10,000 people in the disfrict.The bed utilization rate was over 80％.There were 467 psychiatrists (including the assistants) and 833 psychiatric nurses in Hangzhou,in other words,there were 5.37 psychiatrists and 9.57 psychiatric nurses serving every 100,000 people.The ratio of beds and personnel of the mental health service was 1:0.42.Conclusion The mental health service resources in the urban was better than the county,but the distribution of service resources among different areas was not balanced.Although the level of the density of beds,and the number of people practicing were high,that still can not meet the needs of society.

La inclusión laboral de personas con discapacidad: Un estudio etnográfico en cinco Comunidades Autónomas de España / The work inclusion of people with disabilities: an ethnographic study in five Autonomous Communities of Spain

Objetivo: describir y comprender las fortalezas, temores, percepciones y barreras que se presentan en el proceso de inclusión laboral de personas con discapacidad en cinco Comunidades Autónomas de España. Materiales y métodos: estudio cualitativo, abordado a través de técnicas como la observación participante, cuestionarios y entrevistas en profundidad, que buscaban identificar las fortalezas, motivaciones y temores que suscita el proceso de inserción laboral de las personas con discapacidad adscritas a un programa de inclusión laboral. Así, como, dar a conocer la percepción de los empresarios y los preparadores laborales sobre este proceso, y develar las barreras que debe sortear la población con discapacidad para obtener un empleo.La muestra estuvo constituida por 161 personas, de las cuales 80 pertenecían al colectivo de personas con discapacidad, 70 empresarios y 11 preparadores laborales.Resultados: a través del estudio, las personas con discapacidad o diversidad funcional fortalecieron competencias laborales y personales, lo que les permitió una mejora ostensiblemente en la posibilidad de empleabilidad. Pese a ello, el resultado fue de 0,01 de empleabilidad del colectivo en mención. Conclusiones: es complejo abordar y dar soluciones concretas en el proceso de inserción laboral de las personas con discapacidad, no obstante, la existencia de políticas europeas y españolas que estimulan e incentivan tanto a la empresa pública como privada, para contratar a estas personas. Incluso, se evidenció que a cambio de emplear a este colectivo, las empresas prefieren comprar productos elaborados por personas que trabajan en los Centros Especiales de Empleo, posiblemente por el desconocimiento sobre el proceso de inclusión laboral de este colectivo y además, la presencia constante de acciones y actitudes de discriminación hacia esta población...(AU)

Objective: to describe and understand the strengths, fears, perceptions and barriers that arise in the process of work integration of persons with disabilities in five autonomous regions of Spain. Methods: qualitative study, addressed through techniques such as participant observation, questionnaires and in-depth interviews, which to identify the strengths, motivations and fears aroused the process of job insertion for persons with disabilities assigned to a work program inclusion. And to publicize the perception of employers and job coaches on this process, and uncover the barriers to must overcome people with disabilities to obtain a job. The sample consisted of 161 people, of who 80 belonged to the group of persons with disabilities, 70 entrepreneurs and 11 job coaches. Results: through the study, people with disabilities or functional diversity strengthened labor and personal competencies, which allowed them an ostensibly improvement in the possibility of employability. In spite of this, the result was of 0.01 of employability of the collective in mention. Conclusions: it is complex to approach and give concrete solutions to the process of labor insertion of people with disabilities, despite the existence of European and Spanish policies that stimulate and encourage both public and private companies to hire these people. It was also pointed out that in exchange for employing this group, companies prefer to buy products made by people working in the Special Employment Centers, possibly because of the lack of knowledge about the labor inclusion process of this group and, moreover, the constant presence of Actions and attitudes of discrimination towards this population...(AU)

El trabajo emocional desde una perspectiva clarificadora tras treinta años de investigación / The Emotional Work from a Clarifying Perspective after Thirty Years of Research

El presente trabajo tiene como objetivo el análisis del concepto de "trabajo emocional". Específicamente, a través de un enfoque integrador, se pretende clarificar a qué hace referencia el trabajo emocional y diferenciarlo de conceptos con los que comúnmente se relaciona en la literatura existente. Además, se analiza una de las últimas propuestas sobre cómo se podría producir el trabajo emocional aplicado al contexto de las organizaciones de servicios. Por último, se analizan los antecedentes que la literatura señala como aspectos potenciales para la aparición del trabajo emocional y las consecuencias que éste puede ocasionar en los resultados organizacionales, como es la calidad de servicio y en la salud psicosocial de los trabajadores.

This paper aims to analyze the concept of Emotional Work. Specifically, through an integrated approach, it is intended to clarify what is Emotional Work and differentiate concepts that are commonly associated in the literature. Also, one of the latest proposals on how they could produce the Emotional Work applied to the context of service organizations is analyzed. Finally, the background literature identifies as potential issues for the appearance of emotional labor and the consequences it can have on organizational outcomes, such as quality of service and the psychosocial health of workers are analyzed.

An exploration of the PLA Medical Library Medical Information Service marketing model / 中华医学科研管理杂志

The article presents the contents of marketing of medical information services,explores the model of the marketing of medical information services suitable for the Medical Library of Chinese PLA,discusses the meaning of the marketing of medical information services,the status in this field in China and other countries,and the efforts we need to make next.The purpose is to match the information services to the information needs,support the innovation of medical science.

Práticas de enfermagem empreendedoras e autônomas / Autonomous and business practices in nursing / Prácticas de enfermería emprendedoras y autónomas

Estudo descritivo, com abordagem quantitativa, teve como objetivo caracterizar as práticas de enfermagem empreendedoras no Estado do Paraná. Foi realizada uma amostra intencional por convite a 11 enfermeiros com empreendimentos na área da saúde, os dados foram coletados por meio de questionário online. Os resultados apontam uma população adulta jovem; com prevalência feminina e experiências profissionais variadas. O interesse pelo empreendedorismo surgiu da busca pela satisfação profissional; a gestão de negócios foi destacada como habilidade necessária para empreender. Em relação às facilidades e dificuldades para abrir o próprio negócio, destaca-se o apoio de outros profissionais e as questões burocráticas; os participantes mostraram-se satisfeitos com seus empreendimentos. Conclui-se que a enfermagem tem caminhado e explorado um novo mercado, promovendo a profissão como capaz de conduzir sua prática de forma autônoma e inovadora.

This descriptive study with a quantitative approach aimed to characterize the business practices in nursing in the state of Paraná. An intentional sample was undertaken by invitation to 11 nurses with businesses in the health area, the data collected via an online questionnaire. The results point to a young adult population; with a predominance of females and with varying professional experience. The interest in entrepreneurship arose from the search for professional satisfaction; business management was emphasized as the skill necessary to run a business. In relation to the easy aspects and difficulties for opening one's own business, support from other professionals and bureaucratic issues stand out; the participants showed themselves to be satisfied with their businesses. It is concluded that nursing has sought and explored a new market, promoting the profession as able to conduct its practice autonomously and innovatively.

Estudio descriptivo, con abordaje cuantitativo que tuvo el objetivo de caracterizar las prácticas de enfermería emprendedoras en Estado de Paraná. Fue realizada una muestra intencional por invitación a 11 enfermeros con emprendimientos en área de salud. Los datos fueron recogidos por medio de cuestionario online. Los resultados apuntan una población adulta joven; con prevalencia femenina y experiencias profesionales variadas. El interés por el hecho de emprender surgió de la búsqueda por la satisfacción profesional; la gestión de negocios fue destacada como habilidad necesaria para emprender. Acerca de las facilidades y dificultades para abrir el propio negocio, se destaca el apoyo de otros profesionales y las cuestiones burocráticas; los participantes se mostraron satisfechos con sus emprendimientos. Se concluye que la enfermería viene caminando y explorando un nuevo mercado, promoviendo la profesión como capaz de conducir su práctica de forma autónoma e innovadora.

Impacto de diferentes estilos de liderazgo sobre el engagement y burnout: evidencia en una muestra de trabajadores argentinos / Impact of different leadership styles on work engagement and burnout: evidence from a sample of argentine workers

En el presente estudio se analizó la relación entre diferentes estilos de liderazgo basados en el modelo de liderazgo de rango completo y el engagement y burnout en una empresa de servicios de Córdoba, Argentina. Se aplicó el Cuestionario de liderazgo CELID-S, el MBI-GS y el UWES a una muestra de 125 trabajadores. Los resultados apoyan la idea de que el liderazgo transformacional y en menor medida el liderazgo transaccional afectan de manera positiva el engagement e inciden de manera negativa sobre el burnout, mientras que el estilo laissez faire presenta un patrón de relaciones opuestas. Análisis más específicos mediante métodos de regresión múltiple stepwise revelaron que la inspiración fue el factor del liderazgo transformacional que mejor predijo la dedicación y el vigor de los trabajadores, mientras que la estimulación intelectual fue el factor más relevante en la predicción de la absorción. Con respecto al burnout, los datos indicaron que el factor carisma fue el que mejor predijo, negativamente, el agotamiento y cinismo, en tanto que la consideración individualizada fue el factor que mayor contribuyó, negativamente, en la despersonalización. Se discuten las implicaciones de este estudio junto con sus limitaciones y se recomiendan futuras líneas de investigación.

In the present study the relationship between different leadership styles based on the model of full-range leadership and engagement and burnout in a service of Córdoba, Argentina is analyzed. Leadership Questionnaire CELID-S, the MBI-GS and UWES to a sample of 125 workers was applied. The results support the idea that transformational leadership and transactional leadership to a lesser extent positively affect the engagement and impact negatively on burnout, while the laissez faire style presents a pattern of opposite relationships. More specific analysis using stepwise multiple regression methods revealed that the inspiration was the factor that best predicted transformational leadership dedication and vigor of workers, while intellectual stimulation was the most important in predicting the absorption factor. In regard to burnout, the data indicated that charisma factor was best predicted negatively, exhaustion and cynicism, while individualized consideration was the biggest factor that contributed negatively, depersonalization. The implications of this study are discussed along with their limitations and future researchs are recommended.

Avaliação do perfil epidemiológico e das dificuldades encontradas pelos pacientes para o atendimento de primeira consulta no ambulatório de triagem da nefrologia da UNIFESP / Evaluation of profile epidemiologic and the found encountered by patients to the care o the first query in the ambulatory screening of Nephrology UNIFESP

INTRODUÇÃO: O objetivo deste estudo foi avaliar o perfil epidemiológico dos pacientes e das dificuldades dos pacientes encaminhados, pelas unidades básicas de saúde (UBS) ou outros hospitais, ao ambulatório de triagem da disciplina de Nefrologia do Hospital São Paulo (UNIFESP) para avaliação e tratamento de doenças renais. MÉTODOS: No período de fevereiro a setembro de 2009, foram avaliados 341 pacientes encaminhados das UBS da cidade de São Paulo e de outras localidades do País. RESULTADOS: Desses pacientes, 26% (86/341) necessitaram de novos exames para definição do diagnóstico por encaminhamentos duvidosos, incompletos, ou devido ao período de espera para a realização dos exames e o atendimento, que variou de uma semana até três anos. Parte deles não trouxe nenhum tipo de exame para essa avaliação, 12% (45/341) retornaram para acompanhamento na própria unidade local, 13% (46/341) foram encaminhados para local de tratamento mais próximo de sua residência, 47% (164/341) para nosso ambulatório de subespecialidades: 24% (82/341) uremia, 8% (27/341) rins policísticos, 7% (23/341) hipertensão, 4% (16/341) litíase renal e 4% (16/341) nefrites. CONCLUSÃO: Nossos resultados sugerem investimentos em infraestrutura na capacitação dos funcionários das UBS e do HSP, reorganização das centrais de referências para melhor gerenciamento e encaminhamentos dos pacientes, humanização no atendimento e capacitação dos profissionais de saúde para o atendimento ambulatorial nas UBS, particularmente naqueles com diabetes mellitus e hipertensão arterial, que podem levar ao desenvolvimento da doença renal crônica (DRC).

INTRODUCTION: The aim of this study was to evaluate the epidemiologic profile of patients and difficulties of patients referred by basic health units (UBS) or other hospitals, outpatient screening of the Division of Nephrology, Hospital São Paulo (UNIFESP) for evaluation and treatment kidney disease. METHODS: From February to September 2009, has been evaluated 341 patients referred from UBS in São Paulo and other parts of the Country. RESULTS: Of these patients, 26% (86/341) required for new tests to confirm the diagnosis doubtful for referrals, incomplete, or because of the waiting period for the care and exams, which ranged from one week to three years, and part of them did not bring any kind of examination for the evaluation, 12% (45/341) returned for follow-up at the unit location, 13% (46/341) were referred for treatment site closest to their residence, 47% (164/341) for our sub-specialty Clinics of Nephrology (HSP): 24% (82/341) uremia, 8% (27/341) with polycystic kidney disease, 7% (23/341) for hypertension, 4% (16/341) renal Lithiasis and 4% (16/341) nephritis. CONCLUSION: Our results suggest investments investment in infrastructure in the training of officials of UBS and HSP, reorganization of central references for better management and referral of patients, humanization of care and training of health professionals for outpatient care at UBS in preventive work and basic monitoring of patients, particularly those with diabetes mellitus and hypertension, which can lead to the development of chronic kidney disease (CKD).

Cultura y eficacia: el papel de la orientación cultural para el aprendizaje en la determinación de la eficacia del grupo/equipo / Culture and effectiveness: the role of cultural orientation for learning in determining the effectiveness of the group/team

En la medida en que los grupos van asumiendo cada vez mayor importancia en el seno de las organizaciones, surge, también, la necesidad de examinar las variables que interfieren con la eficacia de los mismos. El presente estudio tuvo como objetivo analizar el impacto que la orientación cultural para el aprendizaje tiene en la eficacia del grupo, en lo que concierne a las dimensiones socioafectivas y tarea. Para lograr este objetivo se llevó a cabo una investigación empírica de la naturaleza correlativa, centrada en nivel delgrupo, sostenida por el recurso a tres instrumentos: la OCA (Orientación Cultural para el Aprendizaje) (Rebelo 2001), la ESAG (Escala de Satisfacción del Grupo) (Dimas 2007), y la EEDG (Escala de Evaluación del Desempeño del Grupo) (Dimas 2007). La muestra utilizada estuvo constituida de 73 equipos de trabajo, los cuales, en gran parte, ejercían funciones de alta complejidad, en organizaciones industriales o de servicios. El análisis de los datos, realizado a través de la Regresión Lineal Múltiple, refuerza un concepto ampliamente presente en la literatura: la orientación cultural para el aprendizaje se refleja en ganancias significativas para los individuos y para los grupos (a nivel de los resultados de rendimiento y, también, relativamente a los niveles de satisfacción).

As groups are assuming increasing importance within organizations also there arises the need to examine the variables that interfere with their effectiveness. The purpose of this study was to analyze the impact that cultural orientation for learning has on the effectiveness of the group with regard to socio-affective dimensions and task. To achieve this objective an empirical correlative research was conducted, focused on the group level, supported by the use of three instruments: the OCA (Cultural Orientation for Learning) [ Rebelo 2001] the ESAG (Group Satisfaction Scale) [Dimas 2007] and EEDG (Evaluation Scale of Group Performance) [Dimas 2007]. The sample was made up of 73 teams, which in large part, exercised functions of high complexity in industrial or services organizations. The data analysis conducted by Multiple Linear Regression reinforces a concept widely present in literature: the cultural orientation for learning is reflected in significant gains for individuals and for groups (at performance results level and also in relation to the level of satisfaction).