O percurso construtivo do enfermeiro gestor: uma teoria fundamentada nos dados / The constructive path of the manager nurse: a grounded theory

RESUMO Objetivo compreender como os enfermeiros vivenciam o planejamento da sucessão na gestão. Métodos estudo qualitativo assente na teoria fundamentada nos dados como referencial teórico e metodológico, com uma amostra de 20 enfermeiros. A coleta dos dados foi efetuada por entrevista e análise de conteúdo, e do processo de codificação emergiu o modelo conceitual. Resultados verificou-se que o planejamento da sucessão é um processo implementado informalmente no diagnóstico dos enfermeiros gestores, mas persistem algumas lacunas na sistematização do processo. Os concursos, o perfil de liderança e a experiência assumem destaque no diagnóstico, e a experiência casual em gestão é relevante na preparação dos enfermeiros gestores. Apesar da sua necessidade, subsistem entraves como a resistência dos gestores, a rotatividade dos conselhos de administração hospitalares e a pandemia da COVID-19. Conclusão os enfermeiros destacam muitos benefícios com o planejamento da sucessão, mas identificam obstáculos à sua implementação, o que contribui para a relutância na participação ativa dos enfermeiros gestores. Contribuições para a prática o modelo conceitual teórico pode contribuir para a mudança e a estruturação sistemática do percurso construtivo dos enfermeiros gestores e permite identificar as condições promotoras e limitantes no diagnóstico, formação e desenvolvimento destes profissionais.

ABSTRACT Objective to understand how nurses experience the succession planning of manager nurses. Methods qualitative study using grounded theory as a theoretical and methodological reference, with a sample of 20 nurses. Data collection took place through interviews, content analysis, and the conceptual model originated from the coding process. Results the process of succession planning is informally implemented in the diagnosis of head nurses, but there are some gaps in the systematization of the process. The selection processes, the leadership profile, and experience stand out in the diagnosis, and a casual experience in management is relevant for the preparation of head nurses. Although this is necessary, there are still obstacles, such as the resistance of managers, the turnover of hospital administration councils, and the COVID-19 pandemic. Conclusion nurses interviewed highlighted many benefits from the planning of succession, but find obstacles to its implementation, which contributes to the reluctance of head nurses to actively participate. Contributions to practice the theoretical-conceptual model can contribute to change and systematically structure the constructive path of manager nurses, allowing the identification of conditions that promote or limit the diagnosis, education, and development of these professionals.

The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: Results of a multicenter randomized controlled trial (ERIC-HF study).

OBJECTIVE: To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. DESIGN: A randomized controlled clinical trial with follow-up at discharge. SETTINGS: Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. GROUP ASSIGNMENTS: Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). MAIN OUTCOME: Functional exercise tolerance was measured with a 6-min walking test at discharge. RESULTS: In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). CONCLUSION: The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.