A qualidade dos cuidados de enfermagem e a Norma ISO 9001 : Aplicação empírica no Hospital CUF Infante Santo

A preocupação com a qualidade e normalização dos serviços de saúde é cada vez maior, verificando-se que, para responder às progressivas exigências dos utentes, aparecem entidades que criam normas universais, as quais pretendem a garantia da qualidade nos serviços de saúde. Contudo, a implementação de um sistema de gestão da qualidade, através da norma ISO 9001, nestas organizações, é um desafio pela dificuldade de avaliação da qualidade dos serviços prestados- cuidados de saúde. Estando presente num hospital profissional como médicos, enfermeiros e gestores, com características culturais que influenciam a forma de encarar a qualidade e a sua monitorização para a existência de uma mudança profunda, quando se implementa uma política de qualidade, é fundamental conhecer a definição da qualidade de cada profissional, membro de uma cultura e, deste modo, a sua postura perante o fenómeno. O presente trabalho tem como objectivos identificar a percepção dos enfermeiros do Hospital Cuf Infante-Santo, relativamente ao sistema de gestão da qualidade, segundo a norma ISO, e, consequentemente, investigar pontos fortes, pontos fracos, ameaças e oportunidades da implementação dessa norma nessa organização hospitalar. Para atingir os objectivos, foi desenvolvido um modelo de análise, onde se considera o relacionamento entre as características da qualidade em saúde, cultura organizacional hospitalar e do sistema da norma ISO, para o desenvolvimento da melhoria contínua na organização. Os dados, para a elaboração desta dissertação, foram recolhidos através de inquérito por questionários aos enfermeiros do Hospital Cuf Infante-Santo, que se encontravam a laborar na organização aquando da implementação da norma ISO, sendo utilizado o método quantitativo e técnicas do estudo qualitativo na análise de dados orientados para o significado das acções. Do trabalho desenvolvido, conclui-se que a percepção relativamente às alterações na qualidade dos cuidados está limitada pelo facto de a maioria dos respondentes não conhecer o sistema de qualidade (Norma ISO 9001), sendo este um dos pontos fracos para a implementação da norma ISO na organização. Deste modo, a situação diagnosticada constitui um alerta para as organizações de saúde, ao implementarem sistemas de gestão da qualidade, potencializarem os pontos fortes identificados, como a orientação dos enfermeiros para o cuidar e para o cliente e, por outro lado, evitar repetir pontos fracos, como o identificado anteriormente, através do envolvimento e formação dos seus colaboradores nas políticas da qualidade. Os enfermeiros preocupam-se com a qualidade, mas referem que não a monitorizam regularmente. Pelo que, esta necessidade com a implementação do sistema de gestão da qualidade, deverá ser corrigida, de modo a que a organização de saúde em estudo caminhe para a excelência. ABSTRACT: The concern with the quality and standardization of health services is increasing, verifying that to respond to the progressiva demands of the users, there appear entities wishing to create universal standards to ensure the quality in health services. However, implementing a quality management service, through ISO 9001 standard, in these organizations, it is a challenge by the difficulties of evaluation in the quality of the provided services - health care. Being present in a hospital professionals such as doctors, nurses and managers, with cultural characteristics that influence the way and method of facing the quality and its monitoring for the existence of a profound change, when a quality policy is implemented, it is fundamental to know the definition of the quality of each and ever professional, member of a culture, and in this way, their posture towards the phenomenon. This present study aims to identify the perceptions of nurses at the Infante-Santo CUF Hospital, relatively to the quality management system, according to the ISO standard, and consequently, investigating strengths, weaknesses, threats and opportunities of the implementation of this standard in that hospital organization. To achieve these aims or objectives, an analysis model was developed, which considers the relationship between the characteristics of the quality of health, hospital organizational culture and the ISO standard system, for the further development of the continuous improvement in the organization. The data for the elaboration of this dissertation was collected through questionnaire surveys done to the nurses at Infante-Santo CUF Hospital, who were working in the organization during the ISO standard implementation, being used the quantity method and techniques of the quality study in the analysis of data orientated to the meaning of actions. The developed research concluded that the perception related to the alterations in the quality of the care is limited by the majority of respondents not knowing the quality system (ISO 9001 standard), being this one of the weaknesses to the implementation of the ISO standard in the organization. Therefore, the diagnosed situation constituted a warning to the health organizations, to implement quality management systems, potentially the identified strengths, such as the orientation of the nurses to the care and to the client, and on the other hand, avoiding the repetition of weaknesses, as previously identified, through the involvement and training of its employees in the quality policies. The nurses are concerned about the quality but they refer that there is no regular monitoring. Thus, this necessity of the implementation of the quality and management system should be corrected, so that the health organization being studied should proceed to excellence.

Knightly Masculinity, Court Games and Material Culture in Late Medieval Portugal: The case of Constable Afonso (c. 1480–1504)

This article explores the ways in which gender was used in order to transform an exiled and uneducated illegitimate child into a prince. Our study revolves around a member of the royal family, Afonso (c.1480–1504), who was brought up in hiding by peasants and who later, as a teenager, was reincorporated into the court. We argue that the keys to this process of rehabilitation were, on one hand, family politics centred around different configurations and on the other, his introduction into a court environment marked by the ideals of chivalry. Within this dynamic, material culture played a key role, because it gave the prince all the visual attributes of his new status, as well as allowing him the means to create a new self. We shall briefly introduce Afonso and his family context in order to give an insight into his life within changing political and dynastic contexts. Then, we will analyse the expression of manhood in the Portuguese court, using the spectacles at the court as a basis for observation, thus relating gender to material culture in a courtly environment.

Effects of pitch area-restrictions on tactical behavior, physical and physiological performances in soccer large-sided games

The aim of this study was to identify how pitch area-restrictions affects the tactical behavior, physical and physiological performances of players during soccer large-sided games. A 10 vs. 9 large-sided game was performed under three experimental conditions: (i) restricted-spacing, the pitch was divided into specific areas where players were assigned and they should not leave it; (ii) contiguous-spacing, the pitch was divided into specific areas where the players were only allowed to move to a neighboring one; (iii) free-spacing, the players had no restrictions in space occupation. The positional data were used to compute players’ spatial exploration index and also the distance, coefficient of variation, approximate entropy and frequency of near-in-phase displacements synchronization of players’ dyads formed by the outfield teammates. Players’ physical and physiological performances were assessed by the distance covered at different speed categories, game pace and heart rate. Most likely higher values were found in players’ spatial exploration index under free-spacing conditions. The synchronization between dyads’ displacements showed higher values for contiguous-spacing and free-spacing conditions. In contrast, for the jogging and running intensity zones, restricted-spacing demanded a moderate effect and most likely decrease compared to other scenarios (~20-50% to jogging and ~60-90% to running). Overall, the effects of limiting players’ spatial exploration greatly impaired the co-adaptation between teammates’ positioning while decreasing the physical and physiological performances. These results allow for a better understanding of players’ decision-making process according to specific task rules and can be relevant to enrich practice task design, such that coaches acknowledge the differential effect by using specific pitch-position areas restrictions.