Atividades profissionais da enfermagem no contexto hospitalar: influências nas relações de trabalho

The present study is based on an analysis of professional work relationships in the nursing team from the task/skills of its members as a contribution to understanding the work process in nursing. It is aimed to identify the skills of the nursing team members through the vision of nurses, technicians and nursing assistants, thus it attempts to find strategies to improve the health assistance to patients. It is a descriptive and analytical study with a qualitative approach grounded in theoretical and methodological framework of Symbolic Interactionism. The research was carried out in the participant work place, a Public Hospital of Reference for the SUS, located in the eastern health district of Natal/RN. Nineteen nursing professionals participated in the study, which seven was nurse and twelve nursing technician. As procedure to collect data we used an unstructured interview accompanied by a standard topic guide which was recorded and later transcribed. The content analysis was chosen as the main methodology to analyze the discussion, which gave rise to thematic categories that were considered relevant based on the theoretical framework of this study, and the interactionist theory. This study was in accordance with the ethical principles of the Resolution nº. 196/96, it has obtained an appropriate consent of the UFRN Research Ethics Committee. The results indicate that the professionals seen the nursing as a profession strongly attached to the health care process and as a profession that acquired a scientific status very recently. Regarding to the nursing functions in the work process in nursing, the professionals they identified the manage/administer category as the main activities developed by these professionals, thus the education and complex care in nursing categories. Concerning to the technicians and nursing assistants functions, it was figured out in the professional s opinion that there is not distinction among the attribution of these categories. The interviewed were unanimous in report that these professionals are more involved in direct patient health care through performance of basic duties in nursing care. Finally, with regard to the work relationship among nursing team members, the majority of those interviewed see this relationship as disharmony and quarrelsome and in general, there is not bond between categories that comprise the process of work in nursing. On the basis of our results we consider the importance of knowing the meaning of nursing given by these professionals; also their skills could be useful as basis to identify problems, which source could be detected in the power relationship, deviations of functions, gap between design (knowledge) and performance (doing) work, besides the loss of the global activities view in the process of nursing work

Viabilidade do processo de enfermagem no contexto hospitalar

The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others.

Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Trauma em idosos atendidos pelo serviço pré-hospitalar móvel

O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (α> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events

Balanced scorecard como ferramenta de gestão aplicada a unidade hospitalar privada

In this study the objective is to implant Balanced Scorecard administration for the development of a Strategic Map, for the support of the electric outlet of decisions in the administration of operations of an unit of attendance doctor-hospitalar. The present work presents a case study developed at a private hospital in the State of Rio Grande do Norte. The collection of data was developed after the analysis of the revision of the literature, and he/she had as critical judgement of evaluation used by the following Unit. The work is concluded in the proposition of a strategic map that elevates the return on investment (financial perspective), in the item profitability and growth. In the search of the customer's satisfaction (customer's perspective), that is nothing else than it already exists inside of the Unit in study, just needing to be organized and aligned with the executive picture and the other collaborators. The requirements competitiveness, information, innovation and technology (perspective of the internal processes), they were indispensable to eliminate the re-work, waste and to improve the automation. It is finally, the investment and development of innovation mechanisms, they enlarge important competitive advantage in the processes for creation of value, through the ability, attitude and knowledge (perspective of the learning and growth). As one of the results of this study a strategic map was developed, looked for in Balanced Scorecard, for support in the electric outlet of decisions of the administration of operations of an Unit Doctor- Healthcare

Protocolo multiciclos para automação hospitalar sobre Multicast com IEEE 802.3 utilizando

The concepts of the industrial automation are being incorporated in the medical area, in other words, they also pass to be applied in the hospital automation. In this sense, researches have been developed and have usually been approached several of the problems that are pertinent to the processes that can be automated in the hospital environment. Considering that in the automation processes, an imperative factor is the communication, because the systems are usually distributed, the network for data transference becomes itself an important point in these processes. Because this network should be capable to provide the exchange of data and to guarantee the demands that are imposed by the automation process. In this context, this doctorate thesis proposed, specified, analyzed and validated the Multicycles Protocol for Hospital Automation (MP-HA), which is customized to assist the demands in these automation processes, seeking to guarantee the determinism in the communications and to optimize the factor of use of the mean of transmission

WI-BIO: redes de monitoramento de pacientes em ambientes de automação hospitalar utilizando o padrão IEEE 802.11

The monitoring of patients performed in hospitals is usually done either in a manual or semiautomated way, where the members of the healthcare team must constantly visit the patients to ascertain the health condition in which they are. The adoption of this procedure, however, compromises the quality of the monitoring conducted since the shortage of physical and human resources in hospitals tends to overwhelm members of the healthcare team, preventing them from moving to patients with adequate frequency. Given this, many existing works in the literature specify alternatives aimed at improving this monitoring through the use of wireless networks. In these works, the network is only intended for data traffic generated by medical sensors and there is no possibility of it being allocated for the transmission of data from applications present in existing user stations in the hospital. However, in the case of hospital automation environments, this aspect is a negative point, considering that the data generated in such applications can be directly related to the patient monitoring conducted. Thus, this thesis defines Wi-Bio as a communication protocol aimed at the establishment of IEEE 802.11 networks for patient monitoring, capable of enabling the harmonious coexistence among the traffic generated by medical sensors and user stations. The formal specification and verification of Wi-Bio were made through the design and analysis of Petri net models. Its validation was performed through simulations with the Network Simulator 2 (NS2) tool. The simulations of NS2 were designed to portray a real patient monitoring environment corresponding to a floor of the nursing wards sector of the University Hospital Onofre Lopes (HUOL), located at Natal, Rio Grande do Norte. Moreover, in order to verify the feasibility of Wi-Bio in terms of wireless networks standards prevailing in the market, the testing scenario was also simulated under a perspective in which the network elements used the HCCA access mechanism described in the IEEE 802.11e amendment. The results confirmed the validity of the designed Petri nets and showed that Wi-Bio, in addition to presenting a superior performance compared to HCCA on most items analyzed, was also able to promote efficient integration between the data generated by medical sensors and user applications on the same wireless network

Modelagem aplicada à análise de desempenho do provedor de serviços de uma rede de automação hospitalar ieee 802.3/pm-ah de tempo real

The incorporate of industrial automation in the medical are requires mechanisms to safety and efficient establishment of communication between biomedical devices. One solution to this problem is the MP-HA (Multicycles Protocol to Hospital Automation) that down a segmented network by beds coordinated by an element called Service Provider. The goal of this work is to model this Service Provider and to do performance analysis of the activities executed by in establishment and maintenance of hospital networks

Registros de ordens e ocorrências: uma prática de letramento no trabalho da enfermagem hospitalar

Nursing documentation is a literacy practice which is regulated by law. Among the written practices of the literacy field, nursing registration is understood as the attendance resume of the main problems and occurrences on duty. In other words it is a document and a communication instrument used by hospital orderly on duty. It s main goal is to keep a record of the information which is necessary to the continuity of the activities as well as to the assistance to the patients. Taking into consideration the complexity of this kind of literacy practice, this study which took place in a hospital context, aims at studying the nursing registration process in order to explain its implementation in the nursing field. The discussion is situated in the area of applied linguistics, and it makes a linkage between linguistics approaches and language questions which are related to the area of discourse at work. The theoretical foundations come from contemporary literacy studies such as Hamilton (2000) who proposes the following categories: participants, domain, artifacts and activities. The analysis was guided by the principles of the ethnographic methodology which proposes that the researcher spends much time in the field and uses a set of techniques in order to collect data related to the subjects speech as well as their deeds concerning the research main object. The data were collected through field observations, analysis of 100 nursing records, 04 reflective sessions and interviews as well involving 36 nurses. On one hand, the analysis reveals the importance of the nursing records in terms of documentation and communication. On the other hand, it shows informational, compositional as well as normative difficulties in terms of linguistics and legal aspects. For, we conclude that these questions need to be addressed through the process of intervention especially in events of teacher in service activities so that the professional nurses may improve their practice in relation to the elaboration of the nursing documentation on duty

Gestão de estoques: uma proposta de reposição contínua para material médico hospitalar e medicamentos em um hospital universitário federal do estado do Rio Grande do Norte

The inventory management in hospitals is of paramount importance, since the supply materials and drugs interruption can cause irreparable damage to human lives while excess inventories involves immobilization of capital. Hospitals should use techniques of inventory management to perform replenishment in shorter and shorter intervals, in order to reduce inventories and fixed assets and meet citizens requirements properly. The inventory management can be an even bigger problem for public hospitals, which have restrictions on the use of resources and decisionmaking structure more bureaucratized. Currently the University Hospital Onofre Lopes (HUOL) uses a periodic replacement policy for hospital medical supplies and medicines, which involves one moment surplus stock replenishment, the next out of stock items. This study aims to propose a system for continuous replenishment through order point for inventory of medical supplies and medicines to the hospital HUOL. Therefore, a literature review of Federal University Hospitals Management, Logistics, Inventory Management and Replenishment System in Hospitals was performed, emphasizing the demand forecast, classification or ABC curve and order point system. And also, policies of inventory management and the current proposal were described, dealing with profile of the mentioned institution, the current policy of inventory management and simulation for continuous replenishment order point. For the simulation, the sample consisted of 102 and 44 items of medical and hospital drugs, respectively, selected using the ABC classification of inventory, prioritizing items of Class A, which contains the most relevant items in added value, representing 80 % of the financial value in 2012 fiscal year. Considering that it is a public organization, subject to the laws, we performed two simulations: the first, following the signs for inventory management of Instruction No. 205 (IN 205 ), from Secretary of Public Administration of the Presidency ( SEDAP / PR ), and the second, based on the literature specializing in inventory management hospital. The results of two simulations were compared to the current policy of replenishment system. Among these results are: an indication that the system for continuous replenishment reorder point based on IN 205 provides lower levels of safety stock and maximum stock, enables a 17% reduction in the amount spent for the full replenishment of inventories, in other words, decreasing capital assets, as well as reduction in stock quantity, also the simulation made from the literature has indicated parameters that prevent the application of this technique to all items of the sample. Hence, a change in inventory management of HUOL, with the application of the continuous replenishment according to IN 205, provides a significant reduction in acquisition costs of medical and hospital medicine

Humanização hospitalar, ambiente físico e relações assistenciais :a percepção de arquitetos especialistas

The creation of the Humanization Program of Hospital Care and the increasing number of academic works and journal articles that discuss more humane practices in the health care services express the emphasis given to the theme in Brazil. In these discussions, however, it is not usual to find reference to architecture as a relevant factor in the humanization of hospitals, even though it is known that the physical structure of the building may help the recovering of the patients; elements such as gardens, the use of colors and open spaces may soften the impact caused by the hospital routine on patients. Considering the contribution the architectural project may bring to the humanization of hospitals, the aim of this study was to verify how the architects perceive the hospital humanization process. Besides having searched for subsides in informal interviews with health professionals, in visits to hospitals and in related seminars, the study was based on semi-structured interviews with architects of Natal, Rio Grande do Norte, who are specialists in this kind of projects. The content analysis of the interviews showed that physical space and attendance are essential to the humanization process. Those professionals see two humanization tendencies: while private hospitals have the structural physical appearance considered as humanized, public hospitals emphasize the humanization in attendance, fact that illustrates the contradictions in Brazilian health system. The interviewees consider the post-occupancy evaluation of the building as a learning exercise that contributes to new projects, but surprisingly they do not mention the patients opinion as part of it. Two annoying facts have emerged from the interviews, as also seen in preliminary stages of the study: rare are the works that focus on the person-environment relationship, and the definition of humanized hospital environments is still broad and inaccurate. This suggests the need of new studies in order to better understand how the two factors shown in this study attendance and physical space interact towards a true hospital humanization

Processo de trabalho em saúde: uma análise das condições de trabalho dos assistentes sociais no âmbito hospitalar

This paper presents the survey results: PROCEDURE FOR WORK IN HEALTH: an analysis of working conditions of social workers in hospitals. Analyzes the inclusion of social workers in work processes in healthcare, specifically in the public hospital, from the objective conditions of work, according to which materializes professional action. The aim is to understand them from the point of view of its relationship with users and other health professionals through the privatization of health, which prevents the Unified Health System (SUS), limiting the operation of the services and the guarantee of rights. The approach to the reality studied was through theoretical and methodological procedures based on the qualitative and quantitative research, focusing on documentary research, observation, semi-structured interview and the theoretical foundation. It is observed that the inclusion of social workers in this context arises from the demands derived from expressions of social issues, "raw material" of professional work, and the gaps resulting from contradictions in the process of rationalization / reorganization of the SUS, meaning that the needs the population are confronted with the content and form of organization of services. At the hospital, the professional actions are developed through the shift, space contradictory clash between the collective and individual, in which individual activities are prioritized and ad hoc unplanned and reduced to the solution of "problems" of users, through actions assistance in an emergency and bureaucratic. These findings emphasize the inadequacy of space and lack of minimum conditions of service to users, which undertakes the professional with regard to ethical and political principles of the profession, since it is the responsibility and duty of the social guarantee the secrecy and privacy of users what is revealed during the process of professional intervention. The professional social workers is permeated by the diversity of skills and competence; lack of planning activities, by incorporating the institutional discourse at the expense of professional goals, by knowing the Code of Professional Ethics, for small number of professionals, the increasing number informality; by poor working conditions and wages; by discouraging research and participation in social policy councils, as well as professional training

O trabalho dos assistentes sociais no âmbito hospitalar: as particularidades da sua inserção no Hospital Universitário Onofre Lopes (HUOL), em Natal/RN/

This study aimed to analyze the work of social workers at the Hospital Universitário Onofre Lopes (HUOL), with the analytical approach the contracting process with the HUOL with the National Health System (SUS), which is set from 2004. Thus, this study sought in times of state reform, restructuring and tension between enlargement / reduction of social and labor rights, understanding the limits and possibilities of social work in HUOL, analyzing how these determinations bounce in the practice of social workers included in the collective process of health work. From a theoretical and methodological historical and dialectical materialism, we conducted literature search, in which developed book report and readings of texts, articles, books that focus on the central categories of the study, namely: Work, Social Work, Health, Health Reform , Project ethical and professional politician. Operationalized also a documentary research, on the Brazilian Public Health Policy, (SUS) and of the Education, as well as research field in which we conducted interviews with 11 social workers, employees packed the HUOL. We conclude that social workers did not participate in the discussion process of contracting the HUOL with the Municipal Health Secretariat of Natal, RN, manager of health and full resetting of user access, via reference setting - counter-referral services provided by the hospital brought the main demands on Social Work guidance regarding the functionality of SUS, and the social intervention in the struggle to guarantee such access. However, the data show that the expansion of demands that require the intervention of the social worker at HUOL is not associated with quantitative growth of these professionals need. Such conditions inflect the possibilities of materialization of the professional ethical-political project, even though that these professionals worry and seek the intellectual improvement, quality of service and to guarantee the social rights of users in the professional practice everyday

Atividade de formação interprofissional em urgência pré-hospitalar

To acting in emergencies it is important that health professionals develop specific and differentiated skills, which shows us the importance of training in emergency planning. So undergraduate courses in medicine and nursing should encourage the development of these skills and evaluate them through various instruments targeted to the different fields. The aim of this study was to implement an optional and interprofessional curricular component, focusing on interprofessional education in pre-hospital emergency for medical and nursing courses Federal University of Rio Grande do Norte (UFRN). This is an exploratory descriptive study, with 24 medical and nursing graduates of last year undergraduate of supervised training, who underwent theoretical and practical training in the care of pre-hospital emergency services. There were theoretical and practical lessons per week for one school semester, taught by doctors and nurses of the Emergency Medical Service (EMS), where the topics discussed were: basic and advanced life support, safe transport in clinical emergencies, trauma, gynecological, obstetric, pediatric and psychiatric diseases, and have been carried out practical activities in ambulances. The students were evaluated by pre-test, post-test and practical stations made through the Objective Structured Clinical Evaluation (OSCE), in the skills laboratory of the Health Sciences Center. During the activities the students were encouraged to critical and reflective thinking, highlighting the importance of integration between the various health care professionals. It was observed that 88% of the students had a score increase over the pre-test. In the evaluation process carried out by medical students and nursing UFRN have similar expectations regarding the essential skills acquired during the training activity. The results of this study will form the basis for the organization of interprofessional education activity in pre-hospital emergency medical students and nursing, as well as helped to organize practices stations, identifying basic clinical skills, and implementing student assessment tools UFRN.

Avaliação dos impactos do uso do sistema de gestão hospitalar no Hospital Universitário Onofre Lopes

The object of this study was motivated by the need to know the possible causes of differences in results achieved in the implementation of a Computerised Management System (CMS) in a Federal University Hospital, located in northeastern Brazil, to understand the factors that influenced the results in different groups when was used the same systems implementation methodologies. Considering the implication of managers, health professionals, other professionals involved and the existing organizational structure in the period when implantation occurred, aimed to know the perception of these people about the development of CMS in the deployment process in your group or sector and also in the organization.The methodology used in this study was the content analysis which provides a rich set of methodological tools for evaluating speeches,enabling us to discourse from the unknown analysis and subjectivity, but with scientific rigor, allowing, at the end, to understand the disparity in results in the implementation of CMS.It was used as a research tool, a semi-structured interview, which exploits a qualitative approach, as suggested by the authors. It was used the approach of the episodic interview, to be more narrative about the experiences of the interview participants in their practical experience along the CMS deployment process in the hospital.Were interviewed three groups of professional and a group of managers, all with higher education in their professions and who participated in the entire implementation process from the beginning.It followed the Bardin's methodology (2009) in all the phases of treatment and interpretation of data, where emerged three categories: the "Thought and Knowledge"; the "Practices and Changes"; the "Obtained Results". From the category "Thought and Knowledge"emerged three subcategories: the "Administrative", the "Institutional" and the "IT Knowledge". From the category "Practices and Changes" emerged three subcategories: "Reality Prior to CMS"; "The IT Project and the implementation of CMS" and "Impacts of the CMS Implementation". From the category "Results Obtained" emerged three subcategories: "Benefits Promoted by CMS", "Dissatisfaction Observed" and "Level of Use and Understanding CMS ". It was observed that the lack of integration of the sectors was a determinant problem in the implementation of CMS. The CMS implementation project was not well dimensioned and divulged in the institution. Different models of leaderships and of objectives of the sectors influenced in the course of the CMS implementation process. We can mention that an CMS should be a consolidation of organizational practices tool already institutionalized and of integration amongthe sectors and not supporting to isolated practices and personalistsfrom sectors of the institution.