O processo de trabalho e a composição técnica do trabalho do enfermeiro no cuidado à saúde da criança em unidades de saúde da familia

With the trajectory that the problems related to child health are taking in our society, particularly with regard to infant mortality, beyond the process of decentralization of health and the implementation of the Family Health Strategy in the cities, where it has increased considerably performance of nursing staff in Primary Health Care, they can be considered essential factors for reflections on the care of nurse dispenses the health of these children. In order to check how it is organized the working process of the nurse in caring for these children in USFs as well as the difficulties found in the dynamics of this work, this research aimed to analyze the work processes of nurses in care Child Health in USFs, with emphasis on technologies used in producing care. This is a research exploratory and descriptive with qualitative approach, based on the theoretical reference in about Work Process and Composition Technique of Work. The data were collected through semi-structured interviews of 11 nurses who, at the moment, perform their functions for more than 01 year at USF. The guiding questions were based at theoretical reference. To analyze the results, was used the referential of content analysis, and was refer to thematic analysis. In situations that were involved closed questions of the interview, was used the aid of SPSS 15.0 program for Windows. The results indicated that the process of nurse work in health care of children, focuses on the preventive character, whose focus of the actions are healthy children, following the routines and protocols established by the Ministry of Health with a view to maintaining health them. When analyzing the data through theoretical references of Composition Technique of Work found that the core technologies of daily tasks of the nurse are directed for the use of technology soft-hard and hard, and the reason established between the Dead Working and Alive Working, there is prevalence of the first against the second in the production of this care. These situations contribute to the explanation of the emergence problems related to adhesion of mothers / caregivers to monitoring the CD, due to character prescriptive and normalizer of actions. The results also suggested the presence of "vanishing lines" in the make of nurses, confirming the self-governance of health professionals in daily work. These "vanishing lines" express the own execution of the Work Live in action, guided by the use of soft technologies, however, was not characterized as a process of technology transition. So, to get a better resolution to the problems related to child health, the nurse has reorganize your work process by focusing on the execution of work live in action.

Gestão estratégica no terceiro setor: uma análise comparativa da construção de mapas estratégicos de organizações sem fins lucrativos

The strategy has an important role in organizations by identifying factors that need to be emphasized to organizational success and strategic map currently contemplates as a preview of organizational strategy, prepared from your planning. Third sector organizations need to take a competitive posture, establishing a sustainable position and maximizing the use of resources towards their social or humanitarian goals. This research aims to investigate the process of building strategic maps of two non-profit organizations by identifying and characterizing the steps common to these organizations. The research is characterized as qualitative descriptive and applied knowledge. Developed from bibliographical reviews and participant observation gathered in a case study, the data was collected in two third sector organizations and the results show that how to conduct the process may influence directly on your result lists. Among the steps identified, emphasis can be given to the formation of a team, the definition of strategy, the definition of strategic objectives, the gathering of those goals into perspective and the identification of the cause-effect relationship that relate. Marked as optional, but effective, conducting an event outside the premises of the company to complete the process, or any portion thereof. However, stands out as essential the active participation of senior management in the process, as a way to give credit to the initiative. These steps, its characteristics and its factors are described from comparisons between the processes adopted by the organizations surveyed

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

Maturidade em gerenciamento de projetos no contexto da gestão estratégica no setor público: análise na Secretaria de Estado da Tributação do Rio Grande do Norte

This paperwork attempts to measure the project management maturity in the State Department of Taxation in Rio Grande do Norte. Project management has shown to be a critical component to any organization success, as the projects are directly related to a set of activities resulting into organizational innovations such as products, services and processes; and its improvement is directly aligned with the strategic management. Methodologically, this paperwork uses both a quantitative and qualitative approach that will be applied to the coordinators, sub-coordinators, and directors of the Regional Offices of the State Department of Taxation. In the theoretical reference it is about the public management and analyzes the strategic management in contemporary public administration. Presents the maturity in project management is by discussing the main models: CMM, Capability Maturity Model; PMMM, Project Management Maturity Model; OPM3, Organization Project Maturity Model and the Prado-MMGP, Modelo de Maturidade em Gerenciamento de Projetos. From this analysis, considering attributes as an aid in taking strategic positioning, access to the model, possibility of benchmarking and continuous improvement, the Prado-MMGP model was the most appropriate for this research process. It has been proved that the State Department of Taxation shows a very low project management maturity level. Regarding the acceptance of the maturity dimensions by the State Department, it is still in an early developmental stage, as one of the dimensions showed a poor performance while the rest showed a regular one. In contrast with similar organizations, the maturity results have shown to be below the national average. The maturity assessment enables in the institution the implementation of a plan for institutional growth with the creation of sector strategic and project management

Influência das medidas antropométricas sobre a pressão arterial sistêmica de hipertensos cadastrados nas unidades de saúde da família no município de João Pessoa - PB

Este trabalho objetiva avaliar a influência das medidas antropométricas sobre a pressão arterial sistêmica de uma coorte de hipertensos atendidos nas Unidades de Saúde da Família (USF) no município de João Pessoa-PB durante o período de 2008 a 2011. Para verificar as diferenças de níveis pressóricos entre as medidas realizadas nas consultas referentes ao cadastro, e a ultima pressão obtida no período de acompanhamento foram utilizadas informações sobre a identificação, dados clínicos do paciente, fatores de risco e doenças concomitantes. Testes estatísticos de comparabilidade entre grupos foram empregados. Para investigar os padrões de associação dos fatores de risco das variáveis antropométricas e sociodemográficas com a hipertensão dos pacientes, foi empregado o Modelo de Regressão Logística. Foram encontradas associações significativas (p<0,005) da hipertensão com a obesidade e o sedentarismo. Com os resultados desta pesquisa pretende-se: fornecer indicadores sobre a efetividade da Estratégia Saúde da Família; avaliar a qualidade das informações antropométricas; contribuir para a definição de estratégias que garantam o melhoramento dos acompanhamentos dos hipertensos e fornecer elementos científicos de apoio para outras USF e instituições governamentais.

O modelo de gestão estratégica do Ministério Público do Estado do Rio Grande do Norte: a análise da implantação do Balanced Scorecard

The goal of this research was to analyze the model of strategic management of the MPRN concerning the methodological guidelines presented by Balanced Scorecard. It is based in a theoretical referential which contemplates the themes, new public management, strategic management and Balanced Scorecard, focusing on applying the methodology in the public sector. This research is classified as descriptive and exploratory. According to the methods applied, it is a case study and, according to its approach, it is qualitative. The subjects of this research are members of the institution involved in the process of its strategic management. The data was collected by means of semi-structured interviews and document analysis, done by means of method content analysis. Concerning the goal of this research, it points out that the MPRN has not concluded the implantation cycle of Balanced Scorecard, furthermore, important flaws in the steps of organizational alingment have been identified, specially when it refers to communication policy, implementing incentive actions and focused training in developing competences. It yet reveals that the implantation of BSC has allowed the introduction of changes in the Institution dynamics to seek better results, however the MPRN has faced and has not adequately gotten over the same difficulties reported in various cases of BSC implantation in public organizations

Prevalência da infecção pelo Papilomavírus humano, Chlamydia Trachomatis e Herpes Simples do tipo 2 em adolescentes atendidas em unidades de saúde pública de Natal

This study assessed the level of knowledge, attitude and practice of Pap smear and human papillomavirus (HPV), in addition to analyzing the prevalence of genital HPV infection, Herpes Simplex Type 2 (HSV-2) and Chlamydia trachomatis in teenagers. The study consisted of two approaches, one based only on interviews conducted with adolescents enrolled in public schools or in public health facilities in the city of Natal. The other approach involved only a group of 132 adolescents enrolled among those admitted to two health units in Natal-RN. This second group of participants two specimens were collected for laboratory analysis: one was directed to prepare the blade for the Pap test, and other processed for DNA extraction for molecular analysis, focusing on the detection of HPV, HSV-2 and C . trachomatis. The presence of DNA of the three pathogens was investigated by the technique of polymerase chain reaction (PCR). The presence of each of the three pathogens was analyzed in terms of socio-demographic characteristics, as well as sexual and reproductive activity to identify risk factors for infection and development of lesions of the uterine cervix. The results show that the adolescents in this study had levels of knowledge and attitude very low, both in relation to cytology to HPV as though they have made a reasonable percentage of adequate practice exam and prevention of HPV infection. The overall prevalence of HPV infection was 54.5% and 48.2% in adolescents with normal cytology and 86.4% in those with abnormal cytology. We observed a higher proportion of cases of infection in the age group of 18 to 21. The prevalence of HPV infection was slightly higher among pregnant teenagers. The overall prevalence of HSV-2 infection was 13.6% and 11.8% in women with normal cytology and 22.7% in those with abnormal cytology. A higher proportion of cases of infection was found in the age group from 14 to 17, with a slightly higher prevalence among pregnant women. The C. trachomatis was found with an overall prevalence of 19.7% and 21.8% in adolescents with normal cytology and 9.1% in those with abnormal cytology. The prevailing rate was highest in the age group 18 to 21 years and in nonpregnant

Um modelo de portfólio para gestão estratégica de compras hospitalares

O presente estudo, baseado no modelo teórico de portfólio de compras proposto por Kraljic (1983), apresenta um modelo de portfólio de compras voltado para gestão de compras hospitalares, por meio da aplicação do método de decisão multicritério Fuzzy-TOPSIS. Para fins de exemplificação do método, a pesquisa foi aplicada em um Hospital de grande porte localizado em Natal/RN e teve como amostra doze itens de compras. Os itens foram avaliados pelo grupo de decisores nas dimensões de importância da compra e complexidade de fornecimento, sendo cada dimensão composta por quatro critérios. Por meio da utilização do método Fuzzy-TOPSIS e de regras de decisão, os itens foram classificados entre as categorias: estratégicos, gargalos, alavancagem e não-críticos. O resultado dessa etapa identificou três itens estratégicos, seis itens gargalos, um item de alavancagem e dois itens não-críticos. Para os três itens classificados como estratégicos, foi aplicado o método Fuzzy-TOPSIS visando a identificar o posicionamento estratégico do Hospital em relação aos fornecedores desses itens, a partir da avaliação das dimensões força do mercado fornecedor e força da empresa compradora, sendo cada uma composta por quatro critérios. Nessa etapa, foi identificada uma postura de balanceamento das forças. Conclui-se a efetividade da ferramenta de portfólio de compras para gestão hospitalar, proporcionando uma visão mais clara das características, inerentes ao processo de compras nesse contexto complexo. O método Fuzzy-TOPSIS apresentou-se como uma ferramenta flexível, capaz de lidar com problemas de classificação, gerando resultados satisfatórios e contribuindo para a tomada de decisão.

O modelo de gestão estratégica do Ministério Público do Estado do Rio Grande do Norte: a análise da implantação do Balanced Scorecard

The goal of this research was to analyze the model of strategic management of the MPRN concerning the methodological guidelines presented by Balanced Scorecard. It is based in a theoretical referential which contemplates the themes, new public management, strategic management and Balanced Scorecard, focusing on applying the methodology in the public sector. This research is classified as descriptive and exploratory. According to the methods applied, it is a case study and, according to its approach, it is qualitative. The subjects of this research are members of the institution involved in the process of its strategic management. The data was collected by means of semi-structured interviews and document analysis, done by means of method content analysis. Concerning the goal of this research, it points out that the MPRN has not concluded the implantation cycle of Balanced Scorecard, furthermore, important flaws in the steps of organizational alingment have been identified, specially when it refers to communication policy, implementing incentive actions and focused training in developing competences. It yet reveals that the implantation of BSC has allowed the introduction of changes in the Institution dynamics to seek better results, however the MPRN has faced and has not adequately gotten over the same difficulties reported in various cases of BSC implantation in public organizations

Avaliação da estratégia saúde da família na capital potiguar

This research aimed to evaluate the Family Health Strategy (FHS) in Natal, Rio Grande do Norte, through its managers, professionals and users, having as its support the Theory of Belief and the Cognitive-Behavioral Theory. This is a multimethod research and is divided into three sub-studies. In the first study, nine managers answered to a semi-structured interview, to verify the knowledge and beliefs on SUS; the quantitative data were analyzed with descriptive statistics with the aid of SPSS software and the qualitative data were submitted to lexical analysis with support of ALCESTE software. In the second study, we have a descriptive correlational research in which the antecedent variables are related to working conditions in the family health units (FHUs) and to the professionals‟ profile; the corresponding variables refer to the evaluations of the FHS; a stratified probabilistic sample with 475 professionals, who answered to two scales, both consisting of three factors: Physical infrastructure, Material resources, and Treatment effectiveness, and data were analyzed using descriptive, bivariate and multivariate statistics, with the aid of SPSS. The third study is a descriptive correlational research in which the antecedent variables refer to the treatment in the FHUs and to the users‟ profile, and the corresponding variables refer to the evaluations of the FHS, with a stratified non-probabilistic sample with 390 users, who contributed to the construction of a new scale with a factor, effectiveness in treatment, analyzed through descriptive, bivariate and multivariate statistics, with the aid of SPSS. The results showed problems which start from management, under the shape of admission due to political indication and lack of knowledge on SUS and the FHS; they pass through the low tenure of professionals and insufficient professional; and they end up spreading all over the analyzed items: infrastructure of FHUs, material resources, professionals‟ training, accessibility and referral system. One concludes that, despite following an ideal model, the FHS is in need of changes with regard to the barriers to its operational reality

Acolhimento prescrito x real: uma análise sobre as relações entre trabalhadores e usuários na estratégia saúde da família

User embracement has been proposed as a tool that contributes to humanize the nursing, to increase the users’ access to the services, to ensure the resolvability of claims, to organize the services and promote the strengthening of the links between them and the health professionals. In the city of Recife, this practice has been fomented by the municipal government and its implementation is guided by normative acts, with evaluation matrices and proposition of goals, based on a model created by the public administration. This study intended to analyze the relation between the prescribed user embracement and the real one and their interferences with the relations of reciprocity between workers and users in the health units of basic attention in Recife. Four units of the Family Health Strategy at the Sanitary District IV of the city of Recife – PE were taken as an investigation field. The investigation had a qualitative character, so, Interviews were performed involving professionals and users whose speeches were recorded by the voice digital mode and literally transcript. The obtained speeches were analyzed mostly through the Discourse of the Collective Subject methodological approach, being also used, but on a smaller scale, the technique of thematic analysis, in the dialogic way, with theoretical contributions and official documents related to the theme. The results pointed that in most of the health units the professionals execute the proposed protocols and consider that these have a positive influence for the working process in user embracement, however, factors such as the excessive demand, the physical structure of the units, little resolvability of the reference network, singularities of the units, among others, have appeared, hampering the accomplishment of the prescribed, creating, thus, a negative influence on the working process of the user embracement. The reciprocal relations have also suffered the influences of these factors, which made difficult, therefore, the circulation of gift. Meanwhile, other factors such as access, resolvability, sheltering attitude and responsabilization, potentiated the reciprocal exchange between professionals and users. The findings demand the prescriptive acts and the reciprocal relations of the user embracement to be directly influenced by the singularities present in each community, by the human variabilities and by factors connected to the structure and working process, so it shall be operated with caution in order to provide a real user embracement with quality

Processo de formulação estratégica sob a perspectiva dos decisores da CAERN

Os estudos sobre estratégia têm se difundido há muitos anos e seu processo de formulação também está inserido no cotidiano dos gestores. O objetivo do presente trabalho é constatar se há relação entre o pensamento, formulação e mudança estratégica e o nível acadêmico, hierárquico e tempo no cargo dos decisores da CAERN. A abordagem teórica é realizada com os seguintes pontos: estratégia, Decisão e liderança organizacional e o processo de formação da estratégia (Pensamento estratégico; Formulação da estratégia; Mudança estratégica). O estudo é de caráter exploratório descritivo. Para a tabulação e análise dos dados, utilizou-se um programa estatístico em que foi adotada a técnica de análise fatorial, e verificou-se a confiabilidade da escala de Likert utilizada no questionário através do teste Alfa de Cronbach e análise de Spearman a fim de constatar a correlação das variáveis e proporcionar uma abordagem quantitativa à pesquisa. Todos os respondentes da pesquisa são tomadores de decisão cujos níveis hierárquicos que obtiveram representatividade na amostra foram coordenadores, gerentes e chefes de seção. A partir das análises dos resultados do estudo, constatou-se que, das hipóteses levantadas, apenas uma se mostrou coerente com a realidade dos profissionais responsáveis pela estratégia organizacional da empresa: Há correlação entre a formulação estratégica e o nível acadêmico dos decisores (no constructo de formulação deliberada). Notouse também que o nível de formação acadêmica (nível superior) é importante e influencia diretamente no processo da formulação estratégica. Conclui-se que na organização em estudo o conhecimento dos gestores interfere na formulação estratégica

Atuação dos enfermeiros da estratégia de saúde da família frente à violência intrafamiliar contra a criança

The family violence against children became visible, in the context of public health, due to the damage and injuries generated in the lives of children and to the growing need of investment in physical and human resources to fill this demand. In this context, it is believed that intervention could prevent such events and are configured as primary strategies to prevent the corollaries generated by the violence. In this perspective, this study aims to analyze the performance of nurses dealing with the Strategy of Family Health viewing to identify actions based on the paradigm of health distribution. This is a descriptive, exploratory and qualitative research. The data were analyzed based on the content analysis about the method proposed by Bardin. The study was conducted in Mossoró-RN and the participants were 14 nurses working for the Family Health Strategy in Health Units of this town. The instrument for data collection was a semi-structured questionnaire, with questions answered by the participants themselves. It was evident to the study that the nurses believe that health education are the main tool for dealing with domestic violence against children, being developed, however, in its positivist and vertical way. The actions used to develop health performed by the team on their daily lives are limited to educational activities and are carried exactly when cases of family violence against children are notified. Barriers to the practice emerged from fear of reprisals from the agressor, overwork, lack of management support and difficulty for the realization of interdisciplinary, intersectorality and comprehensive care.

Entre flores e espinhos: a atuação do técnico em enfermagem na estratégia saúde da família

It is about a study of an exploratory/descriptive type with a qualitative approach whose aim was to analyze the actuation of nursing technicians in Family Health Strategy (FHS), taking into consideration the defined attributions by the Ministry of Health (MH). Thus, it was sought to identify what activities they carry out, the difficulties encountered, what contributed to their professional performance, and what vision they have about FHS and about themselves in the context. Based on the assumption that the practice of Nursing Technician is not still geared to completeness and that the developed actions by this professional are predominantly individual and curative. We know that FHS proposes the work organization as a team, with territory definition, prioritization of promotion actions, protection and recovery of the individual/family/community health, choosing as a central point the establishment of entails between the professionals and the same ones. However, the team work pass through interdisciplinary, tying and competence, starting making the difference in the way of thinking and doing health. To the accomplishment of this study were interviewed twenty one Nursing Technicians of Family Health Units from Sanitário Oeste district in Natal-RN, using semistructured instrument. From the analysis, three empiric categories emerged: starting from the first, The reality of a dream: what FHS is for the Nursing Technician, we obtained two classifications: one inherent to the own conception they have about FHS, nominated The realization of a dream in the possible and another that corresponds to what they think about FHS, while project that doesn't take place fully, denominated of The beauty of a dream that doesn't take place. The second category was The FHS: a dream built in the daily of Nursing Technician treats of the day by day information of that professional; the activities they perform and how those are established. This created three other items, to know: The role of a Nursing Technician: a project that became routine; The pre-determined role of a Nursing Technician: the scale as factor of (non-)autonomy; and, Knowledge about the practice in FHS: challenges that are presented to the role of Nursing Technician. The third category, denominated of Charms and disenchantment in the beginning of a new practice, it is related to the facilities or difficulties in professional's actuation and how he sees himself in the context. From it emerged the "flowers" and the "thorns" found on the construction of a dream, which gave this study the title. The results indicate that, being considered the characteristics of researched professional category, it becomes fundamental the resizing of labor relations in FHS, being imperative that new glances is conducted, so that the way as those Nursing Technicians interacts with the families can become compatible, together with the team, as well as to return the attention for their possibilities and limits in face of the work process in FHS. Besides, it is necessary changes in the professional formation, so that it can guarantee the conceptual bases in the construction of new practices, seeking to answer to the model of current attention.

Trânsito de saberes e campo representacional na visão dos profissionais da saúde da família e do programa de educação pelo trabalho e para a saúde

The Family Health Strategy (ESF) is emerging as a possible restructuring of services and new practices of intervention in health care; it requires skilled professionals to work with that framework. Within this purpose, we established the Education Programme for Work and Health (PET-Saúde), in order to integrate teaching and service activities, focusing on primary care. On this basis, the aim of this work is to apprehend the social representation of nurse, doctor and dentist (Project PET-Natal Health RN preceptors) on the ESF, while practice field of them. It is a descriptive and exploratory study, with a qualitative approach, carried out in 07 Family Health Units (USF) included in the PET-Saúde Natal (RN). The population was composed of 35 professional components of the primary care team with bachelor's degree of the USF linked to this project. The sample was composed of 05 nurses, 05 physicians and 05 dentists, for a total of 15 subjects. Data were collected through three instruments: the drawing-themed story, a semi-structured individual interviews and field diary. The data relating to the identification of the subjects were entered and tabulated by the Microsoft Excel software 2007 version. The drawing analysis and interpretation is given by the significance attributed to the resource chart from title and keywords assigned by the subjects, considering the ESF as an inductive term. The stories and interviews were transcribed and typed and then subjected to read/listen the material and a lexical analysis through Alceste. After this process, the discursive material was analyzed and discussed by theoretical and methodological feature of the Social Representations theory. The majority of health professionals were female, aged between 46 and 52 years old, married, income less than six minimum wage, time since graduation ranged from 22 to 29 years and working time in the ESF range from 02 to 11 years. From the classification system ALCESTE were selected categories identified by: Category 1 - ESF: relations and territory; Category 2 - Training and bond profile; Category 3 - Working process in the ESF; Category 4 - Articulation between teaching and service; Category 5 - Health care and disease prevention. The representational field construction, while a process, followed the logic of structural cores in existing categories. In this sense, it is clear that the ESF is an environment rich in diversity, experience and relationships with potential such as the relationship "very subject-subject" and the link established between professional-community, but also has some weaknesses such as poor working conditions, lack of popular participation and management support, thus difficulties in the achievement of teamwork. Being essential to that end, the teaching-service aimed at the formation of a new health professional able to work in the ESF. In this research, the training of the representational field encountered a diversity of structural cores, or thoughts on training, about the ESF because of the greater emphasis on the here and now of the interaction between health professionals, the ESF, the community, PET Health-UFRN and students, emphasizing that such proposals are still considered as concepts in the context of recent health and that, therefore, are not fully realized in the social imaginary