Nurses, nursing technicians and assistants: who experiences more moral distress?

Objective: To identify the frequency and intensity of moral distress experienced by nurses, technicians and nursing assistants who worked in hospitals in the South of Rio Grande do Sul State. Method: A survey research was conducted with 334 nursing workers from three institutions, through a questionnaire of moral distress. Constructs were validated through factorial analysis and Cronbach’s alpha: lack of competence of the working team, disrespect to the patient’s autonomy, insufficient working conditions and therapeutic obstinacy. Results: With descriptive statistics and analysis of variance, it was found that nurses and nursing assistants have higher perception of moral distress when compared to nursing technicians. Organizational questions and ways of communication influence lower perception of moral distress.Conclusion: Implementation of actions to favor coping, decision making and autonomy exercise from those workers.


Treatment of skin lesions in newborn children: meeting the needs of nursing staff

Objective To understand, together with nursing staff, the care needed to treat skin lesions in newborn children hospitalized in a neonatal unit. Method Qualitative research, of the convergent care type. The data was collected through semi-structured interviews, which were conducted from November to December 2012, in the neonatal unit of a hospital in southern Brazil. The participants were four auxiliary nurses, six nursing technicians and four nurses. Results The following three categories were designated: questions about what can be used in relation to newborn children; hospitalization can cause lesions on the skin of newborn children; and knowledge about care promotes professional autonomy. Conclusion There is an urgent need for staff to know more about the treatment of skin lesions, which would provide safer care for newborn children and would also support the autonomy of professional nurses in providing that care.


La pratique basée sur les résultats probants. Partie 2: Les étapes du processus [Evidence-based practice: Part 2: Steps in the process].

Evidence-based (EBP) aims for a new distribution of power centered on scientific evidence rather than clinical expertise. The present article describes the operational process of EBP by describing the implementation stages of this type of practise. This stage presentation is essential given that there are many conceptions end models of EBP and that some nurses have a limited knowledge of its rules ans implications. Given that number and formulation of the stages varies by author, the process presented here attempts to integrate the different stages reviewed.

Interdependency management in universities: a case study

There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually 'rules' in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge production and diffusion. Organisational and academic rationales coexist in today's management of universities. This article endeavours to clarify some of the ambiguities pertaining to the coexistence of two authorities by demonstrating the working of 'interdependency management' that is taking place within universities. For this purpose, the authors have scrutinised research, teaching and recruitment policies in one Swiss university that is subject to such ambiguities. The study confirms existing research in that a command-and-control system is not applied. Policymaking in universities is instead based on a mix of negotiations in faculties that are taking place in the 'shadow of hierarchy', negotiated bargaining between faculties and leaders and occasional unilateral decisions of leaders. This mitigates latent conflicts between management and the academic community: strategic orientations of the university are generally accepted by the academic community while the academic community has influence on policy formulation and maintains defining powers over policy substance.

Professionalization of controllers in Finland

Professions are a special category of occupations that possesses exclusive rights over its domain of expertise. Professions apply expert knowledge in their work by using professional discretion and judgment to solve their clients’ problems. With control over their expert knowledge base, professions are able to control the supply of practitioners in their field and regulate the practice in their market. Professionalization is the process during which occupations attempt to gain the status of a profession. The benefits of becoming a profession are extensive – professional autonomy, social and financial rewards, prestige, status, and an exclusive community are only a few of the privileges that established professions possess. Many aspiring occupations have tried and failed to gain the status of a profession and one of these groups is the occupation of controllers in Finland. The objective of this study to uncover, why controllers have not professionalized, which properties of the occupation correspond with the elements generally regarded to pertain to professions, and which aspects of the occupational group may hinder the professionalization project. The professionalization project of controllers is analyzed using a multi-actor model of professionalization, in which practitioners, clients, the state, training institutions, and employing organizations are considered to affect the project. The properties of the occupation of controllers are compared to features generally associated with professions. The research methodology for this thesis is qualitative, and the study is conducted as an exploratory research. The data is primarily gathered using semi-structured interviews, which were conducted between March and May 2013 lasting from 40 minutes to an hour. In total, four controllers were interviewed, who worked for different companies operating in different industries, and whose experience of working as a controller varied between a few years to nearly 15 years. The data in this study indicates that although controllers possess qualities that distinguish professions from other occupational groups, the professionalization of controllers may not be plausible. Controllers enjoy considerable autonomy in organizations, and they possess a strong orientation towards serving their clients. The more profound problem with the occupation is its non-exclusive, indistinct knowledge base that does not rely solely on a single knowledge base. Controllers’ expertise is relatively organization-specific and built on several different fields of knowledge and not just management accounting, which could be considered as their primary knowledge base. In addition, controllers have not organized themselves, which is a quintessential, but by no means a sufficient prerequisite for professionalization.

La cultura nacional como espacio emergente de articulación entre el Estado y las letras en la Argentina del centenario (Estudios)

En la Argentina del Centenario de la Revolución de Mayo, al tiempo que se recorta la especificidad de la labor intelectual en relación con el área de las actividades del “espíritu” y se especializan las funciones de la política estatal, emerge una nueva representación de la cultura nacional como espacio de intervenciones estratégicas dirigidas a atender tanto de las nuevas necesidades del Estado oligárquico en crisis como los requerimientos de los escritores que aspiran a la autonomía profesional. La convergencia de las respuestas de los escritores involucrados en esta nueva alianza con el Estado no responde a una coartación de su autonomía, sino a la coincidencia entre los interrogantes que el Estado les formula y las preguntas que, desde la situación histórica específica de la actividad literaria, han venido planteándose.

Professionalism in digitally-mediated project work

Fieldwork in a major construction programme is used to examine what is meant by professionalism where large integrated digital systems are used to design, deliver, and maintain buildings and infrastructure. The increasing ‘professionalization’ of the client is found to change other professional roles and interactions in project delivery. New technologies for approvals and workflow monitoring are associated with new occupational groups; new kinds of professional accountability; and a greater integration across professional roles. Further conflicts also arise, where occupational groups have different understandings of project deliverables and how they are competently achieved. The preliminary findings are important for an increasing policy focus on shareable data, in order for building owners and operators to improve the cost, value, handover and operation of complex buildings. However, it will also have an impact on wider public decision-making processes, professional autonomy, expertise and interdependence. These findings are considered in relation to extant literatures, which problematize the idea of professionalism; and the shift from drawings to shareable data as deliverables. The implications for ethics in established professions and other occupational groups are discussed; directions are suggested for further scholarship on professionalism in digitally mediated project work to improve practices which will better serve society.

Second tier professionals: English teachers in England

The policy context for mother-tongue educators at all levels in England has been dominated by a matrix with four key elements,running along two spectra, one of learning (content↘assessment) and one of teaching (autonomy↘accountability). In each case the trend has been towards increasing external control and decreasing professional autonomy. Whilst some imposed changes have been recognised as intrinsically valuable, the majority are viewed as detrimental to teachers' status and obstructive for students. The research community has been largely marginalised and has had little scope to influence proceedings. A rapidly developing crisis in teacher retention may yet reverse these trends as the government is forced to recognise the long-term implications of their treatment of the profession.

A aplicabilidade do planejamento estratégico no âmbito da perícia criminal federal

A necessidade de lidar com a identificação, o desenvolvimento, a formalização e a implementação de estratégias na Criminalística da Polícia Federal leva a questionamentos quanto à presença das condições necessárias para a implantação efetiva de um processo de planejamento estratégico institucional no ambiente considerado, e cuja resposta constituiu o objetivo da presente pesquisa. Neste contexto, combinam-se elementos ligados à natureza de organização pública da Criminalística e conceitos da Administração advindos do ambiente da iniciativa privada, assim como idiossincrasias da categoria profissional formada pelos peritos criminais. E, por ser o planejamento estratégico uma atividade insólita na organização, está sujeito a uma série de riscos e ameaças sobre os quais ainda não se tem conhecimento suficiente. Este estudo valeu-se de entrevistas semiestruturadas para avaliar, a partir da percepção dos próprios peritos criminais federais, se estão presentes fatores relacionados a três perspectivas de destaque identificadas na literatura acadêmica que poderiam viabilizar a implantação do planejamento estratégico na Criminalística da Polícia Federal. A primeira perspectiva se refere ao contexto mais amplo de organização, extraída a partir de uma abordagem integradora sobre o processo de formação da estratégia, que considera a visão como elemento agregador entre a racionalidade do planejamento estratégico formalizado e a participatividade geradora das estratégias emergentes. A segunda diz respeito ao contexto mais restrito que abrange as organizações do setor público, em que as dimensões de propriedade comum, financiamento público e controle político resultam em uma série de especificidades em relação ao setor privado. Por fim, a terceira perspectiva trata da caracterização da Criminalística como organização profissional, em que a tensão entre controle gerencial e autonomia profissional assume importância de destaque. O resultado, obtido a partir de análise interpretativa fenomenológica das entrevistas, revelou que a falta de um senso comum sobre a direção a ser seguida pela organização, associada ao baixo envolvimento dos peritos, constitui um fator condicionante do sucesso do planejamento estratégico na Criminalística.

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.

Percepção de enfermeiros recém graduados sobre sua autonomia profissional e sobre o processo de tomada de decisão do paciente

O estudo foi realizado junto a enfermeiros recém-graduados que atuam em um hospital público com os objetivos de descrever a percepção destes sobre sua autonomia profissional e sobre o processo de tomada de decisão do paciente. A estratégia adotada para obtenção dos dados foi a de grupo focal e o referencial metodológico a Grounded Theory. Dos resultados emergiram dois fenômenos: 1) Percebendo a fragilidade da autonomia do enfermeiro e do paciente. 2) Movendo-se em direção ao fortalecimento da autonomia do enfermeiro e do paciente. Isto possibilitou a identificação da categoria central: movimento empreendido por enfermeiros recém formados em direção ao fortalecimento de sua autonomia profissional e da autonomia do paciente. A compreensão da experiência nos permitiu ampliar o conhecimento sobre os enfrentamentos dos enfermeiros recém formados, favorecendo nossa atuação como professores de enfermagem.

Entre o êxito e a frustação com a operacionalização da SAE: recursos humanos como componente determinante para a visibilidade do enfermeiro no processo de trabalho

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Políticas e tecnologias de gestão em serviços de saúde e de enfermagem

Objetivo: identificar se os enfermeiros do Brasil têm conhecimento das políticas e tecnologias de gestão nos serviços de saúde e enfermagem. Métodos: realizamos revisão integrativa da literatura, utilizando as bases de dados: LILACS, MEDLINE, SciELO, BDENF e PAHO e os descritores: gestão em saúde, tecnologia em saúde, tecnologia assistencial e enfermagem, incluindo as publicações nos idiomas português, espanhol e inglês. Resultados: A análise resultou em 11 referências completas, no período de 2003 a 2007. Constatamos que os enfermeiros possuem articulação nos serviços de enfermagem e competência técnica no exercício profissional, porém, apresentam-se frágeis politicamente, o que limita sua autonomia profissional e os torna ainda subordinados a outros profissionais. Conclusão: diante dos avanços e constantes mudanças no setor saúde, particularmente no nível organizacional e técnico-científico, torna-se imprescindível que o(a) enfermeiro(a) desenvolva suas habilidades políticas, gerenciais e de liderança com participação responsável e de forma interdisciplinar.

Condições e contradições da atividade artística: um estudo sobre os profissionais da música e seus representantes coletivos no Brasil e em Portugal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

JOB SATISFACTION: A QUALITY INDICATOR IN NURSING HUMAN RESOURCE MANAGEMENT

This descriptive study addresses the job satisfaction of nurse managers and clinical nurses working at the Hematology and Hemotherapy Services of a public hospital in Sao Paulo. The study objectives were to identify the factors that caused job satisfaction among nurse managers and clinical nurses, and support the results in the development of indicators to evaluate the quality of nursing human resource management. The components of the study were: autonomy, interaction, professional status, job requirements, organizational norms and remuneration. Participants were 44 nurses. Data were collected using a Job Satisfaction Index (JSI) questionnaire. In conclusion, this study permitted the identification of the clinical nurse group, which was the most satisfied, with a JSI of 10.5; the managerial group scored 10.0. Regarding the satisfaction levels in regards to the current activity, 88.9% of the nurse managers reported feeling satisfied, as did 90.9% of clinical nurses. For both groups, autonomy was the component with the highest level of professional satisfaction.