Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar
| Ano de defesa: | 2023 |
|---|---|
| Autor(a) principal: | |
| Orientador(a): | |
| Banca de defesa: | , , , |
| Tipo de documento: | Dissertação |
| Tipo de acesso: | Acesso aberto |
| Idioma: | por |
| Instituição de defesa: |
Universidade Federal do Maranhão
|
| Programa de Pós-Graduação: |
PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBS
|
| Departamento: |
DEPARTAMENTO DE SAÚDE PÚBLICA/CCBS
|
| País: |
Brasil
|
| Palavras-chave em Português: | |
| Palavras-chave em Inglês: | |
| Área do conhecimento CNPq: | |
| Link de acesso: | https://tedebc.ufma.br/jspui/handle/tede/4817 |
Resumo: | INTRODUCTION: In early 2020 covid-19 was classified as a public health emergency of international importance becoming the latest global health crisis. In March of the same year, it was classified as a pandemic, causing changes in health services and work processes. OBJECTIVE: To analyze the challenges in hospital care management during the covid-19 pandemic. METHOD: This study with a qualitative, exploratory approach of the case study type. It was developed in a university hospital in a capital of northeastern Brazil, from March to September 2022. The participants were 22 professionals assigned to management, care or support service in the first and second waves of covid-19. Face-to-face or online interviews were conducted, recorded, and later transcribed, of the individual semi-structured type with the application of a structured questionnaire and interview script. Content analysis was used in the thematic modality. RESULTS: They are presented from two categories: Changes, challenges, and decisions: new emergencies and Conflicts, negotiations and cooperation. The pandemic scenario has required rapid decision-making, often surrounded by uncertainty and insecurity. Structural and organizational changes were identified, related to physical reforms, human resources and related to the work process. Thus, sectors had to be closed and professionals relocated to provide care to patients with covid-19, in most cases, with great initial resistance, requiring the management a posture of imposition, on the one hand, and of negotiation. There was also a barrier in the creation of protocols that were in fact effective, given in part to the denial existing in the federal government that impacted the accreditation of these professionals to include ministerial recommendations in their plans and the lack of effective treatment. Faced with the increase in the demand for care, the departure of some professionals and the licenses due to contamination of the teams, some managers also assumed functions in care. The reports of strengthening cooperation relations between professionals in this scenario of uncertainties were highlighted, facilitating interdisciplinary actions and strategies, and producing a tendency to horizontalization of labor relations. CONCLUSION: The various challenges that arose for management during the pandemic required rapid responses and actions by managers for the organization of services, and the lack of clear national policy guidelines caused anxiety. The daily work, with mistakes and successes, enabled the construction and agreement of strategies to cope with the pandemic, seeking to minimize conflicts, promote integration and ensure the safety of workers, patients and families. |
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LAMY, Zeni Carvalhohttp://lattes.cnpq.br/9896819318523369CARVALHO, Ruth Helena de Souza Britto Ferreira dehttp://lattes.cnpq.br/6914279050780248LAMY, Zeni Carvalhohttp://lattes.cnpq.br/9896819318523369CARVALHO, Ruth Helena de Souza Britto Ferreira dehttp://lattes.cnpq.br/6914279050780248RÊGO, Adriana Sousahttp://lattes.cnpq.br/7001225083239682CHAVEZ, Leidy Janeth Erazohttp://lattes.cnpq.br/6870905026005875http://lattes.cnpq.br/3338645230503368MANTESSO, Jhennyfer Barbosa de Oliveira2023-07-12T13:58:06Z2023-05-25MANTESSO, Jhennyfer Barbosa de Oliveira. Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar. 2023. 101 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luis, 2023 .https://tedebc.ufma.br/jspui/handle/tede/4817INTRODUCTION: In early 2020 covid-19 was classified as a public health emergency of international importance becoming the latest global health crisis. In March of the same year, it was classified as a pandemic, causing changes in health services and work processes. OBJECTIVE: To analyze the challenges in hospital care management during the covid-19 pandemic. METHOD: This study with a qualitative, exploratory approach of the case study type. It was developed in a university hospital in a capital of northeastern Brazil, from March to September 2022. The participants were 22 professionals assigned to management, care or support service in the first and second waves of covid-19. Face-to-face or online interviews were conducted, recorded, and later transcribed, of the individual semi-structured type with the application of a structured questionnaire and interview script. Content analysis was used in the thematic modality. RESULTS: They are presented from two categories: Changes, challenges, and decisions: new emergencies and Conflicts, negotiations and cooperation. The pandemic scenario has required rapid decision-making, often surrounded by uncertainty and insecurity. Structural and organizational changes were identified, related to physical reforms, human resources and related to the work process. Thus, sectors had to be closed and professionals relocated to provide care to patients with covid-19, in most cases, with great initial resistance, requiring the management a posture of imposition, on the one hand, and of negotiation. There was also a barrier in the creation of protocols that were in fact effective, given in part to the denial existing in the federal government that impacted the accreditation of these professionals to include ministerial recommendations in their plans and the lack of effective treatment. Faced with the increase in the demand for care, the departure of some professionals and the licenses due to contamination of the teams, some managers also assumed functions in care. The reports of strengthening cooperation relations between professionals in this scenario of uncertainties were highlighted, facilitating interdisciplinary actions and strategies, and producing a tendency to horizontalization of labor relations. CONCLUSION: The various challenges that arose for management during the pandemic required rapid responses and actions by managers for the organization of services, and the lack of clear national policy guidelines caused anxiety. The daily work, with mistakes and successes, enabled the construction and agreement of strategies to cope with the pandemic, seeking to minimize conflicts, promote integration and ensure the safety of workers, patients and families.INTRODUÇÃO: No início de 2020 a covid-19 foi classificada como emergência de saúde pública de importância internacional tornando-se a mais recente crise de saúde global. Em março do mesmo ano foi classificada como pandemia, provocando modificações nos serviços e processos de trabalho em saúde. OBJETIVO: Analisar os desafios na gestão da atenção hospitalar durante a pandemia de covid-19. MÉTODO: Pesquisa com abordagem qualitativa, exploratória, do tipo estudo de caso. Foi desenvolvida em um hospital universitário de uma capital do nordeste brasileiro, no período de março a setembro de 2022. Os participantes foram 22 profissionais lotados na gestão, assistência ou em serviço de apoio nas primeira e segunda ondas da covid-19. Foram realizadas entrevistas presenciais ou online, gravadas e posteriormente transcritas, do tipo semiestruturadas individuais com aplicação de questionário estruturado e roteiro de entrevista. Foi utilizada análise de conteúdo na modalidade temática. RESULTADOS: São apresentados a partir de duas categorias: Mudanças, desafios e decisões: novas urgências e Conflitos, negociações e cooperação. O cenário pandêmico exigiu a tomada de decisões rápidas, muitas vezes, cercadas de incertezas e insegurança. Foram identificadas mudanças estruturais e organizacionais, relacionadas a reformas físicas, recursos humanos e relacionadas ao processo de trabalho. Assim, setores tiveram que ser fechados e os profissionais remanejados para realizar assistência aos pacientes com covid-19, na maioria dos casos, com grande resistência inicial, exigindo da gestão uma postura firme, mas também de negociação. Houve também barreira na criação de protocolos que fossem de fato eficazes, dado em parte ao negacionismo existente no governo federal que impactava a acreditação desses profissionais para incluir as recomendações ministeriais em seus planos e pela inexistência de tratamento efetivo. Diante do aumento da demanda de atendimentos, da saída de alguns profissionais e das licenças por contaminação das equipes, alguns gestores assumiram funções, também, na assistência. Destacam-se relatos de fortalecimento das relações de cooperação entre profissionais nesse cenário de incertezas, facilitando ações e estratégias interdisciplinares e produzindo uma tendência à horizontalização das relações de trabalho. CONCLUSÃO: Os diversos desafios que surgiram para a gestão durante a pandemia necessitaram de respostas e ações rápidas dos gestores para a organização dos serviços e a falta de claras diretrizes de políticas nacionais causaram ansiedade. O cotidiano do trabalho, com erros e acertos, possibilitou a construção e pactuação de estratégias para o enfrentamento da pandemia, buscando minimizar conflitos, promover a integração e garantir a segurança de trabalhadores, pacientes e familiares.Submitted by Jonathan Sousa de Almeida (jonathan.sousa@ufma.br) on 2023-07-12T13:58:06Z No. of bitstreams: 1 JHENNYFERBARBOSADEOLIVEIRAMANTESSO.pdf: 1777479 bytes, checksum: 41bd1aaac3d1c3c1b32c8ec33e6b1a35 (MD5)Made available in DSpace on 2023-07-12T13:58:06Z (GMT). No. of bitstreams: 1 JHENNYFERBARBOSADEOLIVEIRAMANTESSO.pdf: 1777479 bytes, checksum: 41bd1aaac3d1c3c1b32c8ec33e6b1a35 (MD5) Previous issue date: 2023-05-25application/pdfporUniversidade Federal do MaranhãoPROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBSUFMABrasilDEPARTAMENTO DE SAÚDE PÚBLICA/CCBScovid-19;gestão de pessoal em saúde;pessoal de saúde;assistência hospitalar.personnel management;personnel management;health personnel;hospital care.Administração de Setores EspecíficosCiências da SaúdePandemia de covid-19: mudanças e desafios na gestão da atenção hospitalarCovid-19 pandemic: changes and challenges in hospital care managementinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFMAinstname:Universidade Federal do Maranhão (UFMA)instacron:UFMAORIGINALJHENNYFERBARBOSADEOLIVEIRAMANTESSO.pdfJHENNYFERBARBOSADEOLIVEIRAMANTESSO.pdfapplication/pdf1777479http://tedebc.ufma.br:8080/bitstream/tede/4817/2/JHENNYFERBARBOSADEOLIVEIRAMANTESSO.pdf41bd1aaac3d1c3c1b32c8ec33e6b1a35MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82255http://tedebc.ufma.br:8080/bitstream/tede/4817/1/license.txt97eeade1fce43278e63fe063657f8083MD51tede/48172023-07-12 10:58:06.342oai:tede2: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Biblioteca Digital de Teses e Dissertaçõeshttps://tedebc.ufma.br/jspui/PUBhttp://tedebc.ufma.br:8080/oai/requestrepositorio@ufma.br||repositorio@ufma.bropendoar:21312023-07-12T13:58:06Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA)false |
| dc.title.por.fl_str_mv |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| dc.title.alternative.eng.fl_str_mv |
Covid-19 pandemic: changes and challenges in hospital care management |
| title |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| spellingShingle |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar MANTESSO, Jhennyfer Barbosa de Oliveira covid-19; gestão de pessoal em saúde; pessoal de saúde; assistência hospitalar. personnel management; personnel management; health personnel; hospital care. Administração de Setores Específicos Ciências da Saúde |
| title_short |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| title_full |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| title_fullStr |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| title_full_unstemmed |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| title_sort |
Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar |
| author |
MANTESSO, Jhennyfer Barbosa de Oliveira |
| author_facet |
MANTESSO, Jhennyfer Barbosa de Oliveira |
| author_role |
author |
| dc.contributor.advisor1.fl_str_mv |
LAMY, Zeni Carvalho |
| dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9896819318523369 |
| dc.contributor.advisor-co1.fl_str_mv |
CARVALHO, Ruth Helena de Souza Britto Ferreira de |
| dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/6914279050780248 |
| dc.contributor.referee1.fl_str_mv |
LAMY, Zeni Carvalho |
| dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/9896819318523369 |
| dc.contributor.referee2.fl_str_mv |
CARVALHO, Ruth Helena de Souza Britto Ferreira de |
| dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/6914279050780248 |
| dc.contributor.referee3.fl_str_mv |
RÊGO, Adriana Sousa |
| dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/7001225083239682 |
| dc.contributor.referee4.fl_str_mv |
CHAVEZ, Leidy Janeth Erazo |
| dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/6870905026005875 |
| dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/3338645230503368 |
| dc.contributor.author.fl_str_mv |
MANTESSO, Jhennyfer Barbosa de Oliveira |
| contributor_str_mv |
LAMY, Zeni Carvalho CARVALHO, Ruth Helena de Souza Britto Ferreira de LAMY, Zeni Carvalho CARVALHO, Ruth Helena de Souza Britto Ferreira de RÊGO, Adriana Sousa CHAVEZ, Leidy Janeth Erazo |
| dc.subject.por.fl_str_mv |
covid-19; gestão de pessoal em saúde; pessoal de saúde; assistência hospitalar. |
| topic |
covid-19; gestão de pessoal em saúde; pessoal de saúde; assistência hospitalar. personnel management; personnel management; health personnel; hospital care. Administração de Setores Específicos Ciências da Saúde |
| dc.subject.eng.fl_str_mv |
personnel management; personnel management; health personnel; hospital care. |
| dc.subject.cnpq.fl_str_mv |
Administração de Setores Específicos Ciências da Saúde |
| description |
INTRODUCTION: In early 2020 covid-19 was classified as a public health emergency of international importance becoming the latest global health crisis. In March of the same year, it was classified as a pandemic, causing changes in health services and work processes. OBJECTIVE: To analyze the challenges in hospital care management during the covid-19 pandemic. METHOD: This study with a qualitative, exploratory approach of the case study type. It was developed in a university hospital in a capital of northeastern Brazil, from March to September 2022. The participants were 22 professionals assigned to management, care or support service in the first and second waves of covid-19. Face-to-face or online interviews were conducted, recorded, and later transcribed, of the individual semi-structured type with the application of a structured questionnaire and interview script. Content analysis was used in the thematic modality. RESULTS: They are presented from two categories: Changes, challenges, and decisions: new emergencies and Conflicts, negotiations and cooperation. The pandemic scenario has required rapid decision-making, often surrounded by uncertainty and insecurity. Structural and organizational changes were identified, related to physical reforms, human resources and related to the work process. Thus, sectors had to be closed and professionals relocated to provide care to patients with covid-19, in most cases, with great initial resistance, requiring the management a posture of imposition, on the one hand, and of negotiation. There was also a barrier in the creation of protocols that were in fact effective, given in part to the denial existing in the federal government that impacted the accreditation of these professionals to include ministerial recommendations in their plans and the lack of effective treatment. Faced with the increase in the demand for care, the departure of some professionals and the licenses due to contamination of the teams, some managers also assumed functions in care. The reports of strengthening cooperation relations between professionals in this scenario of uncertainties were highlighted, facilitating interdisciplinary actions and strategies, and producing a tendency to horizontalization of labor relations. CONCLUSION: The various challenges that arose for management during the pandemic required rapid responses and actions by managers for the organization of services, and the lack of clear national policy guidelines caused anxiety. The daily work, with mistakes and successes, enabled the construction and agreement of strategies to cope with the pandemic, seeking to minimize conflicts, promote integration and ensure the safety of workers, patients and families. |
| publishDate |
2023 |
| dc.date.accessioned.fl_str_mv |
2023-07-12T13:58:06Z |
| dc.date.issued.fl_str_mv |
2023-05-25 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
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MANTESSO, Jhennyfer Barbosa de Oliveira. Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar. 2023. 101 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luis, 2023 . |
| dc.identifier.uri.fl_str_mv |
https://tedebc.ufma.br/jspui/handle/tede/4817 |
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MANTESSO, Jhennyfer Barbosa de Oliveira. Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar. 2023. 101 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luis, 2023 . |
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https://tedebc.ufma.br/jspui/handle/tede/4817 |
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por |
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por |
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openAccess |
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Brasil |
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DEPARTAMENTO DE SAÚDE PÚBLICA/CCBS |
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Universidade Federal do Maranhão |
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