Configuração da prática de gerência do cuidado do enfermeiro em centro de terapia intensiva.

• Ano de defesa: 2025
• Autor(a) principal: Giselle Dias de Queiroz
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais
• Palavras-chave em Português: Cuidados de Enfermagem; Enfermeiras e Enfermeiros; Gestão em Saúde; Unidades de Terapia; Dissertação Acadêmica; Enfermeiros; Cuidados de enfermagem; Gestão em saúde; Centro de terapia intensiva
• Link de acesso: https://hdl.handle.net/1843/5064

The management of nursing care within Intensive Care Units (ICUs) constitutes a fundamental axis in the organization of healthcare work, particularly in environments of elevated clinical complexity. In such settings, nurses occupy a strategically central position, assuming responsibilities that encompass direct patient care, resource coordination, team supervision, conflict mediation, and the assurance of safety and quality in care delivery. Nonetheless, the articulation of these practices is not neutral; rather, it is shaped and conditioned by institutional mechanisms, power relations and normative devices that establish ways of acting, thinking, and producing care. In this regard, examining care management from a Foucauldian perspective — specifically through the analytical framework of disciplinary power — enables the unveiling of operational dynamics that structure professional practice, as well as the subjective, ethical and organizational effects that permeate the daily functioning of the ICU. Given this context, the aim of this study was to analyze how nursing care management is configured in the ICU setting, considering the articulation of the five dimensions of the nursing work process — caring, managing, educating, researching and political action — and the effects of Foucauldian disciplinary power on professional performance. This research employed a qualitative, single case study design, conducted in an adult ICU of a large public hospital. Data collection was carried out through interviews with 16 nurses, participant observation and document analysis, and the analytical process was consolidated through methodological triangulation, which broadened the depth and reliability of the findings by integrating multiple sources of evidence. The results indicate that direct care remains the most visible, demanded and socially recognized dimension of practice, even though all dimensions emerge in the nurses’ daily work — albeit not always in an integrated and harmonious manner. Care management, therefore, extends beyond supervision and procedural oversight, involving coordination of institutional flows, conflict negotiation, decision-making, human resource governance and interprofessional articulation. In light of Foucault’s theoretical framework, the study demonstrated that institutional norms, protocols, audits and surveillance operate as disciplinary devices that organize conducts, normalize behaviors and produce “docile bodies,” while simultaneously enabling productive dimensions of power, such as permanent education, knowledge creation and reinforcement of technical-scientific and critical autonomy among nurses. Interpersonal and interprofessional relationships were marked by hierarchical tensions and power disputes — particularly in interactions with medical staff and in the supervision of nursing technicians — yet they also revealed movements of cooperation, dialogic construction and shared responsibility capable of sustaining integrative care. The findings suggest that the ICU nurse occupies a dual and complex position as a producer of knowledge, an operator of discipline and a mediator of relationships, reinforcing the understanding that ICU care management constitutes a field of knowledge-power. Strengthening this field demands reflective professional practices, continuous qualification processes, and institutional recognition of the breadth, depth and complexity inherent to nursing work in high-complexity care environments.