Search

The study presents some reflections on the possibilities and limitations of the rationalization and flexibilization of the management process of the health services under the economic perspective, focussing on the introduction of mechanisms and instruments centred in the economic and organizational responsibilization of the resources and nursing participation in these processes. Authors discuss the adoption of a system of economic control in order to coordinate the interests of the several subjects involved; to privilege the results of the processes and to improve the economic combination of the resources. Under this perspective, two concepts are considered relevant in the elaboration of the budget of the Nursing Services: the controllability of the resources and the negotiation in the processes of allocation and utilization of these resources. The use of these concepts in the organization of health services, especifically in nursing area, creates new possibilities of participation in the processes of services production, enabling more transparency in the decision processes and restructuring new modalities of management for the nursing services.

This study aimed at estimating the employment "survival" time of nursing workers after their admission to a public hospital as a turnover index. The Life Table method was used in order to calculate the employment survival probability by X years for each one of the categories of workers. The results showed an accentuated turnover of the work force in the studied period. The categories nursing auxiliary and nurse presented low stability in employment while the category nursing technician was more stable.

The present study aimed at identifying supply and demand of university-level nursing programs in São Paulo, Brazil, during the 1980s. A questionnaire was sent to the 28 nursing programs (public and private) existing in São Paulo in 1991. The 24 institutions that responded to our survey provided information on: year when the program was established, year when program was officially recognized by the Ministry of Education and Culture; year when entrance examinations began to be required for the nursing program; sources (public or private) of financial support received; and number of students accepted for each term (day or night) in 1980 and 1991. The data collected revealed that every year fewer students applied to nursing programs in São Paulo. In 1986, 34% of the vacancies remained unfilled; this was the lowest occupancy rate registered during the period studied. The situation outlined by our study suggests that in the medium and long run nursing work potential in Brazil could be compromised.

The present study was carried out in 1990 with the objective of measuring and analyzing the turnover of nursing personnel in nine general hospitals located in Ribeirão Preto, São Paulo State, Brazil. The population under study consisted of nurses, nursing assistants, nursing technicians, and nursing attendants who started work or left their jobs between 1 January and 31 December 1990. Employment status for these workers was checked monthly based on information from the human resources department of each hospital. Two types of turnover indices were calculated: the liquid rate of substitution and the median length of service of the departing workers. Results showed that the number of nursing personnel employed in Ribeirão Preto increased in 1990. However, results also revealed a high turnover rate, especially for philanthropic and private institutions, with liquid substitution rates of 32% and 39% per year and median lengths of service of 8 months and 12 months, respectively. These circumstances could lead to higher costs and reduced productivity. The only public hospital in the study presented the lowest level of turnover (liquid substitution rate of 6% and median length of service of 42 months). Nurses and attendants had the highest substitution rates and thus were the least stable categories.

The present study aims at reflecting about the organization of the information system as an important tool in the management of health services, especially in the process of municipalization.

Introduction After successful medical management of a patient with a clinical picture suggestive of post sphincterotomy duodenal perforation, and in which the Computed Axial Tomography (CT) scan of the abdomen revealed the presence of subcutaneous emphysema and retroperitoneal air, there was concern about the frequency of post ERCP with sphincterotomy pneumoretroperitoneum and if any procedure dependent factors were associated with this problem. Aim To assess the frequency and clinical significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Methods Fifty consecutive patients, who had undergone ERCP with sphincterotomy, were submitted to abdominal CT examinations within 24 h after completion of the procedure. One patient with a large precut but a failed ERCP was also included. The ERCP findings were unknown to the radiologist. Results Seven (14%) of 50 patients showed CT findings of retroperitoneal air. All of them had uneventful postprocedural recovery. No clinical or laboratory abnormality was found in this group of patients. The presence of retroperitoneal air was not associated to the variables: precut, biliopancreatic disease type, endoscopic sphincterotomy length, additional endoscopic procedure (balloon exploration, gallstone extraction, stent insertion) or procedure duration. Conclusion After endoscopic retrograde cholangiopancreatography with sphincterotomy, retroperitoneal air is frequently found. In absence of physical symptoms, retroperitoneal air is not clinically relevant and does not require specific treatment. Competing interests None.

The authors discuss the activities developed by Nursing in two general orientations: the assistance and the management, concerning the concrete work and its perspectives. Therefore, they engage in polemics around the administrative versus assistance functions and attract the attention to the impossibility of thinking the nursing work inarticulated of different health practices, as a whole they accomplish each other in attempting the necessities of health of the population in a social level.

The administrative role of the nurse has been a polemic matter for the theory of nursing. The practice of nursing administration has been limited to meeting the employers and other professionals expectations. In this context the authors attempt to characterize their position towards the importance of the administration of the assistance scheme as one of the roles of the nurse.