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Liderança em enfermagem: Contributos para a segurança cirúrgica no bloco operatório
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A liderança em enfermagem encontra-se entre os elementos mais sensíveis para o sucesso das organizações de saúde. Os enfermeiros gestores assumem um papel determinante na gestão dos serviços de saúde e na promoção de ambientes saudáveis e seguros, tanto para profissionais como para cidadãos. Os blocos operatórios são, particularmente, um contexto onde a segurança do doente é uma dimensão crucial e intimamente ligada com os modelos de gestão e liderança.
Ancorado nestes pressupostos, desenvolveu-se um estudo, integrado no projeto de investigação “Qualidade e Segurança nos Cuidados de Saúde (QSCare)”, ESEP/CINTESIS@RISE, que pretendeu: caracterizar os papéis de liderança, analisar a associação entre os papéis de liderança identificados e as caraterísticas sociodemográficas e profissionais, caracterizar a segurança cirúrgica no bloco operatório, analisar a associação entre a segurança cirúrgica no bloco operatório e as caraterísticas sociodemográficas e profissionais e analisar a associação entre a segurança cirúrgica no bloco operatório e os papéis de liderança.
Estudo quantitativo, correlacional e transversal, numa amostra de conveniência de 88 enfermeiros do contexto perioperatório, de um hospital da região Norte de Portugal. Aplicou-se um instrumento de recolha de dados, via online, para caracterização sociodemográfica e profissional, o Questionário de Liderança de Quinn (Parreira et al., 2006) e o Questionário de Segurança do Doente no Bloco Operatório - itens relativos à Área “Segurança Cirúrgica” (Mota, 2021).
Dos principais resultados, relativamente aos papéis de liderança, evidenciou-se o papel “Diretor” com a média mais elevada e o “Inovador” com a média mais baixa. Os papéis de “Facilitador” e “Inovador” associaram-se à "Categoria profissional” e ao "Local onde exerce funções” respetivamente. Quanto à “Liderança total” esta foi percecionada moderadamente positiva, com valor médio superior a 4, em todos os papéis. No que concerne à Segurança Cirúrgica, o valor médio mais elevado identificou-se no item “A Lista de Verificação de Segurança Cirúrgica (LVSC) é aplicada, pela equipa cirúrgica, aos doentes submetidos a procedimentos cirúrgicos incluindo aqueles com anestesia local” e o mais baixo no item “Os resultados das auditorias à utilização da LVSC são analisados em equipa”. A dimensão “Boas práticas” variou em função do “Título profissional”, “Local de trabalho”, “Categoria profissional” e “Duplo emprego”. Já a dimensão “Auditoria" variou em função das “Habilitações literárias”, “Título profissional” e “Categoria profissional”. No que toca à “Segurança cirúrgica total” pelo menos metade da amostra apresentou perceção de segurança de 3,81.
Os resultados corroboram os autores que defendem que os enfermeiros em contexto perioperatório têm um nível moderado de perceção do exercício da liderança, apontando para a necessidade de promover o desenvolvimento de diferentes papéis de liderança exercidos por enfermeiros gestores. Fica demonstrado que existe predomínio dos papéis de “Diretor”, “Produtor” e ”Mentor” com foco na produtividade, no controlo e orientados para resultados. No que toca à “Segurança Cirúrgica,” os resultados estão alinhados com estudos anteriores revelando a importância do preenchimento da LVSC e da partilha das auditorias com a equipa.
Em conclusão, as caraterísticas de liderança e da segurança cirúrgica identificadas, na amostra de enfermeiros perioperatórios estudada, revelam que existe espaço para a reflexão e para o desenvolvimento de competências neste contexto. O investimento nestas dimensões contribuirá, certamente, para a melhoria contínua da qualidade e da segurança dos cuidados prestados.
Leadership in nursing is among the most sensitive elements for the success of healthcare organisations. Nurse managers play a decisive role in managing health services and promoting healthy and safe environments for both professionals and citizens. Operating theatres are a context where patient safety is a crucial dimension and closely linked to management and leadership models. Based on these assumptions, a study was carried out as part of the research project "Quality and Safety in Healthcare (QSCare)", ESEP/CINTESIS@RISE, which aimed to: describe leadership roles, analyse the association between the identified leadership roles and sociodemographic and professional characteristics, describe surgical safety in the operating theatre, analyse the association between surgical safety in the operating theatre and sociodemographic and professional characteristics and analyse the association between surgical safety in the operating theatre and leadership roles. This was a quantitative, correlational, and cross-sectional study with a convenience sample of 88 perioperative nurses from a hospital in the north of Portugal. An online data collection instrument was used to characterise sociodemographic and professional characteristics, as well as Quinn's Leadership Questionnaire (Parreira et al., 2006) and the Questionnaire on Patient Safety in the Operating Theatre - items relating to the "Surgical Safety" area (Mota, 2021). Of the main results, with reference to leadership roles, the "Director" role had the highest average and the "Innovator" role had the lowest average. The roles of "Facilitator" and "Innovator" were associated with "Professional category" and "Place of work" respectively. As for "Total leadership", it was perceived as moderately positive, with an average value of over 4 in all roles. About Surgical Safety, the highest mean value was identified in the item "The Surgical Safety Checklist (SSC) is applied by the surgical team to patients undergoing surgical procedures, including those with local anaesthesia" and the lowest in the item "The results of audits on the use of the SSC are analysed by the team". The "Good practices" dimension varied according to "Professional title", "Place of work", "Professional category" and "Dual employment". The "Audit" dimension varied according to "Academic qualifications", "Professional title" and "Professional category". With regard to "Total surgical safety", at least half of the sample had a perceived safety score of 3.81. The results corroborate the authors who argue that perioperative nurses have a moderate level of perception of the exercise of leadership, pointing to the need to promote the development of different leadership roles exercised by nurse managers. There is a predominance of the roles of "Director", "Producer" and "Mentor" with a focus on productivity, control and results-orientated. Regarding "Surgical Safety," the results are in line with previous studies, revealing the importance of completing the SSC and sharing audits with the team. In conclusion, the characteristics of leadership and surgical safety identified in the sample of perioperative nurses studied show that there is room for reflection and the development of competences in this context. Investing in these dimensions will certainly contribute to the continuous improvement of the quality and safety of the care provided.
Leadership in nursing is among the most sensitive elements for the success of healthcare organisations. Nurse managers play a decisive role in managing health services and promoting healthy and safe environments for both professionals and citizens. Operating theatres are a context where patient safety is a crucial dimension and closely linked to management and leadership models. Based on these assumptions, a study was carried out as part of the research project "Quality and Safety in Healthcare (QSCare)", ESEP/CINTESIS@RISE, which aimed to: describe leadership roles, analyse the association between the identified leadership roles and sociodemographic and professional characteristics, describe surgical safety in the operating theatre, analyse the association between surgical safety in the operating theatre and sociodemographic and professional characteristics and analyse the association between surgical safety in the operating theatre and leadership roles. This was a quantitative, correlational, and cross-sectional study with a convenience sample of 88 perioperative nurses from a hospital in the north of Portugal. An online data collection instrument was used to characterise sociodemographic and professional characteristics, as well as Quinn's Leadership Questionnaire (Parreira et al., 2006) and the Questionnaire on Patient Safety in the Operating Theatre - items relating to the "Surgical Safety" area (Mota, 2021). Of the main results, with reference to leadership roles, the "Director" role had the highest average and the "Innovator" role had the lowest average. The roles of "Facilitator" and "Innovator" were associated with "Professional category" and "Place of work" respectively. As for "Total leadership", it was perceived as moderately positive, with an average value of over 4 in all roles. About Surgical Safety, the highest mean value was identified in the item "The Surgical Safety Checklist (SSC) is applied by the surgical team to patients undergoing surgical procedures, including those with local anaesthesia" and the lowest in the item "The results of audits on the use of the SSC are analysed by the team". The "Good practices" dimension varied according to "Professional title", "Place of work", "Professional category" and "Dual employment". The "Audit" dimension varied according to "Academic qualifications", "Professional title" and "Professional category". With regard to "Total surgical safety", at least half of the sample had a perceived safety score of 3.81. The results corroborate the authors who argue that perioperative nurses have a moderate level of perception of the exercise of leadership, pointing to the need to promote the development of different leadership roles exercised by nurse managers. There is a predominance of the roles of "Director", "Producer" and "Mentor" with a focus on productivity, control and results-orientated. Regarding "Surgical Safety," the results are in line with previous studies, revealing the importance of completing the SSC and sharing audits with the team. In conclusion, the characteristics of leadership and surgical safety identified in the sample of perioperative nurses studied show that there is room for reflection and the development of competences in this context. Investing in these dimensions will certainly contribute to the continuous improvement of the quality and safety of the care provided.
Descrição
Palavras-chave
Enfermagem Perioperatória Liderança Segurança do Paciente Cuidados Perioperatórios Gestão em Saúde