The meaning of care to brain dead potential donors involves understanding the complexity of this patient who can save somebody's life through organ donation.

Objectives: to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing. Method: an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis. Results: the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing. Conclusion: this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient.

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RESUMO: Objetivou-se apresentar aspectos inovadores para a prática profissional do enfermeiro, no que se refere ao diagnóstico de morte encefálica no processo de doação e transplante de órgãos e tecidos, abordando as interfaces entre a gerência do cuidado e a segurança do paciente. Enfatiza-se a padronização de processos, utilizada para promover agilidade, redução das perdas por parada cardíaca com aumento concomitante das doações reais, e diminuição do tempo entre o primeiro exame clínico e o explante. Permite que a equipe reconheça as anormalidades e faça as correções necessárias em tempo hábil. Assim, vislumbra-se que a segurança do paciente deve subsidiar as tomadas de decisão e intervenções de gestão, de modo a qualificar a prática de cuidado. DESCRITORES: Gerência; Cuidados de enfermagem; Segurança do paciente; Obtenção de órgãos e tecidos; Transplantes. SEGURANÇA DO PACIENTE NO PROCESSO DE DOAÇÃO E TRANSPLANTE DE ÓRGÃOS E TECIDOS PATIENT SAFETY IN THE PROCESS OF ORGAN AND TISSUE DONATION AND TRANSPLANTABSTRACT: This article aims to present innovative aspects for the professional practice of the nurse, regarding the diagnosis of brain death in the process of donation and transplantation of organs and tissues, addressing the interfaces between the care management and patient safety. Emphasis is placed on the standardization of processes, used to promote speed, reduction in losses from cardiac arrest with a concurrent increase in actual donations, and reduction of time between the first clinical examination and harvesting of the organ. It allows the team to recognize abnormalities and make the necessary corrections in time. Thus, it is seen that patient safety should be a basis for management's decision-making and interventions, so as to make the care practice of adequate quality. DESCRIPTORS: SEGURIDAD DEL PACIENTE EN EL PROCESO DE DONACIÓN Y TRASPLANTE DE ÓRGANOS Y TEJIDOSRESUMEN: Estudio cuyo objetivo fue presentar aspectos innovadores para la práctica profesional del enfermero acerca del diagnóstico de muerte encefálica en el proceso de donación y trasplante de órganos y tejidos, considerándose las relaciones entre la administración del cuidado y la seguridad del paciente. Se destaca la estandarización de procesos, utilizada para promover agilidad, reducción de pérdidas por parada cardíaca con aumento concomitante de las donaciones reales, así como disminución del tiempo entre el primer examen clínico y el explante. Eso posibilita que el equipo reconozca las anormalidades e haga las correcciones necesarias en tiempo hábil. De ese modo, se constata que la seguridad del paciente debe subsidiar las decisiones e intervenciones de gestión, a fin de calificar la práctica de cuidado.

Objectives: to identify information that can support creating good practice assumptions to develop family interview for organ and tissue donation. Methods: this scoping study, conducted in two Brazilian hospitals in the southern, between April and December 2017, included integrative review and consultation with 15 families who experienced interview for organ donation. For data analysis, thematic content analysis was used. Results: three categories emerged: communication of death, which shows the need to know the history of hospitalization of patients; emotional support, the team must have mastery of the stages of mourning; information about donation, professionals need to know the stages of the donation process and respect families’ time. Final Considerations: good practice assumptions point to the need for team training, respect for family time and the use of simple language.

Objective: To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward. Method: Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding. Result: The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care. Conclusion: Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards. Descriptors: Management; Nursing Care; Nursing Supervision; Obstetric Nursing; Research About Nursing Administration. RESUMOObjetivo: Compreender as estratégias de gerência do cuidado utilizadas pelos enfermeiros para a governança da prática de enfermagem em uma maternidade. Método: Pesquisa qualitativa do tipo Teoria Fundamentada nos Dados, realizada com 27 participantes, divididos em quatro grupos amostrais. Os dados foram coletados por meio de entrevistas semiestruturadas e analisados mediante codificação aberta, axial e seletiva. Resultado: As estratégias de gerência do cuidado utilizadas pelos enfermeiros identificadas foram o planejamento da prática profissional, a liderança da equipe de enfermagem, a busca do conhecimento científico e a realização de capacitações sobre melhores práticas no cuidado obstétrico. Conclusão: A articulação entre gerência do cuidado e governança de enfermagem pode propiciar melhores resultados assistenciais e potencializar a autonomia do enfermeiro na coordenação do trabalho de enfermagem em uma maternidade. Descritores: Gerência; Cuidados de Enfermagem; Supervisão de Enfermagem; Enfermagem Obstétrica; Pesquisa em Administração de Enfermagem. RESUMENObjetivo: Comprender las estrategias de administración del cuidado utilizadas por los enfermeros para la gobernanza de la práctica de enfermería en una maternidad. Método: Investigación cualitativa del tipo Teoría Fundamentada en los Datos, realizada con 25 participantes, divididos en cuatro grupos muestrales. Los datos fueron recogidos a través de entrevistas semiestructuradas, y analizados mediante codificación abierta, axial y selectiva. Resultados: Las estrategias de administración del cuidado utilizadas por los enfermeros que fueron identificadas fueron: planificación de la práctica profesional, liderazgo del equipo de enfermería, búsqueda del conocimiento científico, y realización de capacitaciones acerca de mejores prácticas en el cuidado obstétrico. Conclusión:Care management and nursing governance in a maternity ward: grounded theory 1278Care management and nursing governance in a maternity ward: grounded theory Copelli FHS, et al. INTRODUCTIONCare management is one of the main anchors of professional nursing practice in health services, as it encompasses the relationship betwe...

Objetivo: evidenciar el conocimiento científico sobre la teoría de la complejidad en las publicaciones científicas sobre gestión en enfermería y salud. Método: revisión integrativa que se realizó en mayo del 2014, en las bases de datos LILACS, BDENF y PubMed por medio de la combinación de las siguientes palabras clave: teoría de la complejidad, pensamiento complejo, Edgar Morin, enfermeros, enfermería, organización, administración, gestión y gerencia. Se incluyeron diez artículos, publicados entre 2004 y 2013. Resultados: se evidenció el crecimiento de la producción científica sobre el pensamiento complejo en la gestión de enfermería y salud. Todos eran artículos originales; siete de abordaje cualitativo. Interpretación: se construyeron dos categorías temáticas: “Pensamiento complejo que sostiene las prácticas de la gerencia del cuidado” y “Administración compleja en la perspectiva de las organizaciones de enfermería y salud”. Conclusiones: el pensamiento complejo es un paradigma relacionado a la integralidad, multidisciplinariedad, atención a las redes de apoyo y articulación de los saberes. Se ha usado como modelo de gestión en organizaciones vivas e imprevisibles para promover la organización de los sistemas complejos adaptativos. Este estudio contribuye con la aproximación del referencial de la complejidad con los conceptos de gestión en enfermería y salud, dando mayor visibilidad para futuras publicaciones.

Objective: Identify by means of a management tool causes of losses of possible and potential organs and tissues donation as opportunities of improvements in the organs and tissues donation system. Method: Descriptive and quantitative study developed in three hospitals in the south of the country, which used an instrument of the National Transplant Organization of Spain to trace opportunities of improvements in the scenario of the organs and tissues donation. Tha data collect was carried out in patients´medical records from July and October 2017. The data were analyzed through the descriptive statistics. Results: Of the 321 deaths occurred, 73% were heart arrested and 27% were brain death. In all hospitals the percentage of brain death was higher than 25%. The causes of losses involve hemodynamic alterations 78.3% and medical contraindications 21,7%, with respect to hemodynamic instability 33% related to the hypotension, polyuria 28% , sodium more than 155mEq/l 22% and temperature below 35.5ºC in 17%. Conclusion and Implications for practice: The main causes of loss involve the hemodynamic instability and the contraindication, with respect to opportunities of improvements it was possible to measure the causes of the non-validation of the potential organs donor. The management tool used in the study allows the healthcare team to develop strategies directed towards actual problems incurred at the stages of the donation and transplantation process.