Objective: To analyze the influence of shift work on blood pressure, the presence of burnout and common mental disorders in nursing professionals. Method: A cross-sectional study. Burnout was assessed by the Maslach Burnout Inventory, and Common Mental Disorders by the Self-Reporting Questionnaire. Casual blood pressure measurement and Ambulatory Blood Pressure Monitoring (ABPM) were performed. Results: 231 professionals participated. The majority (59.7%) worked in shifts, and this condition was associated (p≤0.05) with: higher weekly workload; doing the night shift; shorter training and work time at the institution; alcoholism; leisure activity; and alteration in ambulatory blood pressure monitoring of the sleep period. The professionals with common mental disorders and who worked in shifts had lower casual diastolic pressure levels (p = 0.039) and higher hypertension prevalence (p = 0.045). The presence of emotional exhaustion was associated with normal waking blood pressure and depersonalization with altered sleep blood pressure. Conclusion: Shift work was associated with a higher prevalence of work-related negative factors, inadequate habits and lifestyles, and change in sleep blood pressure.
Introdução: Na gestão hospitalar, sistemas de referência e contrarreferência efetivos atuam como elementos essenciais para a integração das redes de saúde diante da complexidade dos serviços. Objetivo: Mapear o processo de alta de um hospital público de ensino de alta complexidade do município do São Paulo e criar protocolos de contrarreferência para pacientes atendidos nos Ambulatórios do Serviço de Cirurgia do Esôfago e Fígado e Hipertensão Portal. Método: Estudo descritivo, com revisão bibliográfica e realização de Benchmarking, sendo desenvolvida uma proposta de melhoria para a área interessada. Resultado: Foi realizado um diagnóstico situacional do setor ambulatorial onde se notou uma falta de padronização em relação ao documento utilizado e elaborados relatórios de alta e protocolos para diagnósticos específicos de acordo com os protocolos terapêuticos dos grupos analisados. Conclusão: Faz-se necessário a criação de protocolos de contrarreferência a fim de diminuir a demanda e a superlotação dos hospitais de alta complexidade com casos que poderiam ser sanados na rede de saúde com atenção menos especializada, otimizando assim o sistema de saúde e respeitando seu caráter hierarquizado e de rede.Palavras-chave: Administração de Serviços de Saúde; Assistência Ambulatorial; Administração Hospitalar; Gestão em Saúde; Hospitais Públicos; Hospitais de Ensino. Abstract:Introduction: In hospital management, effective referral and counter-referral systems act as essential elements for the health networks integration in the face of service complexity. Objective: To map the discharge process of a high complexity public teaching hospital in the city of São Paulo and create counter-referral protocols for patients attending the Ambulatory Esophageal and Liver Surgery and Portal Hypertension Clinical Services. Method: A descriptive study, with a bibliographic review and Benchmarking, and an improvement proposal were developed for the area. Outcome: A situational diagnosis was performed in the outpatient clinic where a lack of document standardization was observed, then discharge reports and protocols for specific diagnoses were elaborated according to the therapeutic protocols of the analyzed groups. Conclusion: It is necessary to create counter-referral protocols in order to reduce the demand and overcrowding of highly complex hospitals with cases that could be treated in the health network with less specialized health services, thus optimizing the health system and respecting its hierarchical and network character. Keywords: Health Services Administration; Ambulatory Care; Hospital Administration; Hospital Administration; Health Management; Hospitals, Public; Hospitals, Teaching.
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