Nurse Leadership Practices in Primary Health Care: A Grounded Theory

Abstract

This is a qualitative study and its aim was to understand the meaning of nurse leadership exercised in the services of Primary Health Care in a municipality located in Southern Region of Brazil. Grounded Theory was used as methodological framework. Data collection was carried out with semi-structured interviews applied to 30 nurses who worked in Primary Health Care and nursing professors, divided into four groups, between 2011 and 2012. After the analysis process, nine categories emerged and sustained the phenomenon 'Revealing the nursing leadership practices in the complex context of Primary Health Care'. Leadership was understood as a resource in the process of caring/managing people and developing a team of leaders, intending the organization and qualification of health work. It is important to rescue the clinical work of nurses, in order to keep their investment in the health team and to strengthen the binomial leader/caregiver.

Health advocacy by nurses in the Family Health Strategy: barriers and facilitators

“…The existence of communication barriers between the different health system levels was also appointed as a restricting factor to the nurses' work as health advocators. To a large extent, this fact is characterized by double or no information between the unit professionals, coordinators and the population, associated with the consistent displacement of FHS nurses to perform managerial activities, which causes work overload (19) . Among the barriers to the exercise of health advocacy and users' empowerment by nurses, work overload stands out.…”

“…Among the barriers to the exercise of health advocacy and users' empowerment by nurses, work overload stands out. It is also related to the unsuitable physical structures and shortage of health professionals, considering that in the absence of team members nurses have to perform other activities that prevent them from fulfilling with quality their core actions of promotion, prevention and protection to the health of users in the FHS (19) . Work overload usually makes nurses cope with moral problems, notably related to feelings of helplessness and lack of autonomy regarding the users' wellbeing (7,20) .…”

Leadership in the perspective of Family Health Strategy nurses

“…In addition, formal training can increase nurses' skills in leadership practice and address gaps in the teaching-learning process inherited from undergraduate education, as demonstrated in a study conducted with 512 nurses from 23 hospitals in Arizona, United States (17) . The offering of courses organized by the management of health services was identified as a facilitating strategy for the development of leadership by nurses from southern Brazil in the PHC (18) , and this is a necessity pointed out in the speeches of the participants in this investigation.…”

Perspectiva do usuário de drogas sobre seu tratamento e a rede de atenção psicossocial

“…A relação entre profissionais de saúde e usuários do CAPS deveria ocorrer não apenas em consultas individuais, mas em grupos e oficinas. Quanto aos profissionais técnicos de enfermagem, as observações mostraram que seria necessária uma capacitação desses funcionários para abordar os usuários a fim de que a relação profissional/usuários não seja de amizade (12) .…”

“…A enfermagem tem papel de destaque por estar na "linha de frente" do cuidado, sendo que a liderança do enfermeiro está vinculada a sua formação acadêmica, que abrange disciplinas como administração, gerência e outras que trabalham com o âmbito psicossocial e biológico, fazendo desses profissionais aptos a atuarem como importantes formadores de vínculos, sendo essa capacidade observada quando se nota que dos profissionais de nível superior é o que mais se aproxima dos usuários (12) .…”