Atuação do enfermeiro no processo regulatório de acesso: proposta de sistematização

Abstract

INTRODUCTION: The health system has as its principles universality, integrality and seeks efficiency, with a view to quality and meeting the health needs of the population. Nurses are inserted in this context as protagonists of the regulatory process. This study sought to explore the literature on the subject, mainly related to the role of nurses in health regulation, and thus develop a technological tool that contributes to the improvement of care in the health regulation center of the Regional Hospital of Asa Norte, with the possibility of expansion to other units of the Health Department of the Federal District. OBJECTIVE: Presented as a general objective: to develop care technology that helps nurses in decision-making in the face of the regulation of health services, based on the systematization of nursing work, to achieve this objective, it followed the method of applied research. The specific ones were: to identify the main contributions of nurses in the regulatory process of hospitalization; to propose strategies that strengthen the participation of nurses as members of the regulatory process in hospitalization, these two objectives were achieved through the review of the scope, using the theoretical framework of the National Health Regulation Policy of the Unified Health System, elaborated by the Brazilian Ministry of Health, which served as support for the inferences made in the critical reflection of the identified studies; and the third objective, to build the Standard Operating Procedure of the Hospitalization Management Center, which followed the protocol model of the Health Department of the Federal District. PRODUCTS DEVELOPED: Product 1: developed the manuscript entitled "Process of regulation of access to health services: scoping review protocol", submitted to the journal Ciências & Saúde Coletiva, awaiting editorial decision. This study aimed to identify scientific evidence that discusses the nurse's work process within health regulation. It was a scoping review protocol based on the guidelines of the Joanna Briggs Institute. Studies were searched in the Pubmed, Scopus, Lilacs, Embase, ScienceDirect, Cochrane and Google Scholar databases, and the inclusion of gray literature through Google Scholar for online searches of manuals. Studies in Portuguese, English, and Spanish, published between 2006 and 2023, were considered eligible. The studies were organized using the Rayyan tool, and the analyzed data were presented using tables. The protocol was registered in Open Science Framework 10.17605/OSF. IO/QCJ73. Product 2: Developed the manuscript entitled "Systematization of regulation at health care levels: nurses' participation", submitted to the Brazilian Journal of Nursing, awaiting editorial decision. This study aimed to develop care technology for nurses in clinical decision-making, based on the systematization of the nursing service. This is a study of technological development of care, based on Applied Research, conducted in two sequential stages, scoping review and preparation of the manual. The scoping review followed the PRISMA-ScR tool and the guidelines of the Joanna Briggs Institute, registered in the Open Science Framework: DOI 10.17605/OSF. IO/QCJ73. Study developed between 2022 and 2024. In the review, 18 studies related to health regulation were analyzed, observing that the role of nurses as regulators is still little explored. Seven standard operating protocols have been developed and organized in a manual. The organization of the health regulation service reinforces the quality and safety of nursing care in this context, as the nurse's performance in their work routine, reducing empiricism and helping in critical clinical reasoning, which is widely used by professionals when performing regulatory actions in their daily lives, such as in the risk classification of procedures, in the regulation of beds or surgeries, among others. It is necessary to advance in legislation and care protocols, to improve services, especially in the Regulatory Complexes and Internal Regulation Centers. Product 3: health technology is developed, in the form of care protocols, organized in the "Manual called Standard Operating Procedure in the Regulation of Access to Hospitalization at the Regional Hospital of Asa Norte". Produced in order to synthesize information, clarify doubts, promote knowledge and minimize risks, and thus promote scientific credibility for care, being a quality tool, which aims at patient safety and reduction of adverse events related to bed management and other demands. The Inpatient Management Center of the Regional Hospital of Asa Norte was chosen to prepare the protocols of routines and care procedures, in the main activities, developed by the bed regulation team. Seven protocols were elaborated, with the description of the daily activities of this center, and organized in the themes: patient transfer in Panorama 1, patient transfer in Panorama 2, patient transfer in Panorama 3, Procedure for the admission of patients from elective surgeries, Procedure for the admission of patients from emergency surgeries, Procedure for the admission of patients discharged from the intensive care unit, Procedure of administrative and care routines in Bed Management, the topics met the main procedures carried out in the hospital's Bed Management. These protocols were chosen by the team, elaborated and reviewed together with the hospital's Internal Regulation Management, organized in the format of a care manual. The manual was divided into sections, with a total of 58 pages. It can be accessed at the following link: https://drive.google.com/file/d/1SDq5dKY55sg9CsdWqWoCRpKUwwyJOrS2/view?usp=drivesdk. This study is aligned with the research line of Quality in Adult and Elderly Health Care. Conclusion: The method used is adequate and innovative because it reports the systematization of nursing work as relevant to ensure quality care and nursing safety in the field of Health Regulation. It has the potential to influence public policies in the area of health management/regulation, as well as to impact health policies and practices, with the possibility of supporting nurses' actions in their work routine. This study presents originality and relevance for the scientific and technological development of the Nursing Area, by proposing a reduction in improvisation and helping in the critical clinical reasoning of nurses. The technical production developed has applicability because it is widely used by nursing professionals when performing regulatory actions in their daily lives.