RESUMO Objetivo: identificar os modos de manifestação da violência no trabalho em obstetrícia hospitalar, bem como seus fatores relacionados, consequências e estratégias de gerenciamento. Método: trata-se de revisão integrativa, com busca nas bases de dados MEDLINE, Lilacs, CINAHL, SciVerse Scopus e biblioteca virtual SciELO. Após a leitura dos artigos, efetuaram-se a extração e a análise dos dados. Resultados: constituiu-se a amostra de 11 artigos, a maioria de origem australiana. Os principais tipos de violência no trabalho em obstetrícia foram abuso verbal, intimidação, humilhação e assédio moral; relacionados a: trabalhadores com nível elevado de afetividade negativa; colegas de trabalho mais velhos e/ou hierarquicamente superiores; plantão diurno; pacientes e/ou acompanhantes sob estresse ou com transtorno mental; ambientes sobrecarregados/escassez de pessoal; as consequências incluíram os âmbitos pessoal, profissional e organizacional; e as estratégias gerenciais envolveram relatórios de incidentes, diálogos com colegas/familiares, protocolos de segurança, educação permanente. Conclusão: há evidências de violência no trabalho em obstetrícia hospitalar com impacto negativo sobre profissionais, pacientes e instituições. Sugerem-se estudos acerca desse fenômeno no Brasil, possibilitando aplicá-los na gestão de unidades obstétricas. Descritores: Enfermagem; Violência no Trabalho; Incivilidade; Obstetrícia; Enfermagem Obstétrica; Salas de Parto. ABSTRACT Objective: to identify the manifestations of workplace violence in hospital obstetrics, as well as their related factors, consequences, and management strategies. Method: this is an integrative review, with search of MEDLINE, Lilacs, CINAHL, SciVerse Scopus and SciELO virtual libraries. After reading the articles, the data were extracted and analyzed. Results: the sample consisted of 11 articles, most of them from Australia. The main types of workplace violence in obstetrics were verbal abuse, intimidation, humiliation, and bullying; related to: workers with high level of negative affectivity; older and/or hierarchically superior co-workers; day shift; patients and/or companions under stress or with mental disorder; overburdened environments/staff shortages; consequences included the personal, professional and organizational spheres; and managerial strategies involved incident reports, peer/family dialogues, safety protocols, continuing education. Conclusion: there is evidence of workplace violence in hospital obstetrics with negative impact on professionals, patients, and institutions. Studies about this phenomenon in Brazil are suggested, enabling to apply them in the management of obstetric units. Descriptors: Nursing; Workplace Violence; Incivility; Obstetrics; Obstetric Nursing; Delivery Rooms.RESUMEN Objetivo: identificar los modos de manifestación de la violencia en el trabajo de la obstetricia hospitalaria, así como sus factores relacionados, consecuencias y estrategias de gerenciamiento. Método: revisão integrativa, com busca nas bases de dados MEDLINE, Lilacs, CINAHL, SciVerse Scopus y biblioteca virtual SciELO. Após a leitura dos artigos, efetuaram-se a extração e a análise dos dados. Resultados: la muestra fue de 11 artículos, la mayoría de origen australiana. Los principales tipos de violencia en el trabajo en obstetricia fueron abuso verbal, intimidación, humillación y asedio moral; relacionadas a: trabajadores con nivel elevado de afectividad negativa; colegas de trabajo más viejos y/o jerárquicamente superiores; guardia diurna; pacientes y/o acompañantes sobre estrés o con trastorno mental; ambientes sobrecargados/escasez de personal; las consecuencias incluyeron los ámbitos personal, profesional y organizacional; y las estrategias gerenciales envolvieron informes de incidentes, diálogos con colegas/familiares, protocolos de seguridad, educación permanente. Conclusión: hay evidencias de violencia en el trabajo en obstetricia hospitalaria con impacto negativo sobre profesionales, pacientes e instituciones. Se sugieren estudios acerca de ese fenómeno en Brasil, posibilitando aplicarlos en la gestión de unidades obstétricas. Descriptores: Enfermería; Violencia Laboral; Incivilidad; Obstetricia; Enfermería Obstétrica; Salas de Parto.

Objectives: to analyze the predictors of moral harassment in nursing work in critical care units. Methods: a cross-sectional study conducted in a public hospital in Fortaleza, Ceará, with 167 nursing professionals in 2016. Sociodemographic/occupational questionnaire and Negative Acts Questionnaire Revised were applied. The analysis included descriptive statistics, measures of central tendency and dispersion, as well as Mann-Whitney, Kruskal-Wallis and Conover Inman U-tests for multiple comparisons. Results: there was a 33% prevalence of self-perception of moral harassment, highlighting personal/professional disqualification and work-related harassment. The predictors of moral harassment included age, time working in the job and time in the unit, employment relationship and sector. Conclusions: young professionals (< 30 years), cooperative, crowded in intensive care or emergency units, with less time working in the job (< 5 years) or greater time in the unit (above 10 years) are the biggest victims of moral harassment in the work of nursing in critical environments.

Enferm. Foco 2014; 5(3/4): 70-74 70Satisfação do paciente com os cuidados de enfermagem: que dimensões se sobressaem?Resumo: Objetivou-se avaliar domínios e dimensões da satisfação do paciente com a assistência de enfermagem. Estudo transversal, realizado com 156 pacientes em unidades de internação de hospital público de Fortaleza-CE. Para as associações com os domínios empregaram-se os testes de χ2 e de razão de verossimilhança. A assistência foi considerada boa pela maioria dos pacientes, com predomínio dos domínios confiança e profissional em detrimento do educacional. Destacaram-se as dimensões empatia, relacionamento interpessoal e humanização. Apesar dos entrevistados mostrarem-se satisfeitos, é preciso investimento em uma Enfermagem centrada no paciente, inserindo-o como sujeito ativo no tratamento e obtendo maior satisfação pelo cuidado prestado. Descritores: Enfermagem, Cuidados de Enfermagem, Satisfação do Paciente, Qualidade da Assistência à Saúde, Gestão da Qualidade. Patient satisfaction with the nursing care: what dimensions predominate?Abstract: Aimed to evaluate the domains and dimensions of patient satisfaction with nursing care. Cross-sectional study with 156 patients in inpatient units of a public hospital in Fortaleza-CE. For associations with the domains were employed χ2 and likelihood ratio tests. The assistance was considered good by most patients, with a predominance of confidence and professional domains at the expense of education. Notable dimensions were empathy, interpersonal relationship and humanization. Despite the interviewed were satisfied, we need investment in a patient-centered nursing, inserting it as an active subject in the treatment and getting more satisfaction for the care provided. Descriptors: Nursing, Nursing Care, Patient Satisfaction, Quality of Health Care, Quality Management. Satisfacción del paciente con los cuidados de enfermería: qué dimensiones sobresalen?Resumen: El objetivo fue evaluar dominios y dimensiones de la satisfacción del paciente con la atención de enfermería. Estudio transversal con 156 pacientes en unidades de hospitalización de un hospital público en Fortaleza-CE. Para las asociaciones con los dominios se emplearon las pruebas de χ2 y razón de verosimilitud. La asistencia fue considerada buena por la mayoría de los pacientes, con predominio de los dominios confianza y profesional, en lugar del educacional. Las más destacadas dimensiones fueron empatía, relaciones interpersonales y humanización. A pesar de los entrevistados se mostraren satisfechos, es necesario investir en una Enfermería centrada en el paciente, insertándolo como un sujeto activo en el tratamiento y conseguir una mayor satisfacción de la atención recibida.

The United States has the world's highest per capita health care costs, and tax-funded expenditures accounted for nearly 64.3% of US health care spending [1]. Although hospital associated costs continue to rise, the US government sought a way to control costs while encouraging hospitals to provide care more efficiently [2]. Starting in the 1980's, The Centers for Medicare and Medicaid Services, developed a coding system using Diagnosis-Related Group (DRG) to provide guidelines for reimbursement of funds to physicians and medical organizations for services rendered [2]. Diagnosis-Related Group (DRG) is a statistical system of classifying any inpatient stay into groups for the purposes of payment [2]. Rather than paying the hospital for what it spent caring for a hospitalized patient, Medicare pays the hospital a fixed amount based on the patient's DRG or diagnosis [2].Background: Nurses play a vital role as clinical documentation improvement (CDI) specialists to facilitate the coordination of patient care by providing a concurrent review of medical records for every hospitalized patient. They serve as liaisons between physicians and medical coders to ensure accurate coding, improve reimbursements, patient safety and outcomes. CDI specialist may provide support to a more transparent healthcare team by making recommendations for care based upon patient findings after thorough investigation of all laboratory and diagnostic tests along with the physicians' narrative.Method: This paper used two case studies to describe the role of a nurse CDI specialist in a hospital setting. Information from the case studies were used to show the importance of a collaboration between a nurse CDI specialist and physician to improve patient care and provide accurate coding. Discussion/Conclusion: CDI specialist provide additional oversight to help prevent billing and coding mistakes that may lead to federal investigations and or poor patient outcomes. Nurses may be optimal CDI specialists because their education and clinical experience helps them evaluate many aspects of the medical record to make recommendations for care based upon best evidence-based practice. They are able to understand the patients diagnoses and ensure that the patient's course of hospitalization is aligned with accurate treatment. Thus, providing a bridge between clinical coders and physicians by interpreting and coding narrative data concurrently so reimbursements are accurate when completed post discharge.