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OnlineBrazilianJournalofNursing,Vol12,No2(2013)
REVIEWARTICLES

Theroleofanurseinthemanagementofmedicalhospitalmaterial:
anintegrativereview

SimoneDominguesGarcia1,RoseliBroggiGil1,MariadoCarmoLourenoHaddad1,Marli
TerezinhaOliveiraVannuchi1,DanieleBernardidaCosta2
1UniversityofLondrina
2UniversityofSoPaulo

ABSTRACT
Theobjectofthestudyisthemanagementofmedicalhospitalsupplies.Thisisanareathatrequires
thenursetohavespecificknowledgeandwhichhascurrentlysparkeddiscussionsamongexpertson
thesubject.
Aim:Tocharacterizetheproductionofknowledgeonthemanagementofmedicalhospitalmaterial
conductedbynurses.
Method:Aretrospective,descriptivemethodthatfollowedthestepsofanintegrativereview.Forthe
researchtheLilacs,MedlineandGooglescholardatabaseswereused.

Results:Wefound104studies,ofwhichtenwereselected.Theanalysisofthepublicationsshowed
thatthemanagementofmaterialhasbeendiscussedinthecontextofeducationalpractices,controlof
costsandmaterials,asaworkingtool,andfromtheperspectiveofthenurseinmaterialmanagement.
Discussion:Itisnecessarytoincorporatethethemeintheworkingprocessofnurses,providing
criticalthinkinginrelationtomanagement.
Conclusion:Theexpansionofscientificproductionandgreaterinterestofnursesinthisareaare
essential.

Descriptors:ResourceManagementMaterialsadministrationinhospitalNursing.

INTRODUCTION
Inhealthcareinstitutions,especiallyinhospitals,materialresourcemanagement(MRM)constitutesa
particularlyimportantissue,consideringthediversityofmaterialsusedandtheirhighcost,especially
thoserelatedtothecareofthehospitalizedpeople.Theadministrationoftheseisnormallycarriedout
bytheadministrativeareawithouttheinvolvementofspecializedareassuchasnursing (1).
Materialresourcesinhealthcarecanbeclassifiedaccordingtoseveralcriteria:purpose,storage
specificity,valueandlevelofcriticalityorapplication.Inrelationtopurposetheresourcescancomprise
largegroupsofmaterials,namely:medicines,hygiene,laboratory,computer,maintenance,food
productsandmedicalhospitalsupplies(2).
Ithasbeenprovedthatexpenditureonequipmentinahospitaltakessecondplacebehindhuman
resources.,Thismakescleartheimportanceandneedfordataandinformationtoassistmanagement
inthissegment(3).
Efficientandeffectivemanagementofmaterialresourcesinhealthinstitutionsneedstobealignedwith
theissuescare.Effectivecontrolsneedtobeadoptedtoensuretheavailabilityofsuchresourceswith
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quality,timing,quantityandfairprice(8).
Nursingstaffarethegreatestrequestersanduseroftheseproducts,mainlyitemsclassifiedas
medicalhospitalThenursethereforehasagreatresponsibilitytorethinkthesignificanceofmaterial
managementinmanagerialactivities(4).
Thenursesworkincoordinatingpositionshasbeennotedforenabling,encouragingandcreating
technicalconditionssothatassistanceisproperlydeveloped(1).However,thisprofessional,increasingly
involvedinmanagement,isnotproducingscientificresearchandpublicationsthatdemonstratethe
involvementandscale.Thishasrealimportanceinupgradingthearea.
Thelabormarkethasrequirednursestoexpandtheirmanagerialskills,highlightingaspectsof
economicsinhealth,includingfinancing,billingandcost.Thus,thenursehastodemonstrateother
skillsandfunctionsinadditiontocare.BothwithinandoutsidethehospitaltheNurseisbecomingan
importantprofessionalinmanagingmaterialresources(1).
Bystatingthatmaterialresourcesareessentialworkingtoolsforthedevelopmentofassistance
activities,nursingparticipationinitsmanagementisdirectlyrelatedtothequalityofcare(1).
Itis,thus,crucialforthenursetodemonstrate,bymeansofscientificproduction,thenecessary
reasoningfortheworkprocessinmaterialsmanagement.Thiswillhighlightthenursestheoreticaland
practicalcompetenceasthemainstimulatorforimprovingthescienceofadministration(5).
Inthiscontext,theobjectivewastocharacterizetheproductionofknowledgeinthemanagementof
medicalhospitalmaterialconductedbynurses.

METHOD
Thisisaretrospectiveanddescriptivestudy,whichfollowedthestepsofanintegrativereview.The
researchmethodusedwastoanalyzeprimaryresearchandcompileasummaryoftheknowledge
producedaboutatopic.
Theconstructionofthisintegrativereviewwasbasedonstudies(6,7)thatfollowedsevenestablished
stages,namely: (1)problemidentificationanddefinitionoftheresearchquestionofthereview (2)
definitionofthecriteriaforinclusionandexclusionofarticles (3)literaturereview (4)definitionof
informationtobeextractedfromthereviewedstudies (5)analysisofthestudiesincludedinthe
integrativereview (6)discussionandinterpretationofresultsand (7)synthesisofknowledge.
Theintegrativereviewbecomesimportantwhenthereislittleresearchonagiventopic(7).When
locatingandintegratinginformationdevelopedbyvariousauthorsonthesubjectthemethodallows
identificationofthestageatwhichtheknowledgeproducedorevenelucidatesmattersnotsolved(7).
Itisconsideredthatawelldevelopedintegrativereviewonarelevanttopiccouldimpacton
professionalpractice(7).
Inrelationtothefirststepsuggestedbythemethod,whenidentifyingtheproblemoftheneedforthe
participationofnursesinmaterialsmanagement,theguidingquestionofthestudywas:"Inscientific
publications,istheparticipationofnursesinthemanagementofmedicalhospitalmaterialmentioned?"
Thesecondstepestablishedbythemethodologyinvolvestheinclusionofcriteria,whichwere:studies
relatedtomaterialsmanagementbynursing,publishedintheperiodfrom2000to2010,inPortuguese,
EnglishandSpanish,andasummaryavailableinthedatabase.Weconsideredtheresearchpresented
infreeteachingcontests,theses,dissertations,researchpapersandextendedabstractsrelevanttothe
topic.
InthemethodologicalsequencealiteraturereviewwasperformedbyasearchintheVirtualHealth
Library(VHL)ofthefollowingdatabases:Lilacs,MedlineandGooglescholar.
ThepublicationswereselectedfromthefollowingdescriptorsofHealthSciencesinthethreelanguages
coveredbythisresearch:management,materialresources,medicalhospitalsuppliesandnursing
material.WeusedthecombinationoftheseelementsusingtheBooleanoperatorAND.
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Afterwards,therewasanewsearchpreservingthesamedescriptorslistedabove,excludingtheterm
nursing.Thiswastoseeiftherewasachangeinthenumberofstudiesfound,andalsoattemptto
identifyotherareasthatcouldworkwiththistheme,giventheinvolvementwiththemanagementof
materials,suchastheadministrationarea.
Weusedatimeframeofthreemonthsbetweenthefirstandsecondsearch,correspondingtoearly
JuneandearlySeptember2011.Theintervaloftimeisconsideredsufficientforthecorrect
identificationofthesubjectinthestudies,respectingallthestepsrecommendedbythemethodin
question.
Afterdefiningtheinformationtobeextractedfromthearticlesidentifiedcontainingthequoteofthe
nurseinthemanagementofmaterials,weproceededwiththeanalysisofthestudiesincludedinthe
integrativereview.
Thestepsfiveandsixwereperformedbythedevelopmentofcategoriesthatwouldhelpthediscussion
andinterpretationoftheresults.Inaddition,thisenrichedthesynthesisofknowledgewhichispartof
theseventhstageseven.Thislaststepinvolvedtheorganizationoftheinformationprovidedandthe
presentationoftheevidencerevealed.Thiswasimplementedafterevaluationofthestudiesincludedin
thisreview.

RESULTS
Thefirstsearchofdatabasesresultedin76publications,ofwhich24werereturnedinLilacs,38in
Medlineand14inGooglescholar.Ofthosepublications,fourweretheresultofresearchadvocatedin
freeteachingcontests,17weredoctoraldissertations,30mastersdissertations,24journalarticlesand
anexpandedabstract.Atthisstageonlyeightwereselected.
Inthesecondsearch,inwhichthedescriptornursingwasremoved,28publicationswerereturned.
Weappliedtheinclusioncriteriathatrequiredanalysisoftheabstractsandfromthisstageonlytwo
studieswereselected.
Throughtheanalysisoftheabstractsitwasnotedthatthematerialsmanagementbynurseswas
mentionedinthreeMastersDissertationsfromdifferentareas:nursing,productionengineeringand
medicine.
Onceselected,thepublicationswereclassifiedandcategorizedinthefollowingmodalities:1)materials
managementintheprocessofteaching,innursing2)materialsmanagementasaworkingtool3)the
nurseincontrollingcostsandmaterialsand4)nursesasoneoftheplayersofmaterialsmanagement.
Themattersdiscussedinthestudiesarerelatedtothedevelopmentofmedicalhospitalsupplies,
consumption,instrumentvalidationandclassification.
Next,herearetheresultsbycategory,featuringtheselectedpublicationsandtheirmain
characteristics.

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DISCUSSION
Materialmanagementintheteachingprocessinnursing
Materialmanagement,asaneducationalpracticeinnursing,isanimportantskilltobedevelopedby
thestudent.Thestudentscriticalthinkingabouttheproductsusedinthehospitalwillbestimulated(I).
Thus,wereinforcetheimportanceofincluding"Materialmanagement"indifferentareasofgraduation
takingaccountofstudents'developmentandthelearningstagetheyhavereached.Itisnecessaryfor
thegraduatestohavesuccessiveencounterswiththetheme,sothattheymaybuildtheirknowledgeof
materialmanagement,fromtheplanningtotheacquisitionprocess.,Thefeelingofuneaseand
discomfortisconsideredrelevanttothetransformationoftheworkingpracticesofhealthprofessionals.
Itisessentialthattheseconcernsarediscussed,dialoguedandthoughtthroughinalltheirdimensions.
Inthiscase,continuingeducationprovidesthecapacitytodothis (8).
Continuingeducationalonewillnottransformthepractices,butthegradualdevelopmentofthis
educationalprocesscanbefullyexploitedinordertoencouragethegrowthofindividuals.Thus,
educationbecomesapropellingsourceofprofessionaltransformation (8).Whensuggestingtheinclusion
ofmaterialmanagementincontinuingeducationcourses,weproposeanewperspectiveonthe
relevanceofthesubjectfortransformingtheempiricalknowledgeofnursesintoastrategic
differentiatorintheworkplace.
Professionalsbelievethatparticipationisthemostappropriatewaytoachievethechangesthatmeet
theneedsofhumanbeings,whetherinpersonal,professionalorinstitutionalareas(II).Theseworkers
areawareoftheimportanceofopinionsonadministrativeneedsandpriorities,positioningthemselves
andraisingawarenessamonginstitutionalleadersaboutthemanagementofmaterialresources(1).The
strategyofcontinuingeducationoutlinedinthestudy,providedtotheprofessionals,involvedtheneed
forchangeandappreciationthattheroleofeachpersonintheprofessionalpracticewasessentialin
theworkingprocess.
Materialmanagementasaworkingtool
MaterialmanagementasanimportantworkingtoolwasmentionedinthestudieslistedinTable2.
Theseshowtheimportanceofexploitingthepracticeofhealthprofessionals.Whenconsideringworking
toolsitisimportanttocitetheprofessionalskillsofnurseswhichhavebeendefinedas:Toknowhow
toactinaresponsibleandrecognizedway,whichimpliesinmobilizing,integrating,transferring
knowledge,resourcesandskillsthataddeconomicvaluetotheorganizationandsocialvaluetothe
individual (8).
Thestudyalsodiscussestheindividualskillsnecessaryformanagers,suchasleadership,persuasion,
teamwork,creativity,decisionmaking,planning,organizationanddetermination.Theseskillsarealso
listedasfollows:toknowhowtoact,tomobilize,tocommunicate,tolearn,tocommityourself,to
takeresponsibilityandtohavestrategicvision (8).
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Fortheprovisionofnursingcarethenursesresponsibilityarethetasksdirectlyrelatedto
clientsupport,aswellastheleadershipofthenursingstaffandthemanagementofphysical,material,
human,financial,politicalandinformationresources.
Nursesmusthaveknowledge(theymustknowwhattodo),skills(howtodoitcorrectly)andhavethe
appropriateattitudetoperformtheirrolewithpositiveresults (8).Inordertocarryouttheproposed
activitiesthenurseshouldbeequippedwithworkingtoolsthatmeettheneedsoftheservice,the
developmentoftheteamandthequalityofcareofferedtopatients.
Thenurseplaysakeyroleinthemanagementofmaterialandequipmentresourcesinhealthservices.
Thenurseusuallytakesoverthemanagementoftheunitsandthecoordinationofthecareactivities
thatareperformedbytheentirehealthcareteam.Inviewofthistheneedtodevelopamaterial
managementsystemarises.Thiscanbereferredtoasaworkingtool,withthegoaloforganizingthese
resourcestofacilitatenursingcare (9).
InthestudiespresentedinTable2(III,IV,VandVI),thestrategiesresearchedbyprofessionalsin
ordertoprovidethequalificationoftheworkingprocessoffered,eitherinprimarycareorhospital
care,isdemonstrated.Theimportanceoftheinvolvementofnursesinthemanagementofmaterialsis
indisputable.Thetopichasbeengainingstrengthwithdailypracticeandinthestudiesalreadyraisedin
recentyears.However,itisnecessarytostimulatediscussionaboutwhichtoolsarebestsuitedtoeach
typeofhealthservice.
Itisclaimedthattheclassificationofmaterialsisanimportantmanagementtool(VI).Asaresultof
thediversityofmaterialsandwiththeneedtominimizesituationsofshortages,deviationsandwaste
ofmaterialsthathampertheprocessofhospitalmanagement,newmanagementtoolshavebeen
incorporatedinthisprocess(10).
Thenurseonthecontrolofcostsandmaterials
Inrelationtothetopic"costs",discussedinTable3,themanagementofmaterialsandequipmenthas
concernsaboutboththequalificationofnursingcareandthemanagementcostsfortheinstitution.
Facedwithincreasingtechnologicalincorporation,theexpansionofhealthcareexpendituresandthe
needtocontainthemduetolackofresources,moreandmorenurses,worldwide,areinvolvedwith
issuesrelatingtoassistanceeconomicvaluesintheirworkplaces(11).
Theproblemwiththemanagingappropriatecostsinhealthcareisduetothedisproportionbetweenthe
demandfornecessitiesandtheavailabilityofresources.Thishasdrawnattentiontoarecentthemein
nationalnursingliterature:thecostsrelatedtonursingservices.Itisconsideredthatknowledgeof
nursingcostsisamanagementtoolthatallowsnursestoscaletheavailableresourcesandmake
decisionsbasedonthebestscientificevidence (12).
Concernsabouttherisingcostofthehealthcaresupplychainsector,particularlyinhospitals,givesrise
totheadoptionofcontrolstrategies,primarilyinthestockofmaterials,toensuretheviabilityofthese
institutions (10).Unpredictabilityofdemandisapermanentproblemwhichrequiresadministrative
flexibilityinmeetingtherequirementsinherentintheinstitutionsobjectives (1).Inthehospital
environmentmaterialexpensesrepresentapproximately15%to25%ofregularexpenditure.About
3,000to6,000itemsofhighcomplexityconsumedinhospitalsarepurchasedwithcertainfrequency.It
shouldalsobehighlightedthatthepeculiaritiesofthesystemarenotrestrictedjusttothequantityof
itemsortheircost,butalsothediversityoftheproductiveprocesswhichnormallyremainsdetached
fromthesupportsystems,thuscomplicatingitsmanagement(1).
Thedimensionofcostswhendeployingnewtechnologieshasnotalwaysbeenaconcerninpublic
services.However,nowadays,withtheneedforselfsufficiencyandcompetitivenessinthemarket,
managing,reallocatingandoptimizingresourcestominimizecostshavebecomeoneoftheconcerns
ofnursing.Thisissuepointstotheneedforthedevelopmentofmanagerialcompetenceprocesses
focusedonresults(13).
Thus,theparticipationofprofessionalsisthemostappropriatewaytoachievechangesthatmeetthe
needsofhumanbeings,whetherinpersonal,professionalorinstitutionalareas.Theseworkersare
awareoftheimportanceoftheiropinionsontheadministrativeneedsandprioritiespositioning
themselvesandraisingawarenessamonginstitutionalleadersabouttheimportanceofMRM.In
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addition,theyidentifythequestion"costversuseffectivenessversussatisfaction"andnotmerelythe
costs(1).
Therefore,itisimperativetoknowandunderstandtheadministrativerealityexperienced,inorderto
beabletoactonit.Thus,itisnecessarytodiscusswiththepeoplethatpromote,collaborateanduse
thematerials,abouttheknowledgetheyhaveregardingthemanagementofmaterialresources(1).
Thenurseasoneoftheenactorsofmaterialmanagement.
ThenurseasoneoftheenactorsofmaterialmanagementisasignificantfactorInstitutionsrequire
theiremployeeshaveaprofessionalprofileandconstantlydeveloptokeeppacewithtechnological
innovation,thepotentialforproblemsolving,negotiationskillsandproactivity(X).Withinhealth
organizationsthecurrentdemandisanursingprofilethatrequiresagilityaswellasassertive,creative,
andinnovativedecisions,addingeconomicvaluetothecompanyandsocialvaluetotheindividual (13).
Facedwiththerelevanceoftheseachievementsintermsoftherealizationofadvancesinnursing,
comestheimportanceofoccupyingthesespaces,effectively,therebyguaranteeingthosealready
conquered.Thereby,wemustmoveinsearchofnewtargetsfortheeffectiveengagementofthese
workersinthevariousparticipationforums.Preservingtheautonomythattheoccupationof
administrativepositionsprovidesisofvitalimportancetothegrowthofnursinginthesearchfor
desiredquality (1).
NursesaccepttheirjointresponsibilityforMRMandfeeltheyareabletomodifytheexistingsituation.
Theyvisualizealongroad,butunderstandthattheirparticipationalongwiththismanagementisstill
fragileandneedstoadvance.Theyrealizetheneedfornursingstafftobeawareoftheimportanceof
theirinvolvementasastartingpointforadvancesinthisarea.Moreover,theyunderstandthatMRM
shouldbeconsideredanactivityrelatedtonursingandshouldbeincorporatedasaprofessional
attribute(1).
Studiesthatallowenhancementofthemanagementmodalitiesusedareessentialfornursestoreflect
ontheirpracticeandtoproposechangesthatwillcontributetotheimprovementincare.Itisalso
importanttobeawareofthedifferentmanagementmodelstopromoteanawarenessofthesedifferent
managementmodels(14).
Therefore,inthenursingpractice,MRMisofconsiderableimportanceandshouldbegivengreater
emphasisandfrequency,sothatalltheprofessionalsinvolvedmaybecomeawareofitsrelevance.Itis
totallyimpracticabletoconductthemanagementofcarewithoutknowledgeofthemanagementof
materials.Thiscallsfordiscussionsonthesubjectfromtheacademicspheretotheplacesproviding
continuingeducationinhealthservices.

CONCLUSION
Whenperformingasearchforscientificpapers,thesummaryofastudyprovidesthefirstcontactwith
theappraiser'swork,and,therefore,iscommonlyusedbyresearchersasaninstrumentofanalysis,as
inthisstudy.Itisthereforeessentialthattheinformationpresentedinthissectionisclearandof
quality,enablingtheevaluatortomakeaprecisedecisionwhethertoreadthepublicationinfull.
However,duetothelackofcriteriaintheconstructionofabstracts,itwasfoundintheliterature
searched,thatmostshowednoessentialitemsandthisdirectlyinfluencedtheprocessofselectionof
publicationstocomposetheintegrativereview.
Nevertheless,knowledgeaboutthemanagementofmedicalhospitalsuppliesinnursingpracticeisstill
incipient,asevidencedinnationalstudiesincludedinthisintegrativereview.Studiesthatshowedber
evidencewereconsideredoldandwereusedasabase,notpresentingnewcomparativestudiesthat
demonstratescientificdevelopment.
ThereisevidenceoftheneedtoarouseinterestinnursesinthesubjectofMRMinordertousetheir
knowledgeasatoolfordecisionmakingandleadership,aswellasamanagementtoolforhealthcare
forwhichtheyareresponsible.Thiswillempowertheirworkprocesses.

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Received:22/02/2012
Approved:05/03/2013

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