Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Metodologia de implantação da construção enxuta: estudo de caso em construtora de porte médio

In recent years, the Brazilian construction industry has gone by changes like currency stability, increasing competition, shortage of skilled labor and increasing quality importance required by the customer, who made the sector companies seek solutions through new management practices in order to become more efficient. A alternative to these management practices is known as Lean Construction which is derived from the Toyota System Production. Lean Construction main goals are to reduce parts of activities that do not add value, increase product value by considering customer needs, reduce variability and production cycle time, simplify process by reducing the number of parts or steps, increase the flexibility in the product execution and transparency process, focus the control on overall process, introduce continuous improvement process, maintain a balance between improvements in flows and conversions and seek to learn from practices adopted by competitors. However, the construction industry is characterized by having nomadic activity, which undertakes an unique product with high cost of production and big inertia for behavioral change, making it difficult to implement the philosophy of lean construction in companies. In this sense, the main objective of this study is to develop a methodology for implementation of the principles of Lean Construction. The method of implementing the proposed management system was designed with the aid of 5W2H tool, and the implementation process is divided into three phases. The first one aims to know in a macro way the current operation of construction, identify who is its target audience and what are the products and services offered to the Market. The second phase aims to describe what actions should be taken and which documents are needed to be created or modified; finally, the third step goal consists in how to control and monitor established processes, where through Strategic Planning the company goals would be set along with their respective targets and indicators in order to keep the system working, aiming for continuous improvement with focus on the customer. This methodology was conceived as a case study analyzing a medium size construction with more than 18 years of activity and certified for almost 10 years with ISO9001 and level A in PBQP-H. We also conclude that this implementation process can be used in any developer and / or builder

Utilização do controle estatístico do processo para monitoramento do peso médio de cápsulas de Tuberculostáticos: estudo de caso no NUPLAM- RN

This Master Thesis presents a case study on the use of Statistical Process Control (SPC) at the Núcleo de Pesquisas em Alimentos e Medicamentos (NUPLAM). The SPC basic tools have been applied in the process of the tuberculostáticos drugs encapsulation, primarily concerning the objective to choose, between two speeds, which one is the best one to perform the tuberculostatics encapsulation. Later on, with the company effectively operating, the SPC was applied intending to know the variability of the process and, through the tracking of the process itself, to arrive at an estimated limit for the control of future lots of tuberculostatics of equal dosage. As special causes were detected acting in the process, a cause-and-effect diagram was built in order to try to discover, in each factor that composes the productive process, the possible causes of variation of the capsules average weight. The hypotheses raised will be able to serve as a base for deepened the study to eliminate or reduce these interferences in the process. Also a study on the capacity of the process to attend the specifications was carried out, and this study has shown the process´s inaptitude to take care of them. However, on the side of NUPLAM exists a real yearning to implant the SPC and consequently to improve the existing quality already present on its medicines

Aplicação da metodologia seis sigma em uma empresa de médio porte do setor têxtil

The Six Sigma methodology has received considerable attention in the last two decades. This is due to its great potencial to reduce processes variability, through the use of accurate data, facts and statistical techniques. The methodology seeks to improve the quality of products and services, maximizing the company s financial performance. Specifically, its implementation and results in medium-sized textile enterprises is unknow, although there are signs that the methodology can be applied with success. Considering this scenario, the goal of this research is to describe the application of the Six Sigma methodology in a médium-sized textile company specialized in the production of male shirts in the satate of Rio Grande do Norte, Brazil. First, we present a literature review, seeking to highlight the themes of quality, Six Sigma and its methodology for improvement. Then, we show the implementation of the project selected, depicting the steps and procedures that must be performed. The results confirm the efficiency of Six Sigma in providing significant gains to companies. It is observed substantial improvements in the speed of product development and the flexibility of the parts produced, reducing the process lead time from 12.5 to 6.2 days, which means a performance improvement of over 50%. This leads also to cultural and behaviour change, creating motivation for implementation of new projects and a continuous search for knowledge

Gestão dos resíduos sólidos das contruções prediais na cidade do Natal-RN

The present work has the objective of presenting an investigation about the quantification, classification and destination of the waste of construction and demolition (RCD) in the city of Natal - RN, focusing the aspects of the environmental impacts and the strategic importance of the environmental administration in the earnings of productivity of the companies. Of the environmental point of view the research intends to identify and to quantify the monthly and annual production of RCD in the city, as well as to know the places of deposition of those residues. To reach the objectives of the study, an exploratory and descriptive research was accomplished, using a questionnaire with closed subjects and an open one, applied in 25 entrepreneurs of the branch of the building site, being 21 builders and 4 entrepreneurs of collection companies and removal dumps. As form of analysis of the data, the descriptive analysis was used and of crossing. The production engineering considers important the insert of best production practices and administration of the product in the companies, with views to the increase of your competitiveness, productivity earnings and improvement of the environmental aspects with views to the consumer's satisfaction, in that case the buyer of immobile. The principal results of the investigation demonstrate that there was not great variability of answers with relationship to the interviewees opinion in what he refers to the environmental practices. In your majority the building site interviewees entrepreneurs evidenced the absence of the public power, particularly the city hall of Natal, in the control, fiscalization and creation of mechanisms for a correct destination of RCD, as well as for your reuse and recycle. On the other hand also it was evident that the recycle or the reuse of RCD on the part of the companies is a rare practice and a lot of times inexistent, although the entrepreneurs' of the building site section great majority recognizes that would have won of productivity with the correct and intensive use of such measures

Gestão de satisfação e fidelidade do cliente na hotelaria :um estudo sobre os fatores que influenciam a satisfação e a fidelidade do turista internacional no Brasil

The objective of this thesis was studying the factors which contribute to customer s satisfaction and loyalty, focusing the Norwegian model of satisfaction and loyalty of the consumer, applied in the sector of hotel services in Natal/RN, Brazil. The theoretical research was led through the concepts of service quality, customer satisfaction and loyalty, models of quality management systems, national index of customer s satisfaction and methods which evaluate the customer s satisfaction. The field research was carried through from December 1st of 2004 to 24 st, among 381 international tourists who had been housed in the hotels of Natal. The analyses of the data had been made through the descriptive statistics and analysis of multiple regression. The results had evidenced that the main precedents variables of satisfaction had been: hotel s room, staff friendliness, hotel restaurant food and price paid; these are factors which explained, in 56,0% the variation of satisfaction with hotels. In relation to the constructs which had influenced the tourist s loyalty, were founds: tourist s satisfaction, hotel image and affective commitment, which had explained 53.0% of the data variability. The complaint management resulted as a basic factor for the tourist s satisfaction and loyalty

Estratégia ambiental e agências de viagens e turismo :um estudo sobre a importância de práticas ambientais na escolha de um pacote turístico

The objective of the work was to investigate, from the vision of travel agents, the importance of environmental practices as a decision factor in the purchase of a tourist package. For in such a way, it was established as target population, the travel agencies and tourism linked to he Brazilian Association of Travel agencies ABAV, hearing the Brazilian travel agents that exerted the function in Natal, city in 2005. The election of the sample was accomplished using the simple random sampling technique. The amount of agents effectively searched was of 150 agents being distributed 150 questionnaires, with closed and opened questions, applied during the month of November in 2005. Results showed great variability of interviewed answers in that if it relates for sale of package tourist where the customer demonstrates enviromental concern with the environmental quality. Through multiple regression analyses, it was environmental concern with the environmental quality of the place and the perception of the practical importance of the existence environmental practices in the place as important factor in the decision of tourist package purchase

Experimentação, inovação cultura oganizacional: estudo de caso em uma indústria

A experimentação industrial é um método científico de aprendizagem que visa aprimorar conhecimentos sobre o funcionamento de sistemas, almejando redução de variabilidade e incertezas nos processos produtivos. Em inovação, constitui-se como uma oportunidade de teste e pré-implementação, permitindo à empresa aperfeiçoar seus projetos de inovação antes de levá-los ao mercado. Contudo, para que empresas obtenham sucesso em inovar, faz-se necessário um ambiente favorável à inovação, considerando que a cultura organizacional impacta diretamente no potencial inovador. Uma cultura de inovação bem desenvolvida demanda o envolvimento de todos os líderes da empresa atuando como facilitadores do processo. Nesse contexto, esta pesquisa tem como propósito avaliar o perfil da cultura organizacional visando o uso de experimentação no processo de inovação em uma indústria do ramo alimentício no Estado do Rio Grande do Norte. Para tanto, busca-se, por meio de fundamentação teórica, ampliar a compreensão da relação existente entre os temas experimentação, inovação e cultura organizacional, e tem-se como método de pesquisa, uma abordagem quanti-qualitativa em um estudo de caso. Os dados para análise da pesquisa são coletados por meio de entrevistas e aplicação de questionários. Para avaliar a cultura organizacional, utiliza-se como instrumento o questionário baseado no Modelo de Valores Competitivos, desenvolvido por Cameron e Quinn (2006), aplicado com os líderes na empresa em estudo. Este instrumento, denominado OCAI (em inglês Organizacional Culture Assessment Instrument), permite diagnosticar o perfil da cultura organizacional e da cultura da qualidade no cenário atual e no contexto ideal, a partir da percepção dos líderes da organização. Para análise dos dados, utiliza-se a técnica de análise de agrupamento, que permite avaliar a homogeneidade das opiniões dos líderes. Os resultados apontam, conforme a visão dos líderes, a necessidade de mudança no perfil cultural organizacional da empresa em estudo, de uma cultura em que predominam elementos da cultura de mercado (cenário atual) para uma cultura com maior ênfase em elementos da cultura clã e inovadora (cenário ideal), bem como uma cultura de qualidade que estimule a inovação, favorável à geração de ideia e conhecimento, a melhoria contínua e a busca por soluções criativas

Gestão de satisfação e fidelidade do cliente: um estudo com turistas em hotéis

This Thesis deals with a study on customer satisfaction and loyalty focusing on a model of factors antecedents of customer satisfaction and loyalty. The model is based on a Satisfaction Index model adopted in Norway developed by Johnson et al.(2001) and the service quality drivers from the literature. It is surveyed a sample of tourist in Natal. It is used a survey questionnaire applied at the airport in the departure moment of the tourist. The final sample results on 198 cases. Is is used a multiple regression analysis as the method to verify the factor affecting satisfaction and loyalty. Two models arise from the analysis. The first model concerning satisfaction results with cleaness and hygiene of the bathroom, leisure facilities, employees promptness, and price as the significant factors affecting satisfaction. The model has a R2 of 0.6430 and the also check in service, cleaness of the apartment and the hotel in general, bedroom setting have colinearity with some factors entering the model. The loyalty model results with satisfaction, affective commitment as the main factors affecting loyalty, with a R2 0.5396, and also image has collinearity with satisfaction. A small part of the sample has complained and this factor was not considered in the models. The results are consistent with the literature in term of quality as the main driver of the satisfaction and that it is not the only one factor to explain loyalty

Uso de renderização volumétrica e realidade virtual para problemas de percolação na engenharia

In the recovering process of oil, rock heterogeneity has a huge impact on how fluids move in the field, defining how much oil can be recovered. In order to study this variability, percolation theory, which describes phenomena involving geometry and connectivity are the bases, is a very useful model. Result of percolation is tridimensional data and have no physical meaning until visualized in form of images or animations. Although a lot of powerful and sophisticated visualization tools have been developed, they focus on generation of planar 2D images. In order to interpret data as they would be in the real world, virtual reality techniques using stereo images could be used. In this work we propose an interactive and helpful tool, named ZSweepVR, based on virtual reality techniques that allows a better comprehension of volumetric data generated by simulation of dynamic percolation. The developed system has the ability to render images using two different techniques: surface rendering and volume rendering. Surface rendering is accomplished by OpenGL directives and volume rendering is accomplished by the Zsweep direct volume rendering engine. In the case of volumetric rendering, we implemented an algorithm to generate stereo images. We also propose enhancements in the original percolation algorithm in order to get a better performance. We applied our developed tools to a mature field database, obtaining satisfactory results. The use of stereoscopic and volumetric images brought valuable contributions for the interpretation and clustering formation analysis in percolation, what certainly could lead to better decisions about the exploration and recovery process in oil fields

Fermentação alcoólica utilizando líquido da casca de coco verde como fonte de nutrientes

The liquid of the rind of green coconut (LCCV), an effluent stream from the industrial processing of green coconut rind, is rich in sugars and is a suitable feedstock for fermentation. The first step of this study was to evaluate the potential of natural fermentation of LCCV. As the literature did not provide any information about LCCV and due to the difficulty of working with such an organic effluent, the second step was to characterize the LCCV and to develop a synthetic medium to explore its potential as a bioprocess diluent. The third step was to evaluate the influence of initial condensed and hydrolysable tannins on alcoholic fermentation. The last step of this work was divided into several stages: in particular to evaluate (1) the influence of the inoculum, temperature and agitation on the fermentation process, (2) the carbon source and the use of LCCV as diluent, (3) the differences between natural and synthetic fermentation of LCCV, in order to determine the best process conditions. Characterization of LCCV included analyses of the physico-chemical properties as well as the content of DQO, DBO and series of solids. Fermentation was carried out in bench-scale bioreactors using Saccharomyces cerevisiae as inoculum, at a working volume of 5L and using 0.30% of soy oil as antifoam. During fermentations, the effects of different initial sugars concentrations (10 - 20%), yeast concentrations (5 and 7.5%), temperatures (30 - 50°C) and agitation rates (400 and 500 rpm) on pH/sugars profiles and ethanol production were evaluated. The characterization of LCCV demonstrated the complexity and variability of the liquid. The best conditions for ethanol conversion were (1) media containing 15% of sugar; (2) 7.5% yeast inoculum; (3) temperature set point of 40°C and (4) an agitation rate of 500 rpm, which resulted in an ethanol conversion rate of 98% after 6 hours of process. A statistical comparison of results from natural and synthetic fermentation of LCCV showed that both processes are similar

Caracterização de água produzida na indústria de petróleo para fins de descarte e otimização do processo de separação óleo/água

The oil industry has several segments that can impact the environment. Among these, produced water which has been highlight in the environmental problem because of the great volume generated and its toxic composition. Those waters are the major source of waste in the oil industry. The composition of the produced water is strongly dependent on the production field. A good example is the wastewater produced on a Petrobras operating unit of Rio Grande do Norte and Ceará (UO-RNCE). A single effluent treatment station (ETS) of this unit receives effluent from 48 wells (onshore and offshore), which leads a large fluctuations in the water quality that can become a complicating factor for future treatment processes. The present work aims to realize a diagnosis of a sample of produced water from the OU - RNCE in compliance to certain physical and physico-chemical parameters (chloride concentration, conductivity, dissolved oxygen, pH, TOG (oil & grease), nitrate concentration, turbidity, salinity and temperature). The analysis of the effluent is accomplished by means of a MP TROLL 9500 Multiparameter probe, a TOG/TPH Infracal from Wilks Enterprise Corp. - Model HATR - T (TOG) and a MD-31 condutivimeter of Digimed. Results were analyzed by univariated and multivariated analysis (principal component analysis) associated statistical control charts. The multivariate analysis showed a negative correlation between dissolved oxygen and turbidity (-0.55) and positive correlations between salinity and chloride (1), conductivity, chloride and salinity (0.70). Multivariated analysis showed there are seven principal components which can explain the variability of the parameters. The variables, salinity, conductivity and chloride were the most important variables, with, higher sampling variance. Statistical control charts have helped to establish a general trend between the physical and chemical evaluated parameters

Evolução da biodegradabilidade da matéria orgânica em um sistema de lagoas de estabilização

Waste stabilization ponds (WSP) have been widely used for sewage treatment in hot climate regions because they are economic and environmentally sustainable. In the present study a WSP complex comprising a primary facultative pond (PFP) followed by two maturation ponds (MP-1 and MP-2) was studied, in the city of Natal-RN. The main objective was to study the bio-degradability of organic matter through the determination of the kinetic constant k throughout the system. The work was carried out in two phases. In the first, the variability in BOD, COD and TOC concentrations and an analysis of the relations between these parameters, in the influent raw sewage, pond effluents and in specific areas inside the ponds was studied. In the second stage, the decay rate for organic matter (k) was determined throughout the system based on BOD tests on the influent sewage, pond effluents and water column samples taken from fixed locations within the ponds, using the mathematical methods of Least Squares and the Thomas equation. Subsequently k was estimated as a function of a hydrodynamic model determined from the dispersion number (d), using empirical methods and a Partial Hydrodynamic Evaluation (PHE), obtained from tracer studies in a section of the primary facultative pond corresponding to 10% of its total length. The concentrations of biodegradable organic matter, measured as BOD and COD, gradually reduced through the series of ponds, giving overall removal efficiencies of 71.95% for BOD and of 52.45% for COD. Determining the values for k, in the influent and effluent samples of the ponds using the mathematical method of Least Squares, gave the following values respectively: primary facultative pond (0,23 day-1 and 0,09 day-1), maturation 1 (0,04 day-1 and 0,03 day-1) and maturation 2 (0,03 day-1 and 0,08 day-1). When using the Thomas method, the values of k in the influents and effluents of the ponds were: primary facultative pond (0,17 day-1 and 0,07 day-1), maturation 1 (0,02 day-1 and 0,01 day-1) and maturation 2 (0,01 day-1 and 0,02 day-1). From the Partial Hydrodynamic Evaluation, in the first section of the facultative pond corresponding to 10% of its total length, it can be concluded from the dispersion number obtained of d = 0.04, that the hydraulic regime is one of dispersed flow with a kinetic constant value of 0.20 day-1

Investigação dos processos hidrossedimentológicos em parcela experimental no semi-árido potiguar

In northeastern semiarid, seasonality on precipitation temporal distribution, high intensity storm events and inadequate management of native vegetation can promote soil erosion. Vegetation removal causes soil surface exposure, reduces soil water storage capacity and can be the source degradation processes. In this context, this approach aims to analyze water and soil erosion processes on a 250 m2 undisturbed experimental plot with native vegetation, slope 2.5% by using 2006 and 2007 monitoring data. The site was instrumented to monitor rainfall, overland flow runoff and erosion by using a 5 m³ tank downstream the plot. Soil erosion monitoring was made by transported sediment and organic matter collection after each event. Field infiltration experiments were made at 16 points randomly distributed within the plot area by using a constant head infiltrometer during drought and rainy seasons, respectively. Infiltration data revealed high spatial and temporal variability. It was observed that during the beginning of the rainy period, 77% of the events showed runoff coefficient less than 0.05. As the rainy season began, soil water increase produced annual species germination. High intensity storms resulted in runoff coefficients varying between 0.33 and 0.42. Once the annual species was established, it was observed that approximately 39% of the events produced no runoff, which reflects an increase on soil water retention capacity caused by the vegetation. A gradual runoff reduction during the rainy season emphasizes the effect of vegetative density increase. Soil erosion observed data allowed to fit an empirical relationship involving soil loss and precipitation height, which was used to analyze the plot installation impact on soil erosion. Observed soil loss in 2006 and 2007 was 230 Kg/ha and 54 Kg/ha, respectively

Caracterização dos resíduos esgotados de sistemas de tratamento individual de esgotos de Natal

In Natal still dominates the use of individual disposal systems for domestic sewage, once only 29% of the city has a sewarage system. Wastes that are accumulated in these individual treatment systems should be exhausted periodically, service provided by collector entrepreneurs. Some of these companies causing major damage to the environment. In Natal, only two companies have their own septage (RESTI) treatment system, which were designed with parameters from domestic sewage generating strain and inefficient systems. Therefore, the characterization becomes essential as a source of parameters for their design. Thus, this work presents the physical-chemical and microbiological characterization of waste pumped from individual sewage treatment systems. Samples collections were made weekly from 5 different trucks at the reception point on the treatment plant on the point of the preliminary treatment. From each truck it was taken 5 samples during the discharge in order to make a composite sample. Afterwards, samples were carried out to laboratory and analyses for determination of temperature, pH, conductivity, BOD, COD, nitrogen (ammonia e organic), alkalinity, oils, phosphorus, solids, faecal coliforms and helminth egg. The results were treated as a single database, and ranked according to its generating source (multi and single house, lodging, health, services and / or food), area of origin (metropolitan, south and north) and type of system (cesspits, septic tank and / or sink). Through these data it was possible to verify that the type of system adopted by most in Natal and the metropolitan region is cesspit, besides to confirm the difference between the septage of areas with a population have different social and economical characteristics. It was found that the septage have higher concentrations than domestic sewage, except for thermotolerant coliforms that showed concentrations of 1,38E+07. Among the parameters studied, is the median values identified for COD (3,549 mg / L), BOD (973mg / L) and total solids (3.557mg / L). The volatile fraction constitutes about 70% of the total solids of the septage. For helminths has been a median of 7 eggs/L. In general, the characteristics of the waste followed the variability found in the literature reviewed for all variables, showing high amplitudes