Avaliação do cuidado de enfermagem na perspectiva da segurança do paciente em unidades de terapia intensiva: na visão de profissionais, pacientes e familiares

Technological advances combined with healthcare assistance bring increased risks related to patient safety, causing health institutions to be environments susceptible to losses in the provided care. Sectors of high complexity, such as Intensive Care Units have such characteristics highlighted due to being spaces designed for the care of patients in serious medical condition, when the use of advanced technological devices becomes a necessity. Thus, the aim of this study was to assess nursing care from the perspective of patient safety in intensive care units. This is an evaluative research, which combines various forms of data collection and analysis in order to conduct a deepened investigation. Data collection occurred in loco, from April to July 2014 in hospitals equipped with adult intensive care unit services. For this, a checklist instrument and semi-structured interviews conducted with patients, families, professionals were used in order to evaluate the structure-process-outcome triad. The instrument for nursing care assessment regarding Patient Safety included 97 questions related to structure and processes. Interviews provided data for outcome analysis. The selection of interviewees/participants was based on the willingness of potential participants. The following methods were used to collect data resulting from the instrument: statistical analysis of inter-rater reliability measure known as kappa (K); observations from judges resulting from the observation process; and added information obtained from the literature on the thematic. Data analysis from the interviews was carried out with IRAMUTEQ software, which used Descending Hierarchical Classification and Similarity analysis to aid in data interpretation. Research steps followed the ethical principles presented by Resolution No. 466 of December 12, 2012, and the results were presented in three manuscripts: 1) Evaluation of patient safety in Intensive Care Units: a focus on structure; 2) Health evaluation processes: a nursing care perspective on patient safety; 3) Patient safety in intensive care units: perception of nurses, family members and patients. The first article, related to the structure, refers to the use of 24 items of the employed instrument, showing that most of the findings were not aligned with the adequacy standards, which indicates poor conditions in structures offered in health services. The second article provides an analysis of the pillar of Processes, with the use of 73 items of the instrument, showing that 50 items did not meet the required standards for safe handling due to the absence of adequate scientific guidance and effective communication in nursing care process. For the third article, results indicate that intensive care units were safe places, yet urges for changes, especially in the physical structure and availability of materials and communication among professionals, patients and families. Therefore, our findings suggest that the nursing care being provided in the evaluated intensive care units contains troubling shortcomings with regards to patient safety, thereby evidencing an insecure setting for the assistance offered, in addition to a need for urgent measures to remedy the identified inadequacies with appropriate structures and implement protocols and care guidelines in order to consolidate an environment more favorable to patient safety.

Mil cenários: Deleuze e a (in)atualidade da filososfia

Evidentemente, como todas, a filosofia de Deleuze será sempre menos do que exigimos ou esperamos dela, mas também muito mais do que lhe concedemos ou dizemos da mesma. No que tem de vivo, de vital, a obra de Deleuze não deixa de provocar fugas em todos os comentários que perseguem sua totalização à conta de uma imagem, de uma doutrina ou de uma data. Não há «um» Deleuze, radicalizado à força de privilegiar o que tem de irredutível com relação aos diferentes horizontes de leitura. Mas também não existem «dois» Deleuze, desdobrados segundo uma dialética de apropriação que requereria, para a salvação de um punhado de princípios, o anátema de parte de sua filosofia. Digamos, antes, que há «pluralidade» de conceitos, de perspectivas e de textos, que associamos ao nome de Deleuze, mas sempre de um modo local, estratégico, essencialmente aberto. Na sua determinação propriamente deleuziana, a história da filosofia não tem por objeto restaurar o sentido profundo do que os autores teriam dito para nós, mas apenas extrair um duplo. E, com os duplos, já se sabe como é: nunca estamos seguros de quem é quem. Os desiguais textos que compõem o presente livro não pretendem desmascarar impostores, mas multiplicar os espelhos.