Dificuldades e/ou facilidades vivenciadas pelos profissionais que compõem a Estratégia de Saúde da Família

Descriptive and quantitative study, with the objective of review the positive and negative aspects experienced by professionals working in the Family Health Strategy (ESF) of Ceará-Mirim town, at Rio Grande do Norte state. The population included 190 healthcare professionals that integrate the family healthcare staff and the data-collection occurred in a meeting at their workplace, with the implementation of a questionnaire. Results were organized in Microsoft Excel spreadsheet software, with descriptive statistical analysis in tables, graphs and tables through frequencies, averages values and standard deviations. There is a predominance of females (n = 137) and higher rates in almost all professions, and higher average age (38.9%, SD = 7.8) and income wage (average = 10) in the medical category. Regarding the more developed activities, for physicians and nurses are the healthcare actions in the Unit, the oral hygiene for dentists, the immunization for auxiliary nurses (Aux-N), educational meeting for the dental office assistants (ACD), and home visitations to community-based health workers (ACS). About the easiness of work, 93.2% said to be presence of professionals with a personal profile in public healthcare; about the difficulties, 86.8% of professionals cited the unavailability of material, followed by salary range reported by nurses (80.9% ), dentists (80.0%), physicians (73.3%), ACS (83.1%), and Aux-N (90.5%). In relation to working conditions, the unavailability of materials was the most mentioned, with the exception of dentists who reported improvement in wages. We still identify among these difficulties: the drugs availability regarded as first grade obstacle by ACS and physicians, the type of contracts in second grade cited by the ACD and dentists and, in third grade, the salary range cited by dentists and auxiliary nurses. It is concluded that the difficulties and easiness faced by ESF professionals are divergent among themselves. For physicians and nurses, whose healthcare actions become directed to specific groups, the individual and the family, their difficulties relate to the unavailability of materials. For dentists, whose actions more quoted were topical application of fluoride and supervised toothbrush, their greatest difficulty is the salary range. As to the Aux-N, ACD and ACS, for all of them the unavailability of materials has hindered the implementation of their activities in ESF

O acolhimento no ambulatório de um hospital universitário na visão de usuários

This present study of quantitative/qualitative approach, aims to analyze the outpatient care at the Hospital Universitário Onofre Lopes (HUOL), and, having as guide, the reception of the user. In this regard were invited and interviewed 20 users. Besides the interviews, conducted in a period of 45 days, in this same period of time was used a field diary for more significant notes of observations more significant. In the analysis, we drafted the socio-demographic profile of the group and identified their main complaints, problems and suggestions. For this, we have built graphics, tables and pictures, in addition to standing out their testimony, as a resource for better understanding of the subjective aspects. The theoretical reference consisted of documents from the Ministry of Health about the reception and humanization, and the studies of Merhy, Franco, Pinheiro, Matumoto, Mariotti, Teixeira, among others. The results show the ambulatory of HUOL as a privileged space and of credibility, where users commonly, find answers to their problems. However, these same users were unanimous in saying the difficulties they face in obtaining consultations, from the basic unit, until the hospital. Regarding the service, although they feel satisfied as for the assistance received, they list a series of problems, of structural relationship order: lack of visual signalling, information, wheelchairs, hygiene, in the waiting rooms that offer some comfort, besides the inattention of some professionals. In summary, in the study, undertaken now, we cannot say that there is in the reality studied, the reception, in its full meaning, but the HUOL as hospital-school, has all the potential to accomplish it

Diagnósticos de enfermagem em pacientes no pós-operatório imediato de prostatectomia de um Hospital Universitário de Natal-RN

The characterization of the nursing diagnoses in prostatectomized patients is important to provide an unique nursing language, facilitating the communication between professionals and patients. The objective of this study was to analyze the nursing diagnoses of patients in the immediate prostatectomy postoperative period. This is a cross-sectional and descriptive study, developed at the surgical-clinic of Onofre Lopes University Hospital, in the Natal City RN - Brazil. The sample was composed of 50 patients included by the criteria: have presented a diagnosis of a benign prostatic hyperplasia or a prostate cancer, have been subjected to a prostate surgery at the mentioned hospital, and have been in the immediate postoperative period at the moment of the data collection. The exclusion criteria were: haven t been in an appropriate physical and mental condition, have presented a brain vascular disease, a lung disease, an advanced liver disease, a heart disease or a extensive coronary artery disease. The data collection instruments were: the script of an interview and physical examination. The data collection period was between November 2010 and April 2011. The data were organized in two phases: the diagnostic process and the construction of the database. The project was approved by the Ethics Committee of the Federal University of Rio Grande do Norte The results showed that most patients came from the countryside, was living with partners, had an average of 67.78 years, was pensionerthose with low schooling, Catholic and often did not perform preventive examinations of prostatic disease. The patients showed an average of 9.48 nursing diagnoses, defining characteristics 21.70 and 20.72 related or risk factors per patient. We identified 30 nursing diagnoses, of which 7 were above the 75 percentile: Risk of falls, Impaired ambulation, Risk of infection, Self-care deficit bath / hygiene and dress up and Risk for deficient fluid volume. The top six nursing diagnoses were in all patients, and therefore could not apply any statistical test. The others ND were associated with their defining characteristics and related or risk factors. We conclude that the nursing diagnoses identified in this study contribute to the progress of the nursing care to the prostatectomized patients in post-surgery period, allowing the deployment of nursing actions for the effective resolution of identified problems

Validação de conteúdo do instrumento para consulta de enfermagem na visita domiciliar às pessoas com lesão medular: um enfoque no autocuidado

This study aimed to validate the contents of an Instrument for Nursing Consultation in the Home Visit of people with Spinal Cord Injury (INCEVDOP-LM), based on the Self-Care Deficit Theory. The methodological development study was conducted with spinal cord injured (SCI) people ascribed in the Family Health Units the city of Natal/RN/Brazil, and with the nurses of these institutions. The study was conducted from Januray 2012 to January 2013 in two phases: the first aimed to identify the need for self-care of persons with SCI, and the second to develop and validate the INCEVDOP-LM. The first phase consisted of a census study of people with SCI living in Natal/RN. In the second phase, a non-probabilistic convencience sample of subjects was selected to form two groups: First stage - Group 1 of the first stage was comprised by 73 adults with SCI diagnosed with paraplegia or tetraplegia, with cognitive function preserved and that were registered to some family health unit; Group 2 of the Second phase was composed of six experts that were nurses with doctoral formation, scientific experience in the area of technology development or assistance to persons with SCI, and with publications in periodicals Qualis A2. Data collection of the first phase was conducted through home visits of people with SCI that responded three instruments: Questionnaire I (comprised of demographic and socioeconomic variables), The Competency Rating Scale for Self-care (ASA) and the Barthel Index (an instrument for evaluation of functional capacity). The research for the second phase was conducted in two stages: I-construction of the INCEVDOP LM; II-validation of the INCEVDOP-LM. The instrument and an evaluation form were forwarded to the experts for the validation. The correlations between the responses were analyzed by the Kappa test, with accepting values of>0.75. The evaluation criteria were: organization, clarity, simplicity, readability, appropriateness of vocabulary, objectivity, accuracy, reliability and suitability and the positive responses with frequency values of≥90% were considered excellent. The chi-square test was used to investigate the differences between proportions. The study attended to the principles of Human Rights CNS Resolution 196/96. Results were reported by means of four articles derived from the study. The findings indicate that the items that showed disagreement among experts (k=0.02) were diagnoses, interventions and evaluation of the nursing features pertaining to the domains of Nutrition, Hygiene, Elimination, Physical, Social and Psychological, and of the Ability to perform work activities feature. Agreement among the experts were reported for the other items, with kappa ranging from 0.72 to 1. After removing items with disagreement, all criteria achieved excellent rates and no significant differences were observed between the proportions of responses of evaluation of experts (p>0.05). We conclude that the instrument shows validity to serve as a guide for nurses to conduct a systematic consultation during the home visit to people with spinal cord injury, with emphasis on self-care. The instrument must go through other levels of validation when applied in the clinical setting

Validação de instrumentos para avaliação do conhecimento e da habilidade acerca da higienização simples das mãos

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Segurança do paciente no sistema de medicação: análise de enfermeiros de um hospital de ensino

This study aimed to identify and describe the factors related to Patient Safety in a medication system according to the nurses analysis in a teaching hospital from the photographic analysis method. This was a cross-sectional, descriptive study with mixed approach in a teaching hospital in Rio Grande do Norte. The population consisted of 42 nurses from inpatient units, of which 34 composed the study sample. As eligibility criteria, we defined nurses from public service and nurses who agreed to participate. Ethical determinations were observed, the study was submitted to the Ethics and Research of the University Hospital Onofre Lopes, obtaining the assent with ethical assessment certificate (CAAE 0098.0.051.294-11). For data collection, we used the photographic method (Photographic Analysis Technique) by Patricia Marck (Canada). It was developed in two phases: at first, we randomly captured photos from the medication system, resulting in 282 images; then we selected/processed the photographs, which were reduced to 10 images in Microsoft Excel 2010; in the second phase, the nurses answered the questionnaire divided into socio-professional profile and Digital Photography Scoring Tool (questions a and b ). For analysis of the question a , we used the content analysis technique, and for b , we used the Statistical Package for the Social Sciences 20.0 (temporary license). The socio-professional profile revealed the predominance of females; age group 34-43 years; professionals with specialization; 10-18 years of length of service; and nurses working exclusively in the hospital and who know the Patient Safety. The photographic analysis in relation to Patient Safety resulted in specific categories for each stage of the medication system. Regarding disposal, we identified Proper verification ; Improper verification ; Correct identification ; Disposal in single doses ; and Improper Environment , with predominance of that last category. As for storage: Proper storage ; Improper storage ; Risk of exchange/disappearance ; and Poor hygiene , with special reference to improper storage. In preparation: Risk of exchanging medication/patient ; Inappropriate physical space ; and Inadequate 9 preparation of controlled drugs , highlighting the first category. In drug administration: Lack of Personal Protective Equipment ; Use of Personal Protective Equipment ; Improper administration technique ; Proper administration technique ; Correct drug identification ; Incorrect drug identification ; and Peripheral venous access without identification . From the safety assessment of 10 photographs, by adapting the scores (1-10) to the Likert Scale, we identified three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), one Safe (Level 4), and no photograph considered Totally Safe. This study identified the prevalence of unsafety in the medication system in the nurses opinion. We were also able to understand that, although nurses identify safety aspects, the most prevalent categories characterize an unsafe assessment. Nursing needs to reflect on its practice, identifying gaps in the medication system in order to achieve a proper and safe care

A oficina como método de desenvolvimento de projeto do produto aplicado à atividade jangadeira de Ponta Negra Natal-RN

The jangadas (brazilian fishing rafts) are rudimentary artisanal vessels intrinsic to the Northeast of Brazil. The fishery with jangadas is highly representative in the State of Rio Grande do Norte, and source of income for many families in addition to being a strong cultural icon. Is still alive despite the difficulties, bringing the history and customs of the fishermen and their people. However, is in process of extinction due to factors such as the low profitability of the activity, tourism and urbanization. From the understanding of activity involving their context and circumstances, based on identified problems regarding the conditions of use of jangadas as the unpredictability, the risk of accidents, poor working conditions, hygiene and housing, this dissertation aims to: analyzing the design of the jangada on the beach of Ponta Negra and its relationship with the activity in relation to health, safety, productivity and environment, and from such assessments, together with the results achieved during the workshops of the project, proposing a cart to move the raft, adapted to the local fisherman activity studied. To perform analysis of jangadeira activity, we used a methodology based on ergonomic work analysis - AET (WISNER, 1987; GUÈRIN, 2001; VIDAL, 2008, SALDANHA, 2004 and Carvalho, 2005). For data collection were used observational and interaction methods as a conversational action, verbalizations, photographs and video. It is emphasized that the search for solutions appropriate to the jangadeira activity was possible through the collaboration of several people, not just an informational level and understanding during the work activity, but effectively contributing to the making decisions

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

Diagnóstico regional do processo de queijo coalho comercializado em Natal/RN

Coalho cheese is a typical product of the Northeastern Brazil, which is consumed both raw and cooked. The present work aimed to study the characteristics of artisanal and industrial processes in the production of coalho cheese sold in Natal / RN in order to evaluate its quality and consumer s profile. Four artisanal cheeses plants were monitored and a questionnaire was sent to different cheese industries. Besides this, eight cheese samples (four artisanal and four industrial) were evaluated in regard to the microbiological quality, physical-chemical and sensory attributes. The sensory acceptance was evaluated by using 108 non-trained panelists by using the hedonic scale. The consumer s profile survey was applied to 400 consumers of coalho cheese. The lack of hygiene control was detected at the artisanal cheese production, which uses raw milk as its raw material. Research has shown that the industrialized cheeses are made from pasteurized milk provided by their own production or by a third party, as observed in cheese making dairies. In general, the results indicate variation in the manufacturing process of coalho cheese, which results in the lack of product standardization. Regarding the physical-chemical analysis, most artisanal and industrial samples presented moisture content between 36 and 40 %, classified as medium moisture cheese, which is the only parameter that showed no significant difference (p>0.05). However, the water activity (Aw), pH and acidity results differed significantly. All artisanal samples showed coliform contamination at 35 °C, which confirms the poor hygienic conditions. In regard to coliforms at 45 °C, 75 % of artisanal coalho cheese samples had value higher than 103 MPN / g, a value above the lawful limits determined by RDC nº 12. Fifty percent of industrial coalho cheese samples showed coagulase-positive Staphylococcus values above the limit allowed by the RDC nº 12, indicating poor handling. The sensory evaluation revealed that the taste was the only parameter that showed significant difference, and this difference was only between two industrial brands. The consumer s survey showed that the coalho cheese flavor is the most important reason for buying this kind of cheese. Although coalho cheese is mainly bought in supermarkets, open street markets and country shops are still important selling points. It is concluded that there is no coalho cheese standardization in the RN state, which leads to variations in physical-chemical and sensory attributes. Moreover, it is necessary greater hygiene control in the production and handling procedures of coalho cheese.

Efeito do ácido lático sobre as características microbiológicas, físico-químicas e sensoriais na carne do sol

The dried beef is a food traditionally eaten by Northeastern and has an extensive trade in the city of Natal-RN. It is usually produced in an empirical manner, without any standardization in production. Characterized as partially dehydrated meat product, so that the activity of water present is not sufficient to prevent microbial growth, degradation or the production of microbial toxins. The guarantee that the market dried beef is to provide a quality product hygienic, microbiological, physicochemical and sensory stable and adequate for the safety and consumer satisfaction, which has been increasingly attracted to food with natural preservatives. Thus, the meat industries are replacing the current seasonings and natural preservatives for similar, with it without affecting the shelf life of products. Lactic acid has been used to meet these requirements. In this sense, this study aimed to evaluate the effect of lactic acid on the physico-chemical, microbiological and sensory, besides knowing the consumer profile of dried meat of the City of Natal / RN. The results demonstrated that the use of lactic acid in concentrations of 1% and 2% during the processing of dried meat, had statistically significant effect (p < 0.05) on the physico-chemical (pH and water activity) and consequently reduced the microbial count does not alter the taste of the new product developed. Regarding the results on the consumer profile, it was found that the majority of respondents (71.75%) did not observe the presence of the stamp of the Federal Inspection Service (SIF) to buy this meat food that 81.55% of consumers check the hygiene conditions of the site and handlers, however, a large proportion of respondents not concerned with the guarantee of origin of typical regional products featuring a hazard to food safety for consumers of the city of Natal-RN

A construção da natureza saudável: Natal 14900-1930

The Brazilian city of Natal, located between river, sea and dunes, rises up as a peculiar, unique landscape. A landscape made by the junction of what we can call two natures, the first one most known as "native" and the other properly recognized as antr6pica. This landscape has been changing throughout the time as a result of human working activities. In this process of landscape changing, some influent people such as medicine doctors, people from govemment, and also technicians took place and gave their contributions based on hygiene and salubrity principles, since the early years of xx century. They intended to bring up to the Natal s citzens a legacy of new concept of healthier life, as free as possible from pathogenic agents

A criança e a cidade: as transformações da infância numa Natal moderna

The first years of the twentieth century in Natal is characterized by several urban interventions that aim was to change the feature of the city basically rural to another that was in line with cities as models of modernity and civilization. In this case all individuals would have to play important social roles, which included men, women and especially children. It was in this atmosphere of bright future that the children were taken as key parts of an idealized society. Some processes were essential in triggering changes in natal s childhood, among them, operated within the families, that this historic moment in public life sought other possibilities of existence, the school education and the construction of which would be the model for urban education the School Groups, propagators of science as mediators of all knowledge, and finally, the medical interventions that disseminating health and hygiene practices has enabled not only the conservation of child life, but also the possibility of building their individuality in a body healthy. If these processes on the one hand tried to crystallize an ideal image of a child making a child identity directly linked to education and the "body hygiene" on the other, giving specific reflexive autonomy to children, providing them see the world through eyes of subject.

Maus ares e malária: entre os pântanos de Natal e o feroz mosquito africano (1892-1932)

The development of epidemiological practices in the last years of the nineteenth and early twentieth century was characterized by both an influence of medical geography and the emergence of microbes and vectors of diseases. Both theories were used to explain outbreaks in Rio Grande do Norte specially in Natal. In this process were organized new institutions linked to public health, unhealthy spaces and prescribed hygiene measures. The redefinitions of the spaces were linked to updated elements of Hippocratic medicine such as aerism and emphasis on medical topography. How the physicians of the town were organized in the face of new meanings and fields of expertise in the demarcation of diseases and regulation of their own practices against the illegal medical practitioners? Likewise, the very occurrence of epidemics mobilized people, urban institutions and apparatuses. But how the Hippocratic legacy that leads to the idea of bad air originated by swamps from the eighteenth and nineteenth century has been linked to new microbial assumptions and disease vectors in the early twentieth century? How an invader from Africa, (the mosquito A. gambiae) mobilized transnational efforts to combat malaria and redefined the epidemiological practices? The aim of this work is to understand how epidemiological practices redefine the way we define spaces, practices and disease from both an approach influenced by a relational history of spaces and a theoretical synergy which includes topics in Science Studies, Post Structuralist Geography and some elements of Feminist Studies. Documentary research were surveyed in the reports of the provincial presidents, government posts to the Provincial Assembly, specialized medical articles and theses, and documents from the Rockefeller Foundation and national and international journals. In this regard shall be given to both material and discursive aspects of space-related practical epidemiological that Natal as much (in general) Rio Grande do Norte between bad air and malaria.

Fatores associados à condição de saúde bucal de pacientes internados em hospitais públicos do município de Natal-RN

The hospitalization is an event that can attack any person, independent of gender, race, social and economical condition. Last year, the prevalence of hospitalization was 8.1 for 100 inhabitants and the average time of hospitalization was 8.5 days for each patient one in Natal city. Therefore, an important point is whether the attention to the patients during the permanence in these health establishments incorporates the health integral model suggested by the principles proposed by the National Health System in Brazil (SUS), with actions of promotion and protection by different kinds of professionals, beside those called convalescence. Then, the aim of this study was to evaluate the patient s oral health conditions hosted in public hospitals of the Natal city, looking for to establish its relationship with several risk factors by two dimensions: the characteristics of the hospitalization and the patient s general and economical conditions. We accomplished a cross-sectional study with 205 patients distributed among the hospitals Onofre Lopes, Giselda Trigueiro and Monsenhor Walfredo Gurgel, looking for to know the socio-demographic characteristics, the food habits and of oral hygiene and the conditions of oral health, through the Visible Plaque Index and Gingival Bleeding Index. We observed that the conditions of the patient s oral health interned at public hospitals of reference of the municipal district of Natal is bad, existing accumulation of dental plaque and, consequently, a great number of patients with gingival bleeding. However, the time of hospitalization and its reason, the type of medicine used in this time and the toothbrush frequency were not configured as risk factors for this oral health condition

Atividades educativas na rede pública de ensino: efeitos sobre a higiene oral e o nível de informação em Saúde Bucal

The contents introduction concerning the individual health cares reveals important since the school education. In this direction, the present study objectified to know an effect of Oral Health education intervention in the oral hygiene and in the schools children information level, of 4º e 5º basic education years. The study was composed by two groups, chosen of random form: control group (n = 115) and experimental group (n = 132), with 247 public net school children in total sample. The experimental group participated of some educative activities in Oral Health, with biweekly frequency, during the 4 months period, given for a surgeon-dentistry. Both the groups were submitted to a clinical examination for a previous verification of the Plaque Index (PI) and of Loe Silness Gingival Index (GI). A questionnaire with closed questions on Oral Health was applied before and after to verify the school children rightness index. After the intervention, the final data, represented for the PI, GI and Rightness Index verification, has been collected for statistical analyses through the chi-square test to a 95 % of reliable level, using the SPSS 10,0 software. The PI and GI were categorized in high and low on the initials index basis medium; already the Rightness Index was categorized in inadequate (< 50%) and adequate (≥ 50%). It was verified that the PI (p = 0,014; IC 0.24-0.86) and the GI (p = 0,013; IC 0,28-0,84) presented differences statistically significant, after the education activities, when compared to with the control, favoring the experimental group. It was verified too the experimental group got greater rightness index, presenting difference highly significant (p<0,0001; IC 3,73-26,81). It was still observed that there was no association between the oral hygiene indicators and the school children information level. Ahead the results, it can been concluded that education activities related in the school routine were capable to give positives effects in the oral hygiene control and in the information level about Oral Health, however, not necessarily, the individual with bigger information is that one who has practiced an oral hygiene more adjusted. One become necessary, however, that the education in Oral Health occurs of permanent and integrated form with others school actors, for the positive effect does not lose the student s life longterm