Elaboração e avaliação de indicadores comportamentais de aderência ao tratamento hemodialítico

Introduction: This work intents to characterize behavioral indicators of tack to the hemodialysis treatment in a sample of carrying patients of chronic kidney failure (CKF) in the great Natal/RN. The therapeutical adherence represents the agreement degree between the patient behavior and the health team lapsings. The CKF is the gradual and irreversible loss of the renal function, being the hemodialysis treatment an important alternative to assist or to substitute the kidneys. Method: The sample consisted in 80 chronic kidney patients in hemodialysis treatment in two located clinical centers in the region of the great Natal, RN. It was used as instruments (a) a protocol of clinical data collection, (b) the Millon Index of Personality Styles (MIPS) and (c) a script of halfstructuralized interview. Results: The results show a balance between the genders (51% of female and 48.8% of the male sex), average age and equal average time of dialysis respectively to the 43,4 years (±13,25 years) and 22,04 years (±4,24 years). The marital status of half of the sample is married, predominating basic education (43.6%) and a familiar income until a minimum wage (43.8%). It had been defined six physicianlaboratorial indicators to evaluate the therapeutical adherence, further the use of the evaluation of the health team and the patient themselves. Thus, there was an average adherence around 55.97% of the sample ±18.37%). However only between selfassessment of the patients about the adherence and the assessment made by blood pressure post-dialysis indicated a significant association (p=0,029, qui-square test). On the other hand, there was a significant association (p <0.05, chi-square test) among the criteria for treatment adherence and issues investigated in the interview - the perception on the quality of the health services provided to patients, the difficulties following the prescribed diet, the characterization of the days between dialysis sessions and the perception of patients about the dialysis sessions. It was also noted a significant association (p <0.05, Levene test) between adherence to therapy and scales that constitute the MIPS. The health team characterized the patients more adherent behavior as an attitude of acceptance of the treatment, looking actively for their implementation, for more information and knowledge, and establishing a positive communication with the team and with other patients. Similar results were confirmed by the MIPS evaluation. According to that assessment the more compliant patients adopt a more optimistic attitude, trying to act or adapt themselves to their environment, processing cognitively both concrete and objective information, such as more speculative and symbolic information. In addition they establish a gregarious, cooperative, submissive and flexibly pattern of interpersonal relationships to social demands. These characteristics managed to explain 55.7% of the adherence variation according the health team and 23.3% of the variation according the CaxP laboratory indicator. Conclusions: The MIPS shown to be able to identify the most and least adherent to therapy patients. The use of different adherence indicators is important for an evaluation covering the different facets of this process. The adhesion levels are observed within registered by the relevant literature. There is need for further studies with a larger sample to deepen the data findings in this work

Avaliação das habilidades neurocognitivas em crianças e adolescentes sobreviventes da Leucemia Linfoide Aguda - LLA

The present study investigated the impact of the treatment modalities of Acute Lymphoblastic Leukemia on neurocognitive abilities of children and adolescents survivors, aged between 6 and 16 years of age, accompanied in pediatric oncology sectors of public health services in the cities of Campina Grande-PB and Natal-RN. The study included 52 children, 13 of these being children and adolescents diagnosed with leukemia and 39 healthy children matched in relation to the study group considering gender, age, school type and level of maternal education. Later the group of children with leukemia was subdivided into two subgroups depending on treatment modality which were submitted: Group 1A (only chemotherapy) and 1B (chemotherapy and radiotherapy). All participants were subjected to a battery of neuropsychological tests that investigated the following neurocognitive abilities: intellectual ability, memory system, attention, visuospatiality and visuoconstruction, processing speed and executive functions. Data were analyzed using descriptive and inferential measurements with the aid of the U test of Mann-Whitney and T test, considering the influence of the variables: sex, age at diagnosis, time since completion of treatment and level of schooling mothers, on the performance of children. Overall, it is concluded that the illness and the treatment of acute lymphoblastic leukemia significantly favors the emergence of cognitive deficits, particularly in terms of visuospatial skills, and executive skills visoconstrutivas. In turn, the treatment modality of radiotherapy is associated with the presence of more severe deficits, highlighting the significant impact on the speed of information processing. It is hoped that the results presented here will contribute to a better understanding of the nature and extent of neurocognitive effects arising ALL treatment

Impacto do trabalho em profissionais de Saúde Mental de serviços de saúde do município de Mossoró-RN, 2012

The Psychiatric Reform has brought profound changes in assistance to people affected by mental disorders and behavior. In this context, mental health workers have played decisive roles of great impact, acting driving the process. Objective: To evaluate the impact felt by working professionals, because of the daily work with people who have psychiatric disorders. Methodology: This is a search field, a quantitative approach, sectional, descriptive and applied. Data collection occurred through the Assessment Scale Impact of Working in Mental Health Services (IMPACT-BR) applied to mental health researchers city Mossoró - RN. Results: Participants in this study 87 professionals, mostly female married, which took charge of higher education, working on a single service, working in the area for more than six years, aged between 25 and 64 years. There were a low effect of overloading the professionals surveyed. Discussion: Our results corroborate findings in other surveys conducted previously, not identifying large impact load at work among professionals of mental health teams studied. Subscales studied the highest score was observed in measuring the impact of work on team functioning. It was observed that the greater age and duration of action, reduced the emotional impact at work, suggesting that the experience enhances safety in decisions made and the possibility of greater control over the demands of work. Final Thoughts: The work presented showed that the interactive relationships between professionals and users are not the causes of greatest impact in the workplace, although it revealed overload in relation to specific aspects such as: fear of being assaulted by a patient and the feeling of physical exhaustion the end of the workday. Further investigations should be conducted on this topic in order to contribute to the implementation of psychiatric reform proposed by advances both in terms of assistance to individuals and the quality of life in the work of the professionals involved

Avaliação das ações do Núcleo de Apoio à Saúde da Família (NASF) em Macaíba/RN

This research evaluated the contribution of the Support Center for Family Health (SCFH) in relation to its effect on the Family Health Units through perception of the Family Health Strategy (FHS) and SCFH professionals, in addition to the satisfaction of users in relation to that role. Data were collected in the public health services of the city of Macaíba-RN in 2012, through semi-structured questionnaire and non participant systematic observation and it counted as investigated subjects 272 individuals (60 FHS professionals, 12 SCFH professionals and 200 users representatives of 20 units). For analysis of the responses of the opened questions was used categorization process and, in relation to the observational method, that was based on checking the space organization, the characteristics of the participating subjects and the specific set of activities performed by SCFH teams through an observation guide. The results point to a good acceptance of the SCFH teams role by most FHS professionals who reported active participation in the health units routine, its integration activities to the FHS teams with resolving based health promotion actions. Regarding the SCFH professionals, they also reported positive contribution by participating actively in the units routine with integrated activities to the ESF teams and developing resolute actions. For users, the SCFH brought assurance services with better access to specialized, resolving and welcoming care. Systematic observation ratified data obtained by questionnaire. It was perceived the need to implement actions related to man`s health, to invest in expanding the number of the SCFH teams, the greater supply of medications, improving the regulatory process and planning together as a key strategy to promote a more effective integration between teams SCFH / FHS

Avaliação da satisfação das usuárias sobre a atenção à saúde da mulher no Rio Grande do Norte

This work discusses the evaluation of the satisfaction of the users on the women health care focusing on the quality of the primary care in the State of Rio Grande do Norte-BR. The main objective of this research is evaluate the satisfaction of the users about the actions applied to women health in the primary health care in Rio Grande do Norte, observing the information available through the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). The specific objectives are: the evaluation of aspects related to women health; the evaluation of the specific actions related to welcoming the pregnant and; the evaluation of the information related to the postpartum. This dissertation is characterized as an evaluative research made through a multicentric transversal study, using a quantitative approach, which is part of the External Evaluation of the PMAQ-AB in the State of Rio Grande do Norte, made by the Federal University of Rio Grande do Norte. Some secondary data of the interviews with the users who were in the Basic Health Units were used during the External Evaluation of the PMAQ-AB in Rio Grande do Norte. The sample was collected following these criteria: the users that were in the Basic Health Units to attend to any procedure; they must had used the services for at least one year; and they must had agreed to participate the research. The ones that were attending to the services for the first time and the ones that did not use the services for at least 12 months were excluded from the sample. To the data collection it was used a chart of variables/indicators with the following information to the analysis: Women Health Care, Specific Care of the Pregnant and Information about he postpartum. The descriptive analysis of the data were made through absolute and relative frequencies of the variables using the software Statistic Package for Social Sciences (SPSS) for Windows, version 22.0.0. The results show a positive picture of the satisfaction of the users about the actions of the primary healthcare in women health in the State of the Rio Grande do Norte. Another important analysis is the integration of the primary health care with other points of the Healthcare System aiming to reorient the Model of Healthcare as a starter of the access and quality of the services given to the users. Therefore, the evaluation of the satisfaction of the users in health care is essential among all the agents involved in the process of consolidation of the Unified Health System SUS. Also having the need of rethinking the professional practice, reorganizing the processes of work of the multiprofessional teams in health care, enabling financial resources, inputs and materials, planning and systematizing new actions of healthcare aiming to ensure a perfect health care to the people

Avaliação da informação de websites turísticos das cidades-sede da copa 2014

This study aims to analyze tourist information provided by the official websites of the 2014 FIFA World Cup host cities. The framework developed by Díaz (2005) was applied to analyze different aspects, such as: local tourist information, tourist services distribution, communication and interaction between website and users, and website foreign language versions. This dissertation describes how society and tourism are related by analyzing the consequences of technological evolution in the travel and tourism sector, showing the importance of the use of information and communication technology to provide accurate, upto- date and low-cost information to tourist destinations. Because of the nature of the study, the research subjects are the 12 Brazilian host cities represented by their respective official webpages (cities, states and convention bureaus), and also Brazil s official website, totalizing 36 elements to be analyzed. The methodology has been characterized as descriptive and exploratory with quantitative analysis, and also using desk research and survey literature review. In order to analyze the data collected, parametric and nonparametric statistics tests were used, such as: variance analysis (ANOVA and KRUSKAL-WALLIS) to measure means variance between groups combined with multiple comparison tests (Tukey and Games Howell); nonparametric correlations tests (Kendall s Tau b); and cluster analyses. Finally, Microsoft Excel was used to collect data and SPSS for managing data through quantitative analyses tests. Overall, the websites of the south region showed better results than the other Brazilian regions. Despite this result, the data analysis demonstrated that the available tourist information are incomplete as it was verified that tourist host cities websites are unable to provide all the information needed for the web visitors to organize and plan their journey. This means that visitors have to look for more information in other sources

Avaliação das condicionalidades em saúde do Programa Bolsa Família

The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social p olicies for poverty eradication . Consist of transferring monetary funds from the government directly to poor families by fulfilling the condition alities on education and health . In health, even wi th variations between countries , conditionality targeting public pregnant women and children with a view to improving health indic ators maternoinfantil as growth , infant mortality and prenatal care. The objectives of this study are to compare the transfer progr am conditional Brazilian income , the Family and similar programs in Latin A merica in relation to it s effects on growth in children , and to evaluate the effect of Bolsa Família in the prevalence of use of services ( conditionalities ) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ - AB) . For the first objective a systematic review , we selec ted ten articles between 1007 ( one thousand and seven ) found in the databases Embase , PubMed, Scopus , Scielo and Lilacs databases was performed . Articles are ob servational epidemiological studies of transverse descriptive and analytical types of cohort and case - co ntrol. For the second objective, for it is a prevalence study , a statistical analysis using Poisson regression with robust variance was performed to i nvestigate how the prevalence of compliance with conditionalities on health was influenced b y various explanatory variables . Ratios , crude and adjusted prevalence , with their respective confidence i ntervals of 95 % were estimated . The family joined the sch olarship program was considered as the main expo sure variable . Confounding variables were: maternal age , race / color, paid employment , marital status and region of residence . In d ata analysis software R 3.0.1 (RDevelopment Core Team 2013 ) was used . Rega rding the comparison of the Bolsa Família with other programs in Latin America , the review found similar results regarding the positive effect of income transfer in the nutritional status o f beneficiary children programs , and these effects are more evident in children under two years old and belonging to familie s of lower socioeconomic status . For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference betwe en respondents (with children under two years ) registered and not registered in PBF on issues relating to: me et at least six prenatal visits , meet and participate in health education activities . It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The o ther is not confirmed in Brazil , an increase in conditionality expressed in use of primary care by the user s of the Bolsa Família services.

Avaliação da qualidade da assistência prestada pelo serviço de atendimento móvel de urgência do Rio Grande do Norte

O objetivo dessa investigação foi avaliar a qualidade da assistência prestada pelo Serviço de Atendimento Móvel de Urgência do estado do Rio Grande do Norte (SAMU 192 RN), na visão dos profissionais de saúde. Trata-se de estudo descritivo, avaliativo com delineamento longitudinal e abordagem quantitativa, desenvolvido em quatro etapas: construção de perfil dos atendimentos do SAMU 192 RN; revisão integrativa para levantamento dos indicadores de avaliação da qualidade da assistência em serviços pré-hospitalares móveis de urgência; construção e validação de conteúdo do instrumento e definição dos indicadores de estrutura e processo; e aplicação do instrumento aos profissionais de saúde para avaliação da qualidade da assistência. A populaçãoe amostra foram compostas por todos os profissionais do SAMU 192 RN, atuantes no período do estudo. A coleta de dados foi realizada entre janeiro e dezembro/2012. Participaram do estudo: 11 enfermeiros, 24 médicos, 56 técnicos de enfermagem e 88 condutores, totalizando 179 profissionais. O estudo foi aprovado (Parecer nº 437/2010 e CAAE: 0025.0.294.051-10) pelo Comitê de Ética em Pesquisa do Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte. Os dados foram analisados por meio de estatística descritiva e inferencial, nesta foram utilizados os programas Microsoft-Excel XP e SPSS 20.0, com uso do índice Kappa (K) e Índice de Validade de Conteúdo (IVC), considerando K ≥0,61 e IVC>0,80. Além disso, foi considerando nível de significância estatística de ρ-valor < 0,05. Entre os 179 profissionais, 100,0% tinham menos de 5 anos de tempo de serviço, 55,9% tinham menos de 5 anos de experiência na área de urgência, 88,3% referiram trabalhar na instituição porque gosta, 55,3% possuiam outro vínculo de trabalho, 54,3% com jornada semanal de 30 a 40 horas, 98,9% participaram de treinamento, 83,2% valorizam o treinamento em serviço, 87,2% têm boa frequência de participação no treinamento e 96,6% sentem necessidade de realizar mais treinamentos. Com relação à categorização dos itens em indicadores de estrutura ou de processo, os juízes determinaram para estrutura: estado de conservação das ambulâncias; estrutura física geral do serviço; conforto dentro da ambulância; disponibilidade de recursos materiais; segurança para o usuário dentro da ambulância; segurança para o profissional; educação permanente; segurança demonstrada pela equipe profissional; remuneração do profissional e a satisfação profissional. E para processo: acesso ao serviço; acolhimento; humanização; atendimento realizado; tempo resposta; privacidade ao usuário; orientações sobre o atendimento; relacionamento entre o profissional e usuário; oportunidade do usuário realizar reclamações e articulação multiprofissional. O instrumento quando submetido à validação de conteúdo constatou-se que as contribuições dos juízes permitiram melhorar/otimizar o instrumento de avaliação da qualidade da assistência pré-hospitalar móvel de urgência, uma vez que os índices Kappa e IVC foram considerados bons e ótimos e o conteúdo foi validado. Na avaliação da qualidade da assistência, constatou-se que a qualidade da assistência prestada pelo SAMU 192 RN está prejudicada nas dimensões estrutura, com relação à estrutura física, segurança dos pontos de apoio descentralizados, o conforto e o estado de conservação das ambulâncias. Já com relação aos indicadores de processo, os profissionais avaliaram todos positivamente. A avaliação da qualidade da assistência contribui para a busca de soluções dos problemas detectados, permite novas perspectivas e colabora para a consolidação do serviço.

Avaliação da estrutura e processo de trabalho dos centros de atenção psicossocial

Objective: Evaluate the work structure and process in Psychos ocial Care Centers (CAPS) and the professionals profile, the satisfaction, conditions and work overload. Methods: Cross - sectional study conducted in five CAPS in Campina Grande city. The study sample consisted of five coordinators, 42 graduate professional s, 26 mid - level (technical and auxiliary nurses, and caregivers), and the medical records pertaining to 413 users followed up. Data were collected using validated questionnaires (CAPSUL - rating CAPS in southern Brazil) and adapted to the study, between July and October 2014. The questionnaires were double entered and submitted to validation in the sub - program “Validate Epi Info 3.5.4” , used along with the “SPSS 17.0” for processing the statistical analyzes. Measures of central tendency and dispersion were ap plied to the descriptive analyzes; “Fisher's” exact test to check the CAPS impact on hospital admissions and the “Bonferroni” adjusted to verify the diagnoses according to sex. 5% significance level was adopted. The study was approved by the Ethics Committ ee of the Rio Grande do Norte Federal University (UFRN), protocol 719.435, of 05.30.2014. Results: From the structure analysis were identified contextual factors that influenced the work process of CAPS professionals, such as: deficiencies with regard to h uman resources; forms of health professionals employment and qualifications; temporary contract existence. As to process dimension, it was found that the home visits performance by health professionals shows to be ineffective, given its insufficiency and i rregularity, which can be explained by the high demand, reduced staff and transportation lack. It was low coverage of items inherent to Therapeutic Individual Project, as the income generation program, insertion at work and home visit. The reference and co unter reference flow are still not satisfactorily organized. There was statistically significant difference for the diagnosis, with a predominance of mood disorders related to stress among women and those related to alcohol and other drugs among men (p <0. 05). There was an association between the degree of health professionals satisfaction and working conditions, overload and factors related to the content and working conditions, the security measures, comfort and CAPS appearance, contact between the teams and users, families treatment by the teams, temporary employment relationship. Conclusion: The data collected indicate the need for the CAPS organization through increased investments in the sector in order to enhance the infrastructure as potentiating el ement of practices with a view to changing the care model for mental health proposed by the Psychiatric Reform. It is hoped therefore that this research will contribute to better planning in CAPS unit management, with another tool to improve the dimensions involving the structure and the professional work process and improve this mental health care model.

Avaliação da atenção humanizada ao abortamento em maternidade-escola, em Natal, Rio Grande do Norte

Unplanned pregnancy is experienced by millions of women worldwide. Such fact increases the risk of abortion-related morbimortality, which represents a serious public health problem. This study aims to evaluate the advances and challenges of the implementation of Humanized Abortion Care at the Maternity-School in Natal, state of Rio Grande do Norte. The research was evaluative, was preceded by an Evaluative Study, and resulted in a Case Study. The intentional sample totaled 102 subjects (60 users, 39 professionals and 3 managers). The collection techniques included documental analysis, semi-structured interview and observation with a field diary. The documental analysis was descriptive, while the Content Analysis by Bardin was used for semi-structured interviews and field diary. The Evaluative Study observed that Humanized Abortion Care is an evaluative program with preparation and pact of the logical model, of the matrix of indicators and evaluative questions. The Case Study showed that users were satisfied with the problem-solving capacity and access to the service; however, is also showed that they pointed out inadequacy in terms of environment, qualified hearing and reproductive planning. Professionals reported that the inefficiency of service consists of infrastructure and environment, which are considered inefficient and inadequate to humanized care, especially regarding patient accommodation, the lack of hospital beds, the reduced number of rooms in the surgical center and the lack of laboratory inside the maternity. Moreover, reproductive planning does not consist of an institutionalized practice in the service, and integrality with other services or partnership with the community is not in place. The Maternity Board emphasizes that the excessive demand of patients is one of the reasons that hinders the appropriate implementation of the technical standard. We then conclude that although satisfied regarding problem-solving capacity in terms of service and ease of access, there is room for improvement in qualified hearing systems, in the creation of a system to promote team work, implementation of ombudsman and satisfaction surveys. The right of shared choice did not prevail among users and health professionals with regard to the option of uterine evacuation procedure. Environment was the most mentioned category as that requiring more changes, seeing as a limited factor for the development of humanized and welcoming practices. Health professionals do not establish a periodic routine of planning practices, and such practices are not aligned with the Technical Standard. Incorporation of guidelines and availability of a plurality of methods and possibilities of choices for family planning are required. There is no institutionalization of reference and counter-reference, or partnerships with the community, which makes integrality of care not viable. The Standard needs to be included in the action plans of managers as one of the priorities in the construction of care strategies for women's health, in order to enable, allied to other initiatives, the real integration among safe conduct service, primary care network and social organizations. As a result, respect for human rights and adequate humanized care, as a way of attention and prevention of abortion, can be secured.

Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.

Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.

Saúde bucal no Programa Saúde da Família: uma avaliação do modelo assistencial

O objetivo deste estudo foi avaliar a incorporação da saúde bucal no Programa Saúde da Família no Rio Grande do Norte, com base na análise de fatores capazes de interferir no processo de mudança dos modelos assistenciais em saúde bucal. Esta avaliação tomou como referência três dimensões: o acesso, a organização do trabalho e as estratégias de programação. Foram sorteados 19 municípios no estado. Os instrumentos de coleta foram a entrevista estruturada aplicada a gestores e dentistas, a observação estruturada e a pesquisa documental. Foi possível identificar precariedade nas relações de trabalho e dificuldades no referenciamento para média e alta complexidade, na intersetorialidade, no diagnóstico epidemiológico e na avaliação das ações. A maioria dos municípios apresentou pouco ou nenhum avanço no modelo assistencial em saúde bucal. Os municípios que demonstraram avanços apresentaram alta expectativa de vida ao nascer, baixas taxas de mortalidade infantil, valores per capita entre os mais altos do Estado e altos valores de IDH-M. Concluiu-se que políticas públicas que contemplam aspectos além dos pertinentes ao setor saúde são decisivas para uma real mudança nos modelos assistenciais.

Saúde bucal no Programa Saúde da Família: uma avaliação do modelo assistencial

O objetivo deste estudo foi avaliar a incorporação da saúde bucal no Programa Saúde da Família no Rio Grande do Norte, com base na análise de fatores capazes de interferir no processo de mudança dos modelos assistenciais em saúde bucal. Esta avaliação tomou como referência três dimensões: o acesso, a organização do trabalho e as estratégias de programação. Foram sorteados 19 municípios no estado. Os instrumentos de coleta foram a entrevista estruturada aplicada a gestores e dentistas, a observação estruturada e a pesquisa documental. Foi possível identificar precariedade nas relações de trabalho e dificuldades no referenciamento para média e alta complexidade, na intersetorialidade, no diagnóstico epidemiológico e na avaliação das ações. A maioria dos municípios apresentou pouco ou nenhum avanço no modelo assistencial em saúde bucal. Os municípios que demonstraram avanços apresentaram alta expectativa de vida ao nascer, baixas taxas de mortalidade infantil, valores per capita entre os mais altos do Estado e altos valores de IDH-M. Concluiu-se que políticas públicas que contemplam aspectos além dos pertinentes ao setor saúde são decisivas para uma real mudança nos modelos assistenciais.

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.