Análise da atuação do Ministério Público Estadual na assistência materno infantil do Rio Grande do Norte

Maternal and infant mortality have become a serious public health problem in Brazil, especially in northeasternand northern regions.In RioGrande do Norte, the high rates ofdeathsofmothersandbabies haveconcerned not onlythehealthauthorities andjusticeagenciessuch as the prosecution service. In 2011, State Public Ministry (MPE) has developed a proposition which was called “Nascer com Dignidade”, focused on the monitoring ofcare givenin prenatal, childbirth andpost childbirthin the cities. The aim of thisstudy was toinvestigate how the intervention of MPE works in maternal and child care. The method adopted to survey data was the case study by analyzing the skills of the reports which were carried out in four of the eight Public Health Regional Units (URSAP).A total of 26municipalities were chosenand the results showfragilityparticularly inprenatal care which can result in complicationsin childbirthand postpartumlike:incomplete health family teams(in05cities), lack of access orinaccessibility to laboratory tests(16 cities) and lack of the pregnant woman'sattachment to thebirthing place(in26 cities). Based on this reality, MPE has adopted relevant attitudes as filing public civil suits, compliance of Conduct Adjustment Declaration in the municipal management and performing interventions in heath care centers and maternity clinics of the state. Thereforeit is known thatPublic Ministryis of paramount importanceto indicatethe necessaryadjustmentsto addressinfant and maternalmortalityin the state (mean of 65/100,000 and16/100,000respectively) and give the city hall the responsibility for the health care quality provided to their citizens. These factors demand theprinciples ofuniversality and integrality to be performed in order to reduce social inequities.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

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.

Sustentabilidade de destinos turísticos em unidades de conservação: o caso da Praia de Jenipabu

Environmental Sustainability is a very important factor for the Tourist Development of the localities, which should be protected and preserved so many other generations goers enjoy the experiences in their paradisiacal landscapes. The objective of the present study is to analyze the sustainability of the tourist destination of Jenipabu Beach, situated in a conservation area on the northern coast of Rio Grande do Norte state, in the city of Extremoz, 20 km from the center of the Capital Natal, being of great state tourist importance for having the most famous Dunes park in the region. There are several regulars and their proper groups in a tourist area, and the differences in these perceptions about the relationship of certain factors occurring on site, can determine how sustainable the same or its sustainability index is. This research used an Ecotourism Sustainability Indicator System (SEIS) to Tsaur, et al (2006), to assist in the verification of this index, in use methods of exploratory and descriptive research, where the data were collected through a questionnaire applied close to 151 attendees divided among residents, traders and visitors, directly by the author in Jenipabu in August and September 2015. The tabulation, analysis and interpretation of data were taken from the assistance of the technical factor analysis of statistics and ONEWAY ANOVA, which conducted by IBM SPSS software STATISTICS 20. The main findings were, identifying 14 relevant sustainability factors, of which 6 coincide with the indicator model used and 8 are new, as well as verification that Jenipabu is a destination with strong economic dependence of the Tourism, with various impacts of this community, which does not recognize the benefits that the Environmental Protection Area (APA) can bring to this and to the locality tourism. In conclusion on differences in perceptions of the regulars that the studied region Beach has low Sustainability and requires the development of various projects and actions for improvement.

Trabalho em equipe de saúde: uma análise contextual

COSTA, Roberta Kaliny de Souza ; ENDERS, Bertha Cruz ; MENEZES, Rejane Maria Paiva de . Trabalho em equipe em saúde: uma análise contextual. Ciência, Cuidado e Saúde, v. 7, p. 530-536, 2008.

O enfermeiro na sala de vacinação: uma análise reflexiva da prática

Objetiva-se analisar a prática do enfermeiro em sala de vacina, mediante o modelo de vigilância à saúde como referência. Trata-se da análise crítica reflexiva realizada através de observação, durante as práticas como docentes, em Unidades Básicas de Saúde. Percebeu-se que o enfermeiro responsável pela sala de vacinação desenvolve pouca atividade fixa específica, indo à sala para resolver algumas dificuldades ou na ausência de funcionários. O perfil epidemiológico e o modelo de vigilância à saúde são pouco usados, sinalizado pelo comportamento indiferente dos usuários. As atividades de vacinação devem ser desenvolvidas por uma equipe de enfermagem com participação do enfermeiro, a fim de oferecer um serviço de qualidade e atender a demanda individual e coletiva

A satisfação profissional e a cultura organizacional : uma análise a partir do modelo ASH no Centro Federal de Educação Tecnológica do Rio Grande do Norte

With the need of the companies in becoming more competitive within the market, it arises an incessant search for selective human potential, with a high level of capacity and low rotativity, which motivation results in production raise, quality optimization and waste reduction. This scenario requires a strategy development which advantages the Human Resources Quality Management. This way, the model of the Human System Audit (HSA), developed by the Spanish researchers Ouijano and Navarro, presents itself as an important tool to diagnosis and evaluation, contemplating the environment where the organization is inserted, its strategies, its organizational design, its processes and its organizational effectiveness. In this sense, the present study has identified the existent relation between the professional satisfaction and the Organizational Culture, based in the model HSA. The research has been a quantitative-descriptive one and has had as population the technical-administrative workers from the Federal Center of Technical Education of Rio Grande do Norte (CEFET RN). The data collection has occurred during May, 2008, by means of the application of a questionnaire in the HSA model. The sample was composed by 167 subjects, distributed among the Five units of the institution. It was used the factorial analysis, with the extraction method of main components and orthogonal rotation varimax, in order to extract the dimensions of the satisfaction and of the organizational culture and the calculation of Cronbach s Alpha coefficient, to evaluate the reliability of these dimensions. The factorial analysis of the satisfaction indicators has identified four factors,, all of them showing significance: gratefulness and relationship , self-realization , stability and security and physical conditions and social benefits . The result of the factorial analysis with the indicators of the organizational culture has extracted four factors and among them, three of them have obtained significance: Personal Satisfaction Style , Competitive-Denial-Power Style and the Conventional-Dependent Style . After identifying the dimensions of the satisfaction and culture found at CEFET-RN, it has been notice the existence or not of relation among them, through the application of Pearson s coefficient. It has been verified that all of the dimensions of the Professional satisfaction are correlated with some dimension of the organizational culture, having in outstand position, with higher intensity, the relation between the culture style of Personal Satisfaction and the satisfaction factor referring to the self-realization