Riscos ocupacionais e acidentes de trabalho em um serviço de atendimento móvel de urgência do Rio Grande do Norte

Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service.

Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Assistência de enfermagem e o risco para úlceras de pressão medido pela Escala de Braden em unidade de terapia intensiva

The problem facing the incidence of pressure ulcers (UP) in the hospital environment especially in the intensive care unit (ICU), although it is an old and frequent event in our professional practice, it is not notified in the researches as much as it should be. We observed a tendency to invest in therapeutical and in studies about the production of sophisticated new bandages. Few, however, are the investments in research on preventive measures in order to prevent or at least slow down the development of lesions. In this sense, the study aimed to analyze the correlation between nursing care and the risk of developing UP measured by the Braden scale in ICU patients. This is a descriptive study of longitudinal quantitative approach. The project obtained a favourable opinion from the Ethics Committee of HUOL (no 486/10). Data collection was carried out in the Hospital of Unimed in Natal during six months in 2011. The sample was of 32 patients hospitalized in ICU for over four days. The results were processed in SPSS 15.0 for descriptive statistics and inferential statistics. We identified that, only 9.4% of our sample developed UP, being predominantly male, elderly people aged above 60 years, Caucasian, with diagnostic hypothesis at the time of hospitalization of sepsis, were clinical patients, who presented hemodynamic instability, using orotracheal tube (TOT), enteral probe (SNE), vesical probe delay (SVD) and had values of albumin and hemoglobin levels below normal. In addition, these patients had a longer hospital stay, longer usage of TOT, SNE, SVD, increased use of sedation and drain than those who did not develop UP and were all at risk for developing these injuries second Braden scores. 66.7% of the lesions developed were located in the sacral region, limiting the degree I and all patients that developed were considered serious, 100.0% of them have evolved since the death. Small were the differences between the averages of Braden scores between patients with and without UP, 11,9+2,4 against 12,4+2,6 with p = 0.627. The clinical aspects of the patients in the study were instrumental in the development of UP, once, these findings were statistically significant through the Mann-Whitney test, and appropriateness of nursing conduct was decisive for the prevention of pressure ulcers in critical patients, since many were those classified as at risk (28) and few who have developed lesions (03)

Segredos da alma: a dádiva da assistência de Enfermagem

The present study is an analysis of interpersonal relationships between the nursing staff and the patients under their care. Its objectives are to analyze ties/links that may possibly exist in such relationships and to describe, based on the experience of the patients, how they are received by the nursing staff, and what is the extent of their reliability on the nursing staff within the hospital. This investigation is analytical in nature and qualitative in approach, having as its leading thought Marcel Mauss s gift-exchange theory. The study involved eighteen in-patients, eight of them from government institutions, at a large hospital school and ten others from a private specialty hospital; both in the city of Natal, state of Rio Grande do Norte, Brazil. Data were collected between January and March 2006. Results point to ties being created between the nursing staff and patients irrespective of their social status, involving especially the development of friendship and reliability. We have noticed that in both services the interpersonal relationship is associated with the circulation of the symbolic goods mentioned in the patients discourse, such as attention, loving care and concern, among others, marking the formation of ties during hospital stay. Likewise, reliability is also present in close relationship with the technical competence of the professional. Patient hospitality is associated with the manner in which the patients were treated on being admitted to the hospital, although they also refer to hospitality at later moments, during the course of their treatment. Finally, we are in a position to say that there are ties/links between in-patients and nursing staff, irrespective of the patient s social status and class divide. It is thus evident that the antiutilitarian symbolism of gift to give, receive, give back -, which shapes the setting of social ties also takes place in today s utilitarian, individualistic and competitive societies. Thus, human beings whose existence is dependent on mutual relationships try to save their humanity, especially those who are fragile and dependent as is the case of the hospital in-patient

Em busca do conhecimento da equipe de enfermagem na sua prática assistencial às vítimas de traumatismo raquimedular

The great demand of accidents resulting in victims with rachi-medullar traumatism (RMT) and the need for indetifying how they are being assisted, led us to proceed with this investigation. It had as its goal to identify and analyze the knowledge of nurses and nurse assistents regarding the nursing assistance to these patients. It consists of a descriptive exploratory study, with a quantitative method and prospective data. For its execution, 193 subjects were interviewed, 37 of them nurses and 157 nurse assistents in 02 hospitals of the metropolitan zone of Natal. The results reveal that the subjects are not coherent when questioned whether they are prepared to assist victim of RMT and the content described by order of piority regarding the steps followed in the assistance of these victims, both in the pre-hospital and hospital care. Thus, we observe that only 06 nurses and 07 assistents, described correctly all the steps necessary to pre-hospital care and only 01 nurse and 02 assistents registered all the steps in the correct sequence regarding the hospital care. We conclude that, in face of the obtained results, we can urgently modify this reality, improving the nursing staff and giving them better work conditions

A intenção e o gesto :ações gerenciais de enfermeiros em espaços hospitalares

The present study analyses the supervisory practice of the nurse in the hospital environment. It has, as its main objective identify the use of planning, supervision and evaluation, as managerial instruments in the daily nursing practice. It tries also to identify the importance given to these instruments in their supervisory actions and the difficulties encountered in their use. It deals with an exploratory and analytical investigation with a qualitative approach having as its main point of analysis the principles of strategic planning. In order for it to be done 10 nurses were interviewed, distributed in three public hospitals in the city of Natal/RN. The results show that, although the nurses recognize the importance of the managerial instruments, they do not put them into practice in an effective and systematic way. They justify it because of the existence of personal, professional and institutional difficulties. On the other hand we could conclude from what they say that there is the desire to overcome the eminently burocratic vision of the management. Thus, they express a feeling for change and point in the direction of looking for ways that will contribute to innovate this practice

Enfermeiros pós-graduados: continuidades e rupturas no cotidiano profissional de hospitais universitários

A presente pesquisa teve como objetivo analisar as transformações do cotidiano profissional do enfermeiro do hospital universitário após a realização do curso de mestrado. Trata-se de um estudo com abordagem qualitativa, realizado no Complexo Hospitalar Universitário da UFRN, composto pelo Hospital Universitário Onofre Lopes (HUOL), Maternidade Escola Januário Cicco (MEJEC), e Hospital de Pediatria Professor Heriberto Ferreira Bezerra (HOSPED) localizados em Natal-RN; e pelo Hospital Universitário Ana Bezerra (HUAB) situado em Santa Cruz-RN. A população foi composta por vinte e dois enfermeiros, com título de mestre em enfermagem, que trabalham nessas instituições. Após encaminhamento e aprovação pelo Comitê de ética em pesquisa, conforme Parecer nº 268.498 e CAAE: 13922713.1.0000.5537, as entrevistas foram iniciadas, utilizando-se um roteiro semiestruturado, organizado em questões orientadas em conformidade com os objetivos do estudo. Do material empírico, emergiram as categorias que foram trabalhadas com base na análise de conteúdo temática, tendo como aporte teórico os estudos de Agnes Heller acerca do cotidiano e os de Paulo Freire sobre educação e mudanças, buscando a possível interlocução entre esses autores. Os resultados demonstram que o cotidiano dos enfermeiros nos hospitais universitários, após cursarem o mestrado, modifica-se a partir da própria motivação em cursálo e do apoio institucional recebido. As continuidades e rupturas apontadas estão distribuídas nas categorias: a inércia da cotidianidade, na qual os enfermeiros relatam a dificuldade em mudar seu cotidiano devido à rotina exaustiva e à falta de apoio; reconhecem mudanças particulares, compreendendo a formação de um olhar crítico/reflexivo/analítico, e a qualificação para o ensino e pesquisa; e as rupturas do cotidiano, que se referem às mudanças ocorridas no serviço, como a melhoria da assistência, pela implantação de resultados; e uma prática diferenciada por ter um profissional qualificado. Portanto, considera-se que a realização do mestrado contribuiu para o crescimento do intelectual e profissional do enfermeiro e, consequentemente, para o serviço, no cotidiano do Complexo Hospitalar Universitário, sendo reconhecido pelos enfermeiros o compromisso com uma maior responsabilidade social. Porém, ainda são necessárias reflexões sobre maneiras de minimizar as dificuldades apontadas, como forma de incentivar essa qualificação

Critérios na tomada de decisão estratégica em projetos de co-geração a gás natural: um estudo em hospitais

This thesis deals with analyzing the actual perception of the brazilian hospital managers about natural gas fired cogeneration. An study of case is developed to obtain information about the viability of the investments in cogeneration technolgies in four hospitals. These studies are made using a questionnaire, to know and to obtain necessaries data of the managers. The main results shows that the investors have a bad feeling about to invest in a different activity. In other hand, the results show that the investors have a good impression about the configuration of the project that uses the project finance like way of financing

Arquitetura inteligente fuzzy para monitoramento de sinais vitais de pacientes: um estudo de caso em UTI

The area of the hospital automation has been the subject a lot of research, addressing relevant issues which can be automated, such as: management and control (electronic medical records, scheduling appointments, hospitalization, among others); communication (tracking patients, staff and materials), development of medical, hospital and laboratory equipment; monitoring (patients, staff and materials); and aid to medical diagnosis (according to each speciality). This thesis presents an architecture for a patient monitoring and alert systems. This architecture is based on intelligent systems techniques and is applied in hospital automation, specifically in the Intensive Care Unit (ICU) for the patient monitoring in hospital environment. The main goal of this architecture is to transform the multiparameter monitor data into useful information, through the knowledge of specialists and normal parameters of vital signs based on fuzzy logic that allows to extract information about the clinical condition of ICU patients and give a pre-diagnosis. Finally, alerts are dispatched to medical professionals in case any abnormality is found during monitoring. After the validation of the architecture, the fuzzy logic inferences were applied to the trainning and validation of an Artificial Neural Network for classification of the cases that were validated a priori with the fuzzy system

Implementação e análise de desempenho dos protocolos de criptografia neural e Diffie-Hellman em sistemas RFID utilizando uma plataforma embarcada

RFID (Radio Frequency Identification) identifies object by using the radio frequency which is a non-contact automatic identification technique. This technology has shown its powerful practical value and potential in the field of manufacturing, retailing, logistics and hospital automation. Unfortunately, the key problem that impacts the application of RFID system is the security of the information. Recently, researchers have demonstrated solutions to security threats in RFID technology. Among these solutions are several key management protocols. This master dissertations presents a performance evaluation of Neural Cryptography and Diffie-Hellman protocols in RFID systems. For this, we measure the processing time inherent in these protocols. The tests was developed on FPGA (Field-Programmable Gate Array) platform with Nios IIr embedded processor. The research methodology is based on the aggregation of knowledge to development of new RFID systems through a comparative analysis between these two protocols. The main contributions of this work are: performance evaluation of protocols (Diffie-Hellman encryption and Neural) on embedded platform and a survey on RFID security threats. According to the results the Diffie-Hellman key agreement protocol is more suitable for RFID systems

Modelo arquitetural de comunicação para monitoramento de pacientes baseado em middleware, computação móvel e ubíqua

Hospital Automation is an area that is constantly growing. The emergency of new technologies and hardware is transforming the processes more efficient. Nevertheless, some of the hospital processes are still being performed manually, such as monitoring of patients that is considered critical because it involves human lives. One of the factors that should be taken into account during a monitoring is the agility to detect any abnormality in vital signs of patients, as well as warning of this anomaly to the medical team involved. So, this master's thesis aims to develop an architecture to automate this process of monitoring and reporting of possible alert to a professional, so that emergency care can be done effectively. The computing mobile was used to improve the communication by distributing messages between a central located into the hospital and the mobile carried by the duty

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Uma avaliação do serviço de atenção domiciliar/programa melhor em casa: o caso do hospital Monsenhor Walfredo Gurgel

This dissertation try to understand how management actions implemented by Monsenhor Walfredo Gurgel Hospital in the city of Natal promote effectively the benefits of Home Care Services / Programa Melhor em Casa . The research is exploratory and descriptive, qualitative approach. Data were collected through document analysis and the interviews with the managers of the Program in Health Department and Hospital beyond the questionnaires with the home care teams and technical management unit of Hospital Jobs. The information were treatment trough categories that analyzed to implemented actions and program objectives. The results show that: the practices carried out by the host teams produce the humanization of care by seeking to ensure access to health services and solving human form; networks of health care are not yet finalized hindering the referral of patients to other units, the networks allow support from other institutions to minimize the problems encountered, the management unit vacancies allows the reduction of costs, mainly by regulating beds and record of health initiatives in home care assists in the monitoring and evaluation process of the Services Home Care / Programa Melhor em Casa primarily the epidemiological profile and patients individual treatment plan. Concludes that most of the actions implemented by the Hospital contribute to the effectiveness of the goals of Programa Melhor em Casa

Sair curado para a vida e para o bem: diagramas, linhas e dispersão de forças no complexus nosoespacial do Hospital de Caridade Juvino Barreto (1909-1927)

This work has as object of study the Hospital de Caridade Juvino Barreto, nosocomial institution located in the city of Natal (RN), between the Praia de Areia Preta and the Monte Petrópolis, focusing on the period from 1909, the year in which the new hospital building was constructed and opened, and 1927, the date of the transfer of administration of the public domain to the newly created Sociedade de Assistência Hospitalar (SAH). We study the conditions of possibility of the emergence of this hospital space in the urban environment of the capital of Rio Grande do Norte, seeking to understand the different tactics and strategies implemented by the historical subjects involved in the formation of this institution nosocomial. Starting from a corpus of documents consisting of medical memories (with Dr. Januário Cicco as privileged observer), information present in newspapers (the Republic and the Christmas Journa l), photo collection and extensive administrative and legal material (Speeches, Exhibitions, Reports, Laws and Resolutions), we analyzed in detail the medical geography of HCJB, relating the discourses of medicine and geography in choosing the spatial location of the hospital as we examine the architecture of the hospital, its inner spat iality, divisions, forms of space control, and, finally, we discuss the medical practices that took place within it, leading us in this regard, from the experiences of clinical hospital chief, Dr. Januário Cicco, especially the discussion on "ethics" in hospital work. The perception of HCJB as medical nosoespaciality always on the move, incorporated under taxonomic principles based on difference and dispersion forces, led us to articulate it theoretically from the conceptual-methodological arsenal of philosopher Michel Foucault, particularly his reflections of genealogical phase, focusing on the phenomenon of power, a position that allows us to enhance our space-hospital construction, invention, product of power relations, which give the unfinished aspect nosocômio, apparent, always at stake, perpetual non-modeling possibility has previously defined array, establishing it at the field of possible, of virtuality, of power: hospital that could have been and that it was not. Indeed, the investigation of various aspects/elements of hospital space Juvino Barreto revealed us new dimensions of hospital space, far more complex than the simple and the current idea of a place to shelter patients: plasticity and fluidity of space, which is not made to circumscribe the limits of empeiria, engraving up to strength relations fought between different subject; its Constitution as a transitional space, Heterotopic, doing live inside modern elements with premoderns (professional doctors working with religious thought, skeptical of positivist medicine living with the religious faith of the nuns of Santana); the impossibility of thinking hospital space of HCJB while homogeneous unit, static, transistoric, making the spatiality, without considering the profound differences, fractures and dislocations that animated his own existence, multiplying their expressions of identity

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