Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Cuidado de enfermagem ao potencial doador de órgãos em morte encefálica: uma reflexão sobre a prática

Despite of the technological advances that favor the transplant process, there are issues of effectiveness of care necessary for the maintenance of potential organ donors with brain death, which contribute to the no realization of transplants of organs and tissues of these patients. It is presupposed that the problems could be related to perceptions and understandings that the professionals of the units of internment have about the care required by the diagnosis of brain death. The aim of this study was to understand the meaning of the nursing care of the potential organ donor with brain death to the nursing staff. Descriptive study with qualitative approach guided by Action Science Theory and the critic-reflexive research methodology accomplished with five nurses and 19 nursing technicians from Operative Rehabilitation Center in a public hospital at Natal / RN, Brazil, between March and May 2013. Data were collected through semi-structured interviews with individual reflection about the care and through group interview, after approval by the Ethics and Research Committee, CAAE No.: 04255612.7.0000.5537. The analysis was performed in a thematic way according to Bardin. During the group meeting the participants were driven in a discussion about the need for change and how to perform them. The results indicate that the professionals actions are consistent with those required for maintenance of potential organ donors, although the material and human resources are not adequate. That situation leads the professionals to develop a meaning of care as one labor more, demanding more than they can give. They express beliefs and feelings concerning the hope that their care brings a greater good that is to save lives. The reflection for a possible change of action was difficult to accomplish due to professionals not to be able to self evaluate, what lead to direct your changes suggestions for other team members. It is concluded that the care provided to these patients is a difficult care, evidenced by suffering both death situation of the person cared and pain of their families, as the dehumanizing conditions of work, helping themselves to keep distance from patients to not suffer so much. The knowledge impregnated in their act, are scientific, ethical, aesthetic and personal kind with a predominance of the scientific followed by the personal. The study was also relevant to the practice of nursing in maintaining the potential donor, in that it allowed the identification of the knowledge used by nurses in their care practice and the meaning understanding of the professionals on the care provided, as a good action that brings satisfaction when the transplanting is executed. Other experiences are suggested with the critic-reflexive research methodology, both in research as in teaching nursing

Processo de trabalho na estratégia saúde da família: potencialidades e fragilidades da atuação do enfermeiro

The present study aims to analyze the nurse s work process at Family Health Strategy, considering its basic elements and dynamic, and searching to identify aspects that may constitute strengths and weaknesses in its development. This is an analytical case study, with qualitative approach and theoretical-conceptual mark grounded in Dialectic Hermeneutics. Empirical research fields were the Family Health Units of Natal, RN, Brazil. The subjects are nurses working in this Strategy. Data collection was conducted through semi-structured individual interviews combined with field observation. The research was initiated after approval by the Ethics Committee of Universidade Federal do Rio Grande do Norte, according to the guidelines and rules for research involving humans (Resolution 466/12), ensuring proper ethical precepts. The project was approved by register number 398.929, CAAE 19588813.7.0000.5537. From the 9 interviewed nurses, 8 were female and 1 male, average age of 52 years, average graduation time of 27 years and average time they stayed at the same Family Health territory of 7 years. It was found that it is up to the professional nurse in the Family Health care the important role of taking care of human beings in their life, family and community contexts, producing conditions to meet their needs through therapeutic act in health, using for such purpose both materials and immaterial instruments. It was possible to relate aspects that characterize strengths and weaknesses in the work process of nurses in the ESF, according to the speech of the interviewed workers, including the meanings and contradictions. Among the potentialities observed, it was possible to highlight the wide role of the nurse at Family Health; the perception of nurses about teamwork; the relative autonomy of nurses; the commitment of professionals to work; Humanization as a technology; the presence of other agents at work, such as directors and officers at the primary health units; the professional s experience time and contract type in the case studied. As weaknesses in the work process of nurses at Family Health Strategy, were highlighted the limited skills of the workforce; the difficulty in 10 identifying specific limits of the work of nurses in this scenario; the disturbances that occur in the process, the existing gaps in multiprofessional teams; Structural deficits of the units in the studied case, the low coverage of the Family Health in the county, and the political vulnerability of the work conditions. It is considered necessary to understand the dilemmas experienced in everyday life of nurses at Family Health Strategy as part of multiprofessional teams, facing actual achievement of changes in work processes necessary for the reorientation of health care in Brazil. In accordance, it is necessary to promote proper working conditions and welfare of labor agents which are protagonists the work at the United Health System

O ensino de enfermagem gerontológica na formação do enfermeiro

At the current time of demographic changes in the world , it is observed that the health sector requires restructuring of its practices in caring for the elderly , in order to enable a comprehensive and humane care . In this sense, we identify the need for qualified professionals to assist the elderly and, therefore , it is important that training curricula are adequate to this reality . The study aims to analyze how it develops teaching gerontological nursing component in undergraduate nursing . This is a descriptive , exploratory study with a qualitative approach, in two higher education institutions in the city of Natal / RN . The population involved corresponded to the coordinators of graduate courses in nursing and teachers who teach content of health care for the elderly, a total of seven participants . The data collection instruments were used: a questionnaire containing questions related to the characterization of the participants and the teaching of gerontological nursing in undergraduate courses in nursing and a form with items of analysis for pedagogical projects . The results were presented descriptively in tables and analyzed from coming themes of the main themes of the instruments defined in: knowledge about the research participants , knowledge of teaching gerontological nursing component and knowledge of pedagogical projects , discussed under Resolution paragraph . 03 of 7/11/2001 , which establishes standards for the nursing program , the educational projects of educational institutions , the Theoretical Donald Shoon and thematically relevant literature . The results indicate that the majority of participants were female (four), all have graduate though , none of them stated in the qualification of aging or elderly health area; the organization of the contents of the component in the curriculum, workload theoretical- methodological and practical teaching strategies presented was heterogeneous and sometimes diverging at the same institution . On the definition of gerontological nursing component was identified that is not well defined along the pedagogical design of educational institutions surveyed . It was concluded that in the context of this study , teaching gerontological nursing is present in the course of nursing education, but needs reevaluation and updating in order to teach a wider range of driving and health practices

Método de avaliação do gerenciamento de resíduos em canteiro de obras da construção civil : proposta baseada em empresas construtoras da cidade de Natal-RN

According to great concern between the developed industrial activities and resultant impacts over the environment, an association of several factors have occurred, procedures to the efficient management of the rotation between economical development and the environment have been improved. A research in field have been realized inside building sites of companies in order to provide knowledge about the implemented and accomplish actions according to the resolution from CONAMA nº307. Trough the interview among the representations of the companies and photographic survey in loco, such as, what makes the companies implement this management, reutilization and recycling, transport and disposition. The present study had as objective: analyze the insertion of the used tools to residuals management, proposing improvements, in a way that it can be easily identified during the procedures execution in the building sites of the building companies of the city of Natal/RN. To reach the goal, in the first place a revision of the pertinent literature was performed; there for, it can be seen the relation between residues management and environment sustainability, once it happens in a continued way it may prevent the waste and reduces the risk that the activities way bring to the employees, community and environment; once found the great difficult faced with regard to labors, material, equipment, project, planning, costumer s interference, furnisher. And still, it could be verified wich materials generate greater indexes of residues in the works and the main occurrences of waste and loss. However a greater transparency is needed coming from the high administration in the commitment with the continued actions, to make it so, there must be a cultural change inside the company. There for there will be a greater productivity and quality of the under taking such as costumer s satisfaction

Protocolo multiciclos para automação hospitalar sobre Multicast com IEEE 802.3 utilizando

The concepts of the industrial automation are being incorporated in the medical area, in other words, they also pass to be applied in the hospital automation. In this sense, researches have been developed and have usually been approached several of the problems that are pertinent to the processes that can be automated in the hospital environment. Considering that in the automation processes, an imperative factor is the communication, because the systems are usually distributed, the network for data transference becomes itself an important point in these processes. Because this network should be capable to provide the exchange of data and to guarantee the demands that are imposed by the automation process. In this context, this doctorate thesis proposed, specified, analyzed and validated the Multicycles Protocol for Hospital Automation (MP-HA), which is customized to assist the demands in these automation processes, seeking to guarantee the determinism in the communications and to optimize the factor of use of the mean of transmission

Caracterização de estruturas planares com substratos Iso/Anisotrópicos truncados através da técnica da ressonância transversa modificada

This work presents a theoretical and numerical analysis using the transverse resonance technique (TRT) and a proposed MTRT applied in the analysis of the dispersive characteristics of microstrip lines built on truncated isotropic and anisotropic dielectric substrates. The TRT uses the transmission lines model in the transversal section of the structure, allowing to analyze its dispersive behavior. The difference between TRT and MTRT consists basically of the resonance direction. While in the TRT the resonance is calculated in the same direction of the metallic strip normal axis, the MTRT considers the resonance in the metallic strip parallel plane. Although the application of the MTRT results in a more complex equivalent circuit, its use allows some added characterization, like longitudinal section electric mode (LSE) and longitudinal section magnetic mode (LSM), microstrips with truncated substrate, or structures with different dielectric regions. A computer program using TRT and MTRT proposed in this work is implemented for the characterization of microstrips on truncated isotropic and anisotropic substrates. In this analysis, propagating and evanescent modes are considered. Thus, it is possible to characterize both the dominant and higher order modes of the structure. Numerical results are presented for the effective permittivity, characteristic impedance and relative phase velocity for microstrip lines with different parameters and dimensions of the dielectric substrate. Agreement with the results obtained in the literature are shown, as well as experimental results. In some cases, the convergence analysis is also performed by considering the limiting conditions, like particular cases of isotropic materials or structures with dielectric of infinite size found in the literature. The numerical convergence of the formulation is also analyzed. Finally, conclusions and suggestions for the continuity of this work are presented

Análise de Handover inter e intra-célula em um sistema de telefonia celular através de método de medição simplificado

This dissertation has the purpose to present a portable device named PlugData MG100G, equipped with a cellular module, to analyze the radiofrequency coverage in a GSM network situated in João Pessoa city, state of Paraíba, at four distinct regions. The equipment, originally, was developed to be used in fixed environments, so it was adapted so that it could be used in conditions of mobility. From the Mobile Measurement Reports (MMRs) RF coverage and the handover process are analyzed. The MMRs enable the identification of the serving cell and the list of the closest neighboring cells monitored by the mobile. This work analyses only data referent to the serving cell and the two closest neighboring cells. Inter-cell and intra-cell handovers are identified. The frequency planning and quality of service offered by the network related to the regions are discussed as well

Posicionamento e movimentação de um robô humanóide utilizando imagens de uma câmera móvel externa

This work proposes a method to localize a simple humanoid robot, without embedded sensors, using images taken from an extern camera and image processing techniques. Once the robot is localized relative to the camera, supposing we know the position of the camera relative to the world, we can compute the position of the robot relative to the world. To make the camera move in the work space, we will use another mobile robot with wheels, which has a precise locating system, and will place the camera on it. Once the humanoid is localized in the work space, we can take the necessary actions to move it. Simultaneously, we will move the camera robot, so it will take good images of the humanoid. The mainly contributions of this work are: the idea of using another mobile robot to aid the navigation of a humanoid robot without and advanced embedded electronics; chosing of the intrinsic and extrinsic calibration methods appropriated to the task, especially in the real time part; and the collaborative algorithm of simultaneous navigation of the robots

Caracterização de antenas planares com substrato metamaterial

This work presents a theoretical and numerical analysis for the radiation characteristics of rectangular microstrip antenna using metamaterial substrate. The full wave analysis is performed in the Fourier transform domain through the application of the Transverse Transmission Line - TTL method. A study on metamaterial theory was conducted to obtain the constructive parameters, which were characterized through permittivity and permeability tensors to arrive at a set of electromagnetic equations. The general equations for the electromagnetic fields of the antenna are developed using the Transverse Transmission Line - TTL method. Imposing the boundary conditions, the dyadic Green s function components are obtained relating the surface current density components at the plane of the patch to the electric field tangential components. Then, Galerkin s method is used to obtain a system of matrix equations, whose solution gives the antenna resonant frequency. From this modeling, it is possible to obtain numerical results for the resonant frequency and return loss for different configurations and substrates

Uma proposta de um controlador adaptativo por posicionamento de pólos e estrutura variável

There are two main approaches for using in adaptive controllers. One is the so-called model reference adaptive control (MRAC), and the other is the so-called adaptive pole placement control (APPC). In MRAC, a reference model is chosen to generate the desired trajectory that the plant output has to follow, and it can require cancellation of the plant zeros. Due to its flexibility in choosing the controller design methodology (state feedback, compensator design, linear quadratic, etc.) and the adaptive law (least squares, gradient, etc.), the APPC is the most general type of adaptive control. Traditionally, it has been developed in an indirect approach and, as an advantage, it may be applied to non-minimum phase plants, because do not involve plant zero-pole cancellations. The integration to variable structure systems allows to aggregate fast transient and robustness to parametric uncertainties and disturbances, as well. In this work, a variable structure adaptive pole placement control (VS-APPC) is proposed. Therefore, new switching laws are proposed, instead of using the traditional integral adaptive laws. Additionally, simulation results for an unstable first order system and simulation and practical results for a three-phase induction motor are shown

Modelo matemático para otimização dos custos de um sistema híbrido eólico-solar : aplicação no bombeamento de petróleo

This work purposes the application of a methodology to optimize the implantation cost of an wind-solar hybrid system for oil pumping. The developed model is estimated the implantation cost of system through Multiple Linear Regression technique, on the basis of the previous knowledge of variables: necessary capacity of storage, total daily energy demand, wind power, module power and module number. These variables are gotten by means of sizing. The considered model not only can be applied to the oil pumping, but also for any other purposes of electric energy generation for conversion of solar, wind or solar-wind energy, that demand short powers. Parametric statistical T-student tests had been used to detect the significant difference in the average of total cost to being considered the diameter of the wind, F by Snedecor in the variance analysis to test if the coefficients of the considered model are significantly different of zero and test not-parametric statistical by Friedman, toverify if there is difference in the system cost, by being considered the photovoltaic module powers. In decision of hypothesis tests was considered a 5%-significant level. The configurations module powers showed significant differences in total cost of investment by considering an electrical motor of 3 HP. The configurations module powers showed significant differences in total cost of investment by considering an electrical motor of 5 HP only to wind speed of 4m/s and 6 m/s in wind of 3 m, 4m and 5 m of diameter. There was not significant difference in costs to diameters of winds of 3 m and 4m. The mathematical model and the computational program may be used to others applications which require electrical between 2.250 W and 3.750 W. A computational program was developed to assist the study of several configurations that optimizes the implantation cost of an wind-solar system through considered mathematical model

Efeito da introdução de resíduo de cinza de forno cerâmico em massa para cerâmica estrutural

The red ceramics and structural ceramics, as they are known, include ceramic materials made by blocks of seals and structures, bricks, tiles, smail flagstones manacles, rustic floors and ornamental materials. Their fabrication uses raw material such as clay and clay sites, with some content of impurity. It has good durability and mechanical strength to compression, low cost, making it one of the mainly used materials in civil engineering. The incorporation of many industrial activities residue to ceramic products is a technological alternative for reducing the environmental impact caused by its carefree disposal. This incorporation can promote chemical change and inertness of metals from residue, by fixation in the glassy phase of ceramic during the burning stage. The main aim of this project is to study the technical feasibility of the addition of ceramic oven ash into formulations of mass for structural ceramics. In this project two kinds of clay (plastic and non-plastic) were used, as well as the ash from firewood used in the process of burning of structural ceramics. A group of experiments was outlined, which permitted the evaluation of the influence of the burning cycle in different temperatures of the ash content in formulations for ceramic blocks through technological properties, mechanical behavior and microstructure. Five samples were processed of each one of the masses of plastic and non-plastic clay without addition of ash and with addition of ash on the percentages of 10 % and 20 %, for temperatures of 850 °C, 950 °C, 1050 °C and 1150 °C, obtained through sinterization process. Among the studied compositions, the one which presented best performance was the mass of clay with 10 % of ash, at temperature of 1150 °C, with the smallest absorption of water, the smallest apparent porosity, specific apparent mass a bit over the others and greatest mechanical resistance to flexion. The composition made confirmed the technical feasibility of the use of ash in the mass for structural ceramics with maintenance of its necessary characteristics for its purposes

A influência da adição de caulim, quartzo e feldspato potássico na formulação de massas cerâmicas para telhas: Modelo estatístico

The production of roof tiles in the state of Rio Grande do Norte accounts for around 60% of the total of ceramic pieces produced. There is a need for investment to improve quality and productivity, thereby promoting technological innovations. Accordingly, the aim of this study is to determine the effect of kaolin, potassium feldspar and quartz in two standard formulations, as well as the effect of sintering temperature on the technological properties of linear firing shrinkage, water absorption and bending rupture stress, by fitting the statistical model and using multiple linear regression to assess the relationship between technological properties and independent variables. The raw materials were characterized using the following techniques: X-ray fluorescence (XRF), X-ray diffraction (XRF), rational analysis (RA), differential thermal analysis (DTA) and granulometric analysis (GA). The test specimens were compacted by uniaxial pressure (25 MPa), dried in a stove at 110 ºC for 24 hours and sinterized at 850 ºC, 950 ºC and 1050 ºC and held isothermal for 30 minutes. The results obtained indicate that the addition of kaolin to two standard formulations (M and R) promoted a reduction in water absorption values and an increase in bending rupture stress values. The sintering temperatures for group M that resulted in the lowest linear firing shrinkage and water absorption values were 850 ºC and 950 ºC, respectively, and the highest bending rupture stress values were reached at a temperature of 950 ºC. In the case of group R, the sintering temperature that obtained the lowest water absorption and linear firing shrinkage values was 850 ºC, and the highest bending rupture stress values were attained at a temperature of 1050 ºC. This work explains the statistical approach used to fit the model that describes the relationship between the technological properties and percentage of kaolin, quartz and feldspar, as well as the models that enable predictions, provided that the lower and upper limits of the percentage of clay minerals, flux and quartz used in this study are respected. Statistica 6 software was used and results were obtained by stepwise forward regression

Estudo do efeito do óxido de bário no comportamento de massas para porcelanato

In this work, it is proposed the study of the effect of barium oxide acting as synthetic flow in the behavior of masses for stoneware from the use of raw materials found in the deposits of minerals of the Rio Grande do Norte that it makes use of a great natural potential for the industrialization of the product. The porcelanato is a sophisticated product with excellent final properties being applied as ceramic coating in buildings of high standard of engineering. The raw materials selected for the development of the study had been two types of argilas, two types of feldspatos, dolomita, talco, barium carbonate and silica, being characterized by X-ray fluorescence, X-ray diffraction, granulometric analysis, dilatometric analysis and thermal analysis. Thus, it is intended to define four formulations using the cited raw materials that will be processed, conformed and sintered in the temperatures of 1150 °C, 1175 °C, 1200 °C, 1225 °C e 1250 °C. From the physical characterizations, chemical and morphologic of the formed formulations, the effect of barium oxide is determined in the physical and mechanical properties of the studied system carrying water absorption tests, linear retraction, apparent porosity, apparent specific mass, compacting curve, flexural strength and microstructural analysis by XRD and SEM. After analyzing the results, indicated that barium oxide acts as a flux of high temperature and as the ordering of structure, where the embedded glass phase has the nucleating effect phase potassium silico-aluminum reacting with free silica which together with the high content of potassium concentrated form a new crystalline phase called microcline. The masses studied with the addition of barium oxide present physical-mechanical properties highly satisfactory in reduced firing temperatures, which implies a saving in energy given off in the production and increased productivity