Qualidade de vida de pessoas com úlcera venosa: associação dos aspectos sociodemográficos, de saúde, assistência e clínicos da lesão

Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients´ quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients´ QOL. The study´s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universitário Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury

Avaliação da qualidade da assistência a pessoas com úlceras venosas atendidas na estratégia saúde da família

A úlcera venosa constitui importante problema de saúde pública, gera repercussão social, econômica e mudanças nos hábitos de vida, dor, sofrimento, acarretando diminuição da qualidade de vida. O estudo objetivou avaliar a assistência prestada às pessoas com úlceras venosas atendidas pela Estratégia Saúde da Família. É um estudo analítico, transversal e quantitativo, realizado com 59 pessoas com úlceras venosas, atendidas em 36 unidades da Estratégia Saúde da Família. O estudo obteve aprovação do projeto de pesquisa pelo Comitê de Ética da Universidade Federal de Alagoas. Para a coleta dos dados utilizou-se instrumento testado, entrevista, exame físico e informações dos prontuários. Os dados foram organizados em planilha do Microsoft Excel 2007, exportados e analisados em software estatístico por meio de estatística descritiva e inferencial, considerando nível de significância estatística de ρ-valor < 0,05. As pessoas com úlcera venosa eram do sexo feminino (71,2%), ≥ 60 anos (67,8%) e estavam em tratamento > 1 ano (69,5%). Possuíam tempo de lesão > 6 meses (64,4%), dor na úlcera/membro (86,4%) e leito com ≤ 30% de granulação/epitelização (78,0%). A qualidade da assistência foi ruim (< 5 aspectos positivos) em 57,6% (ρ=0,000) e os aspectos que mais interferiram foram as seguintes inadequações: profissional que acompanha/realiza curativo (ρ=0,002, coeficiente de contingência (CC) =0,458, razão de chance (RC) =13,9), produtos nos últimos 30 dias (ρ=0,038, cc=0,334, RC=7,3) e acesso a consulta com angiologista (ρ=0,041, cc=0,305, RC=4,1). Os aspectos clínicos que contribuíram para o aumento do tempo de assistência foram: tempo de lesão >6 meses (ρ<0,001), dor (ρ=0,043), recidiva (ρ<0,001); nos aspectos assistenciais: inadequação dos produtos com 83,1% (ρ=0,036). Essas características dificultaram a cicatrização tecidual, prolongando o tempo de tratamento das lesões,que podem ter contribuído para a cronicidade das úlceras

Assistência a mulher com câncer de mama em um cenro de referência no Estado da Paraíba

The assistance to women who have breast cancer is studied in a Reference Center in Paraiba and also the way this assistance is performed in a School Hospital maintained by SUS (Single Health System) is questioned. Breast cancer demands institutional organization, provision of financial, material and human resources, requiring, from the health system, effective assistance with new technologies which make it possible for the population their access to specialized medical services although it not always is able to guarantee those services nor the rights which the legislation granted them, inhibiting a proper relationship between the health professional and the patient. The theme is discussed through a transdisciplinary knowledge view and has as its theoretical referential the contribution of classical and contemporary authors from the human and social sciences and, as an empirical research strategy, the structured interview. The objectives of the research were: identify how the assistance to women with breast cancer is carried on at a Reference Center on Oncology in Campina Grande, Paraiba, identifying their difficulties and their satisfaction with the received assistance; draw up a profile of the women with breast cancer who were assisted in this Reference Center; understand their gynecological and obstetric antecedents, life styles, age group and stage of the disease when the treatment started; check their knowledge about their rights and which benefits they had received. Most women ranged between 40 and 59 years old (63%), which corresponds to the risk range of developing breast cancer. As to their occupations, 38.3% were housewives and 30.1% retired, whose family income was among those who received between less than a minimum salary and one minimum salary (58.2%). This population was mainly constituted of married women (60.2%), whose most frequent schooling was an incomplete elementary school (27.6%) and complete elementary school (24.1%), which added up to 51.6%. It was observed that the majority of the women seemed to be satisfied with the assistance received, noting that a minimum care was enough to define this satisfaction, although it is perceived that the access to the health system does not ensure the ideal attention conditions they need; it was verified that the availability of the services and the assistance itself are seen (in the local culture) as a favor and not as a right. It is also observed that only 30% of the women mentioned that they knew about their rights and the most mentioned ones were the disease assistance (13%), the medicines (13%) and the treatment (12%), which represent the most important triad to face the disease and around which the oncologic assistance most focus on. It is concluded that the condition of the users´ minimum existential of a public health unit and the condition of belonging to a lower social stratum were variables that influenced the respondents´ satisfaction in relation to the assistance received but the importance of the Reference Center for the women with breast cancer´s assistance for the whole region cannot be denied as well as the need to broaden the way the policy of the oncologic assistance in Brazil in the local realm is seen

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

Humanização hospitalar, ambiente físico e relações assistenciais :a percepção de arquitetos especialistas

The creation of the Humanization Program of Hospital Care and the increasing number of academic works and journal articles that discuss more humane practices in the health care services express the emphasis given to the theme in Brazil. In these discussions, however, it is not usual to find reference to architecture as a relevant factor in the humanization of hospitals, even though it is known that the physical structure of the building may help the recovering of the patients; elements such as gardens, the use of colors and open spaces may soften the impact caused by the hospital routine on patients. Considering the contribution the architectural project may bring to the humanization of hospitals, the aim of this study was to verify how the architects perceive the hospital humanization process. Besides having searched for subsides in informal interviews with health professionals, in visits to hospitals and in related seminars, the study was based on semi-structured interviews with architects of Natal, Rio Grande do Norte, who are specialists in this kind of projects. The content analysis of the interviews showed that physical space and attendance are essential to the humanization process. Those professionals see two humanization tendencies: while private hospitals have the structural physical appearance considered as humanized, public hospitals emphasize the humanization in attendance, fact that illustrates the contradictions in Brazilian health system. The interviewees consider the post-occupancy evaluation of the building as a learning exercise that contributes to new projects, but surprisingly they do not mention the patients opinion as part of it. Two annoying facts have emerged from the interviews, as also seen in preliminary stages of the study: rare are the works that focus on the person-environment relationship, and the definition of humanized hospital environments is still broad and inaccurate. This suggests the need of new studies in order to better understand how the two factors shown in this study attendance and physical space interact towards a true hospital humanization

O entre do carvão ao corpo - em - arte de ator-brincante

I propose with this paper a reflection on the experiences contained in the creation of the body- in-art (FERRACINI, 2006a, b) that originated the show Rosmaninhos... This process was developed within the coletivo UZUME teatro from João Pessoa PB, through recreations and resignifications of the corporeity and physicality contained in the steps, loas, aboios, songs and choreography observed in the manners that Mestre Zequinha plays in his group of Cavalo Marinho (Sea Horse), resident in the city of Bayeux - PB, and starting from the appropriation of the text Hamlet of William Shakespeare. The body-in-art is understood in this work as a vectorial body that dilates its daily functionality, recognizing a potential learning area capable to generate creative escape lines that destabilize the "subject centered in an individuality and identity" (FOUCAULT apud FERRACINI, 2006b, p.14), being open to the differentiation of itself, indicating the possible existence of an itself-other and of the exchange-in-art space. This process of construction of the body-in-art based on Master Zequinha s ways of playing the Cavalo Marinho was methodically guided by the appropriation of the coletivo UZUME teatro of the stages of Observation, Codification and Theatricalization contained in the technique of corporal mimeses proposed by the LUME Teatro (Campinas - SP). That use resulted in two phases: Active Observation and Composition of the body-in-art. Through the repetition of these aesthetic matrixes of the Cavalo Marinho, the actors discovered actions that when, codified and organized, can configure their body-in-art, which created a vectorial exchange-in-art space to what was found in the Cavalo Marinho party. This search proposed the means of potentiating the actors' work when it comes to a preparation that allowed to dilate the scenic presence and stimulated the production of actions, which culminated in the mounting of the show Rosmaninhos...

As repercussões dos serviços hospitalares em diferentes contextos: uma análise de profissionais de saúde

This study has as general object: to verify as the health professionals that work in different hospitals evaluate the hospital services; and specific objectives: identify how health professionals evaluate the work conditions in different hospitals and verify the central nucleus and the peripheral elements of the social representations elaborated by these professionals about these institution. This is a descriptive study realized in Natal, capital of Rio Grande do Norte. Were collected 213 questionnaires. Concerning the evaluation of the health services, high averages had been verified in the philanthropic hospital, for example, quality of the customer service. At the state hospital was observed lowest ones: respect to the privacy of the patients. Similar results were found about work conditions. It was observed as central nucleus the categories Overcrowded and Humanized care, in the state and philanthropic hospital respectively, and as peripheral elements Low wages and Overcrowded. Being thus the conflicts in this scene are inevitable because of the poor structure of some public hospitals, however, these problems can be foresee and solvable if the hospital has a free expression channel accessible to all agents. The evaluation has to become integrant part of the culture of the organization, a time that this will guide the steps in direction to the best quality in the hospital assistance

Úlcera de pressão em pacientes internados em um hospital universitário em Natal/RN: condições predisponentes e fatores de risco

The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.

O processo de cuidar em Unidade de Terapia Intensiva

The environment of Intensive Care Unit (ICU) is commonly referred to as a place where caring is inextricably linked to high technology. The care in ICU often changes the patient into a taxpayer being left apart from its complexity and sometimes seen through a reductionist perspective. Thus, studies circa the care process are needed oriented from a historical ransom, raising the prospect of a more centralized human care. Hence, this study aimed to analyze the care process in a nursing intensive care unit from the perspective of the professional, family and patients. The study is characterized from a qualitative, descriptive and exploratory methodological approach. The actors were participating nursing professionals, patients and family members of an intensive care unit of Mossoró / RN. Data were collected in the period of May-June 2011, through interviews and observation of activities performed by nursing professionals, and their records in the chart. Data analysis was divided into topics and subtopics representing the phases and shapes that formed the collection. The analysis and discussion of the interviews were based on Bardin's proposal, when we created categories from a process of sorting and grouping criteria adequately defined. The observation of nursing records intended to observe the emphasis which is described in those notes as well as their consistency with practice of FCN and resolution 358/2009. The analysis showed that the nursing staff also performs work focused on mechanized activities and technical-bureaucratic institution that seem to override the needs of patients. In an overview, the care provided by professionals occurs either fragmented or insipient, however there is a service that involves other aspects beyond technical-curative practice, considering that major attention is given to the family and patient, focused on the concern of Nursing guiding their actions in not only the performance of procedures. However, the process of humanizing not always ends with an engagement between professional and patient, which mischaracterizes the true meaning of human care. The records also showed a tendency to focus on caring in a positivist line, where, in most cases, the factors of the disease and the obligation to meet the productivity have overshadowed other relevant aspects to a holistic understanding of caring. Regarding FCN Resolution No. 358/2009, which guides a systematization of nursing care, it is confirmed a technical view, a fragmented and superficial view of the patient, as well as a weakness of care, caused by ignorance and unpreparedness of the entire team. The perspective of caring demonstrates a reality with dialectic between what is proposed in a humane nursing and what happens in this performance space. Besides, it was shown a daily full of important considerations that arise in professional practice, in their views and also those people who were participants in the process

Inclusão da criança com deficiência na estratégia de saúde da família

The objective of analyze the shift of the working process of the ESF team in care of children with disabilities, from awareness-raising actions. It is a qualitative study, with the action-research method. Thirteen health professionals were involved from two teams of ESF unit area of the Unidade de Saúde da Família Dr. Chico Porto (UBSFCP) in Mossoró, from March to August 2011. Data were analyzed following the direction of freirean s thematic analysis. In the situational diagnosis of the current reality of CwD assistance in that UBSFCP, through participant observation and application of semi-structured interviews with professionals, we realize that despite these actions carry some assistance to the CwD, in practice few are used for inclusion and accessibility. The monitoring of the CwD is done through individual consultations by each team professional, home visits when possible, both ruled on the complaints and problems, with little solving in the used actions. Since the need for a change in the treatment model and training requirements as pointed out by professionals in the interview, then we decided to build the proposed of training suggested by the multidisciplinary team and put together collectively the achievement of this moment in all its phases. In the step of implementation (action), aspects related to the current situation in Brazil and Mossoró (Laws, policies and health care) for the CwD and CwD Assistance and their family in the ESF in the first two moments of the first training (action) were contemplate. On the second day we discussed the specialized care to CwD, contribution of the Handicapped Parents and Friends Association of Mossoró and in a second moment a workshop was held in which awareness for inclusion of CwD and actions of ESF were discussed. All these moments were discussed and collectively constructed. In the evaluation, we found that implementation (action) allowed to the professional the comprehension of new understandings about people with disabilities, on ways to include, guiding, caring, watching, and mainly to have a new vision on health assistance of the CwD, expanding assistance beyond clinical aspects and recognizing the educational aspects of the rights and duties of citizens and the inclusion of these children in the social spaces area. As difficulties, we face the need for some professionals to be absent to attend another job, solve personal problems, and little or no participation. Thus, during this action-research, the subjects were able to realize the importance of carrying out their practice to the quality of life for him and to the one they care

O entre do carvão ao corpo - em - arte de ator-brincante

I propose with this paper a reflection on the experiences contained in the creation of the body- in-art (FERRACINI, 2006a, b) that originated the show Rosmaninhos... This process was developed within the coletivo UZUME teatro from João Pessoa PB, through recreations and resignifications of the corporeity and physicality contained in the steps, loas, aboios, songs and choreography observed in the manners that Mestre Zequinha plays in his group of Cavalo Marinho (Sea Horse), resident in the city of Bayeux - PB, and starting from the appropriation of the text Hamlet of William Shakespeare. The body-in-art is understood in this work as a vectorial body that dilates its daily functionality, recognizing a potential learning area capable to generate creative escape lines that destabilize the "subject centered in an individuality and identity" (FOUCAULT apud FERRACINI, 2006b, p.14), being open to the differentiation of itself, indicating the possible existence of an itself-other and of the exchange-in-art space. This process of construction of the body-in-art based on Master Zequinha s ways of playing the Cavalo Marinho was methodically guided by the appropriation of the coletivo UZUME teatro of the stages of Observation, Codification and Theatricalization contained in the technique of corporal mimeses proposed by the LUME Teatro (Campinas - SP). That use resulted in two phases: Active Observation and Composition of the body-in-art. Through the repetition of these aesthetic matrixes of the Cavalo Marinho, the actors discovered actions that when, codified and organized, can configure their body-in-art, which created a vectorial exchange-in-art space to what was found in the Cavalo Marinho party. This search proposed the means of potentiating the actors' work when it comes to a preparation that allowed to dilate the scenic presence and stimulated the production of actions, which culminated in the mounting of the show Rosmaninhos...

Hospital humano: etnografia da humanização hospitalar na perspectiva de usuários

This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals´ human and technical competence, the hospital´s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user´s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user´s perspective as a socially critical ethnoevaluator

Sofrimento psíquico: representações sociais dos enfermeiros em ambiente hospitalar

We believe that the dissatisfaction arising from the lack of belief in the possibilities of change in the workplace, which cause difficulties to achieve professional results in the professional psychological distress that currently fits into the context of mental health. This is a qualitative, descriptive and representational research aiming to discover how the professional nurses represent the very psychological distress from work in the hospital environment. Aided and supported by specific objectives of identifying factors that generates this suffering and strategies for defense and confronting these professionals in the hospital. 22 nurses participated in this research, officials of the University Hospital Onofre Lopes, located in the city of Natal / RN, with length of service in the institution more than one year and less than five, and they accepted, by signing the Term of Free and Informed Consent, participate in the study. We use plurimethodological approach: a questionnaire, a semi-structured interview and the design-story with a theme adapted from Trinca with the support of the Theory of Social Representations and that nurses do in their psychological distress of the Central Core. We reviewed the data from the results generated by the ALCESTE software, based on hierarchical categorization downward, leading seven classes used as categories: Work process: completeness vs. incompleteness; labor contradiction of the nurse; qualitative aspects of interpersonal relationships; hospital surveillance: Challenges, muteness and neglect; Expectations, conflicts and feelings in the work process; Leisure: the other side of the work process, and Suffering generating aspects of in the work process. We consider the analysis of quarters generated by the program, which SLQ houses in the central core of the representations; the SRQ and the DLQ the intermediaries elements and the DRQ the peripheral elements that nurses do in their psychological distress. We analytically adequate results in the three belonging dimensions of social representations: the Subjectivity, the Intersubjectivity and Trans-subjectivity. We infer that the interpersonal relationship, the extra work, the deviation in the role of nurse show themself as the factors responsible for psychological distress of it. In that sense, the central core of SR of this profession is based on the level of trans-subjectivity and understood as a Social Representation controversy

Assistência aos portadores de úlceras venosas: proposta de protocolo

Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequié/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K ≥ 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference

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)