Avaliação do conhecimento e de habilidades clínicas em saúde sexual e reprodutiva na graduação de medicina

No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação

A Humanização e a Formação Médica na Perspectiva dos Estudantes de Medicina da Universidade Federal do Rio Grande do Norte

The aim of this study is to understand the perception of medical students at the Federal University of Rio Grande do Norte (UFRN) about humanization in the context of their medical formation, using a qualitative approach. The focus group and participant observation techniques were used, involving a multidisciplinary team composed of professionals from the areas of anthropology and psychology, as well as professors from the medical course, who studied two groups of nine students in their final year. The data were analyzed using the categorical thematic content analysis technique, from which emerged three categories: student/patient relationship, teaching/learning and student/professor relationship. The first allows us to identify that student-patient contact is an essential experience for adopting a more humanized view of the disease process. The second category shows that unqualified professors in the pedagogic practices inherent to the teaching profession and the theory the practical dichotomy hinder the autonomous and holistic formation of knowledge. Similarly, the lack of practices outside the academic environment and the absence of multiprofessional stimulation interfere in the construction of an integral view of the individual. From the third category, the student/professor relationship, emerge two opposing subcategories (professor model and assymetric relationships), which reflect the importance of the professor`s ethical humanist position, as opposed to an authoritarian attitude, to form the professional attitude of the student. The results point important aspects of the medical formation that may open a discussion about humanization, in the context of new national curricular guidelines

O cuidado humanístico como foco institucional: um estudo sobre empatia dos profissionais de saúde na área obstétrica

Empathy is a basic facilitating element of the therapeutic helping relationship and the humanization process in health care. The objectives of this study were to identify the empathy level of health professionals working in the obstetrical sector of a university hospital recognized for its humanistic care and the perceptions of the women under their care regarding the empathic behavior shown by these professionals during hospitalization. We conducted a quanti/qualitative study with 47 health professionals that worked in the obstetrical sector (13 obstetricians, 12 nurses, 22 nurse technicians) and an intentional sample of 101 women that received cared from these professionals during the study period. We collected data by means of the Jefferson Empathy Scale for Health Professioals (JEPS-HR) and the Patient´s Perception of Health Professional Empathy (PPHPE), and two additional open questions designed to obtain the subjective opinion about the empathic behavior during the care. We utilized thematic analysis for the data obtained through the open questions and descriptive and inferential statistics for the quantitative data. We identified five thematic categories that represent the aspects valued by the professionals in their relationship with the women under their care: emotional involvement, communication, warm environment, integral vision and technical/scientific knowledge. The mean score on the JEPS-HR reported for the health professionals was 120,40, being that the maximum possible was 140.The Cronbach Alpha for the JEPS-HR was 0,83, indicating an acceptable level of reliability for this population. We consider therefore, that these professionals presented an acceptable empathy level when compared to other populations observed with the JEPS-HR. The results also indicated that women had statistically significant (p ≤ 0,05) higher scores than men and that professionals with higher working hours tended to have lower scores in the empathy scale (r = -0,288; p ≤ 0,05). The analysis of the subjective responses of the women indicated that they were satisfied with the humanistic care provided by the professionals but they also point out the existence of some power relationships. There were no significant differences in the empathy level of the medical or nursing team perceived by the women who registered means of 41,90 and 41,20 respectively on the PPHPE. In view of these results and considering the relevance of the element of empathy for care based on humanistic values, we reiterate the importance of further in-service training for the health team of the hospital in focus, on the topics of empathy and global aspects of humanized care for the implementation of its mission

Programa de odontologia para bebês: uma avaliação quantitativa e qualitativa

The objective of this study was to evaluate a baby dentistry program which has been in the city of Natal for five years. The research was based on two analysis: a quantitative one, which tried to check caries prevalence in 52 children supported by the program and a qualitative one, which, through interviews carried out with the mothers, using the focus group technique, tried to realize the effect of the program their attitudes related to the care of their children´s oral health. For the quantitative analyses of caries prevalence there was the use of def-s and knutson rates and the values obtained were shown in a descritive and analytical way.The results showed that 4.2% of babies ranging 24 to 36 months old presented carie disease. Children from 36 to 48 months old and above 48 months old presented 18.2% and 16.7% carie prevalence respectively.The def-s averages found in ages 24 to 36, 36 to 48 and 48 to 60 months old were 0.08; 0.40 and 1.16 respectively, considered as being equally low, going along with Knutson rates. The qualitative analyses showed a high level of the mothers` satisfaction, considering the access,practitioner-patient relationship and opportunity to keep the oral health. Children supported by the program showed a low carie prevalence and the program turned out to be effective under the mothers` point of view

O processo ensino-aprendizagem e suas conseqüências na relação professor-aluno-paciente.

This study deals with the ethical and human aspects present in the teaching-learning process within the dentists' formation. It arises from the growing need for professionals involved with the quality of the services they provide for the population in health care centers. In this research a qualitative approach was used and data was obtained by means of focal groups, interviews and participative observation. The sample consisted of 28 dentistry students and 33 patients attended at the dentistry course. According to the results, it was shown that the main problems are the excess of authority in the teacher-student-patient relationship and the dissociation of the body-mind-spirit as seen in the biomedical model health practice. These findings show the future professionals' insufficient abilities for developing a satisfactory relationship with their patients and the need of considering these aspects during their formation.

O processo ensino-aprendizagem e suas conseqüências na relação professor-aluno-paciente.

This study deals with the ethical and human aspects present in the teaching-learning process within the dentists' formation. It arises from the growing need for professionals involved with the quality of the services they provide for the population in health care centers. In this research a qualitative approach was used and data was obtained by means of focal groups, interviews and participative observation. The sample consisted of 28 dentistry students and 33 patients attended at the dentistry course. According to the results, it was shown that the main problems are the excess of authority in the teacher-student-patient relationship and the dissociation of the body-mind-spirit as seen in the biomedical model health practice. These findings show the future professionals' insufficient abilities for developing a satisfactory relationship with their patients and the need of considering these aspects during their formation.

Morte como desafio afetivo para o profissional da saúde: ansiedade e sentimentos de quem lida com o paciente terminal com câncer

It is a Cross-sectional and multi-disciplinary study whose population selection was made by department of human resources (composed by a Manager, an Oncologist and a Psychologist) from the hospital where this research was realized. They also collaborated with important information about the work of that professionals in the hospital. We also counted on a Statistic who made study design calculating the sample and analyzing data. This research issued Evaluating health professionals anxiety levels who care for cancer terminally ill and their feelings about that work as well as identifying the factors which have influence on it. 100 health professionals from the Hospital which is a reference on cancer caring in Brazil situated in the city of Natal, state of Rio Grande do Norte, participated of this research. There was a sample loss of 21%. Data were collected through a questionnaire and State-Trait Anxiety Inventory (STAI). Results showed that 15% of the professionals have low State Anxiety levels, 70% Medium State Anxiety levels and 15% high State anxiety levels. The Number of Patients and Working in another Institution have interfered in the anxiety levels. Doctors and Nursing Assistants and Technicians have got the highest high State Anxiety percentage (25%). 73% of them declare to feel some sort of different behavior and/or feelings in caring for terminally ill. The most remarkable professionals feelings were Suffering and Sadness, and Terminally ill Children was the most difficult age group to care for. We conclude that work overload and having more than one job can interfere in professional stress levels and anxiety. Dealing with terminally ill, specially children one, can cause on the professionals psychological suffering. It s recommended the development of supporting and training strategies to reduce and/or to prevent Stress and Anxiety high levels

ANÁLISE COMPARATIVA DO CONHECIMENTO, ATITUDES E PRECONCEITOS DE UNIVERSITÁRIOS DOS CURSOS DE PEDAGOGIA, EDUCAÇÃO FÍSICA E MEDICINA EM RELAÇÃO À EPILEPSIA

Epilepsy is a chronic disorder of the central nervous system, most frequently characterized by abnormal electrical impulses in the brain. It is the oldest recorded neurological disease and has been surrounded by myths, mistaken beliefs and preconceptions. Three professionals work with epileptic patients on a daily basis: teachers, physical educators and physicians . This study aimed to analyze and compare the level of knowledge, preconceptions and attitudes of undergraduate students in the courses of Pedagogy, Physical Education and Medicine, future professionals who will deal with epileptic patients. This descriptive observational study was conducted with 286 university undergraduates of both sexes (women 99/34.6% and men 187/65.4%) from the first to fourth year of Pedagogy, Physical Education and Medicine courses at the Universidade Estadual Rio Grande do Norte (UERN), with mean age of 23 years. A validated and adapted 17-question questionnaire, divided into nine knowledge-based questions, five related to preconceptions and three on attitudes, was applied. Results allowed elaboration of a manuscript entitled Comparative Analysis of Knowledge, Attitude and Preconceptions in University Undergraduates of Pedagogy, Physical Education and Medicine Courses in Relation to Epilepsy. The findings of this article show that knowledge of epilepsy in the three groups is very satisfactory. The low level of preconception indicates that educational or clarifying information is being transmitted, albeit by television, a layman s information vehicle, which has undoubtedly contributed to reducing the stigma of epilepsy through educational information. Results also suggest a lack of knowledge on how to act during a seizure, especially in education professionals. Although there are limitations in our sample, the relevance and contribution of this study is to call attention to the importance and need for these future professionals to be informed and learn correct attitudes with respect to epilepsy during their academic formation. This is essential at a time when the disease is being brought out of the shadows. This research was supported by the Office of the Dean of Teaching, and Deans of Pedagogy, Physical Education and Medicine at UERN. The research was made possible by the multidisciplinary interaction among a physical educator, child neurologist and statistician, all contributing to achieving the aims set out here

Vivências de familiares do paciente internado em unidade de terapia intensiva: estudo fenomenológico

This study originated from my concerns as critical care nurse, regarding the lived experience of the family member of the patient that is hospitalized in the intensive care unit - ICU. The purpose of the study was to comprehend the experience of the family members while having a loved one interned in an ICU, and to identify the common elements of the phenomenon, based on the descriptions of their experiences. Considering that the object of study involves subjective and social questions, the study was conducted using some fundamental ideas of descriptive phenomenology as a referential and the situated phenomenon as suggested by Martins and Bicudo (1989). Ten (10) family members of patients that were interned in the ICU of private hospital in Natal, RN were interviewed using the following leading question: What is it like to have a member of your family interned in the ICU? Five thematic structural categories emerged from the comprehensive analysis of the interviews: Fear of the family member s death; Lack of humanization; Social isolation; Confidence in the ICU; and Overload to the personal life. The description of the phenomenon enabled a new look at how the care team relates to the family members of the patients interned in the ICU, providing some guidance on how to construct a humanized care that involves the family and that is based on affective human relations. This involves a rethinking of the care provided by team to the family and stimulates the reformulation of personal and social attitudes, and of hospital organizational norms

Conhecimento do enfermeiro sobre o processo de cuidar do paciente com traumatismo cranioencefálico

Estudo de caráter exploratório e descritivo, de abordagem quantitativa, realizado num hospital de urgência hospitalar referência em traumatologia, em Natal/RN, com o objetivo de identificar o conhecimento do enfermeiro a respeito da ECGl para avaliação do nível de consciência e do processo de cuidar na fase pré-hospitalar e hospitalar às vítimas de TCE. A população constou de 44 enfermeiros e os dados foram coletados entre abril e maio de 2010. Os resultados mostram que, 35 (79,5%) dos enfermeiros eram do sexo feminino; 17 (38,64%) estavam na faixa etária entre 24 a 30 anos e 12 (27,27%) entre 51 a 60 anos; 25(56,82%) solteiros, 30 (68,18%) católicos e 25 (56,82%) sem filhos; 40 (90,90%) eram formados por instituições públicas, 18 (40,92%) tinham tempo de serviço na enfermagem acima de 21 anos e 14 (31,82%) até quatro anos; 18 (40,91%) estavam alocados nas UTIs e 13 (29,55%) atuavam em mais de um setor e 20 (65,90%) possuíam especialização. Dos que estavam mais especializados, 18 (40,92%) tinham tempo de serviço até quatro anos e 08 (34,48%) acima de 21 anos. Todos relataram ter prestado assistência às vítimas de TCE e 36 (81,82%) sentiam-se preparados; 35 (46,67%) adquiriram essas informações na prática e apenas 8 (10,67%) na graduação. Em relação a opinião dos pesquisados sobre os empecilhos que dificultam esta assistência, 23 (23,01%) relataram déficit de recursos humanos e 19 (20,65%) despreparo da equipe de enfermagem, estrutura física inadequada e recursos materiais precários. Como propostas de solução para os problemas, 26 (47,27%) sugeriram reforma na gestão e 13 (23,63%) referiram educação continuada. Em relação a ECGl, 40 (90,1%) afirmaram conhecê-la, 33 (82,50%) a utilizavam, 32 (80%) conheciam sua finalidade, 25 (62,5%) acertaram os indicadores fisiológicos e 36 (90%) classificaram corretamente a gravidade do TCE. Dos enfermeiros que utilizam a ECGl, 23 (92%) conheciam seus indicadores e classificação e 20 (60,61%) utilizavam uma vez por plantão. Em relação às dificuldades no manejo da ECGl, 11 (21,58%) não tinham nenhum problema; 10 (19,60%) citaram a falta de tempo e com o mesmo percentual responderam interpretação da resposta verbal nos pacientes intubados. Quanto ao conhecimento dos enfermeiros na descrição do processo de cuidar, 31 (70,45%) das respostas da fase pré e 35 (79,55%) da hospitalar não possuíam etapas importantes, sendo consideradas como incorretas. Quanto à afirmativa dos enfermeiros em estar, e realmente estar preparados para esta assistência, detectamos que daqueles que disseram estar preparados, apenas 12 (33,33%) acertaram todos os passos do atendimento pré hospitalar e 6 (16,67%) no atendimento hospitalar. Concluímos que diante dos resultados obtidos, os enfermeiros conhecem a ECGl, no entanto, necessitam de capacitação para sua melhor compreensão e utilização. Quanto ao conhecimento do processo de cuidar aos pacientes com TCE, é necessário modificar urgente esta realidade, especialmente na atenção às ações desenvolvidas pelo enfermeiro no âmbito hospitalar, onde as consequências das lesões secundárias, muitas delas evitadas com diagnóstico precoce e intervenções imediatas, podem acarretar incapacidades permanentes e prejudicar a qualidade de vida desses indivíduos

Segurança do paciente no sistema de medicação: análise de enfermeiros de um hospital de ensino

This study aimed to identify and describe the factors related to Patient Safety in a medication system according to the nurses analysis in a teaching hospital from the photographic analysis method. This was a cross-sectional, descriptive study with mixed approach in a teaching hospital in Rio Grande do Norte. The population consisted of 42 nurses from inpatient units, of which 34 composed the study sample. As eligibility criteria, we defined nurses from public service and nurses who agreed to participate. Ethical determinations were observed, the study was submitted to the Ethics and Research of the University Hospital Onofre Lopes, obtaining the assent with ethical assessment certificate (CAAE 0098.0.051.294-11). For data collection, we used the photographic method (Photographic Analysis Technique) by Patricia Marck (Canada). It was developed in two phases: at first, we randomly captured photos from the medication system, resulting in 282 images; then we selected/processed the photographs, which were reduced to 10 images in Microsoft Excel 2010; in the second phase, the nurses answered the questionnaire divided into socio-professional profile and Digital Photography Scoring Tool (questions a and b ). For analysis of the question a , we used the content analysis technique, and for b , we used the Statistical Package for the Social Sciences 20.0 (temporary license). The socio-professional profile revealed the predominance of females; age group 34-43 years; professionals with specialization; 10-18 years of length of service; and nurses working exclusively in the hospital and who know the Patient Safety. The photographic analysis in relation to Patient Safety resulted in specific categories for each stage of the medication system. Regarding disposal, we identified Proper verification ; Improper verification ; Correct identification ; Disposal in single doses ; and Improper Environment , with predominance of that last category. As for storage: Proper storage ; Improper storage ; Risk of exchange/disappearance ; and Poor hygiene , with special reference to improper storage. In preparation: Risk of exchanging medication/patient ; Inappropriate physical space ; and Inadequate 9 preparation of controlled drugs , highlighting the first category. In drug administration: Lack of Personal Protective Equipment ; Use of Personal Protective Equipment ; Improper administration technique ; Proper administration technique ; Correct drug identification ; Incorrect drug identification ; and Peripheral venous access without identification . From the safety assessment of 10 photographs, by adapting the scores (1-10) to the Likert Scale, we identified three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), one Safe (Level 4), and no photograph considered Totally Safe. This study identified the prevalence of unsafety in the medication system in the nurses opinion. We were also able to understand that, although nurses identify safety aspects, the most prevalent categories characterize an unsafe assessment. Nursing needs to reflect on its practice, identifying gaps in the medication system in order to achieve a proper and safe care

Protocolo de avaliação do cuidado de enfermagem e da segurança do paciente em unidades de terapia intensiva

The reports of adverse events date from 1990 up to the present day. Conceptually, these adverse events are unintentional injuries unrelated to the underlying disease, causing measurable lesions in patients, extending the period of hospitalization, or leading to death. These issues require discussions with regard to patient safety, improved quality of service, and preventing medical errors. In the Intensive Care Units, this concern is greater because these are sectors of intensive care to individuals with hemodynamic changes and imminent risk of death. Therefore, it is essential to conduct evaluation processes to investigate aspects of quality of nursing care and patient safety in these spaces. For that reason, we aimed to propose the Evaluation protocol of nursing care and patient safety in Intensive Care Units. For its achievement, we needed to: 1) analyze the evolution of the patient safety concept used in scientific productions, under Rodgers evolutionary concept; 2) identify the necessary items to build the evaluation protocol of nursing care and patient safety in the Intensive Care Unit, from the available evidence in literature; 3) construct an instrument for content validation of the evaluation protocol of nursing care and patient safety in the Intensive Care Unit; and 4) describe and evaluate the appropriateness of the content for an evaluation protocol of nursing care and patient safety in the Intensive Care Unit. This is a methodological study for the content validation of the abovementioned protocol. To meet the first three specific objectives, we used the integrative literature review in Theses Database of the Coordination for the Improvement of Higher Education Personnel and the portal of the Collaborating Centre for Quality of Care and Patient Safety. The fourth specific objective happened through the participation of judges, located from the Lattes curricula, in the content validation process developed in two stages: Delphi 1 and Delphi 2. As instrument, we used the electronic form of Google docs. We present in tables the answers from the evaluation instruments by Delphi consensus and Content Validity Index (CVI) of the entire protocol. We summarized the results in articles entitled Analysis of the patient safety concept: Rodgers evolutionary concept ; Scientific evidence regarding patient safety in the Intensive Care Unit ; Technological device for the content validation process: experience report ; and Evaluation protocol of nursing care and patient safety in Intensive Care Units. The Embodied Opinion of the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, No. 461,246, under CAAE 19586813.2.0000.5537, approved the study. Thus, we conclude the protocol valid in its content, constituting an important tool for evaluating the quality of nursing care and patient safety in Intensive Care Units

Atuação e o conhecimento dos profissionais de enfermagem quanto a morte encefálica e manutenção do potencial doador de órgãos e tecidos para transplantes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

O médico diante da morte na urgência e emergência:reflexões sobre o ser médico

The literature pointed that the way which people deal with death have been changing along centuries, and nowadays what is realized it is that, each time more, the human being have difficulties to deal with death. Due to the fact that the main function of the physician is to save their patients lives; responsibility that is aggravated by the necessity of to take decisions quickly, once he need to deal with the unexpected situations of the urgency and emergency, many times these professional have to face of impotency and fail situations, when he lose a patient. The main goal of this study was to understand the experience of physicians that work in the urgency and emergency, in front of death. These questioning it justified by the fact of the physicians do not have, many times, a space to express their suffering and anguish about the issues related to death in their work routine, despite lifedeath question to be often present their everyday. It is still possible to verify in the literature, an appointment of the necessity of to include in the curriculum of Medicine courses, subjects that approach such questions. The method used was based on the existential-phenomenological perspective, using as instrument the participant observation, to the intent of understand the routine in the urgency and emergency context, and semi-structured interview. It was interviewed six physicians that work in the urgency and emergency of the most important hospital of public health system of Natal-RN. The results showed that the physicians reported pleasure in work in the urgency and emergency, despite of they presented stress and the difficulties that they deal with in the public system. Despite of the fact that the death to be considered as a phenomenon that make part of the physician s routine, sometimes, deals with these one is more difficult. Many times losses generate an impotency and guilty feeling, as well as questionings about their performance during the attempts to save lives. We verified, from this study, the importance of the existence of some kind of intervention in the emergency, in order to the physicians can elaborate the questions about death and die emerged in their work. We consider yet that this study corroborates and reiterates the discussions concerning the importance of this thematic to be approached in a more effective way, during the academic formation of these professionals, as well as, the importance of a larger investment from the part of Government in the urgency and emergency sector, in order to propitiate to these professionals a work that brings less harmful for their health

O cotidiano do(a) Assistente Social frente as demandas apresentadas pela paciente portadora do câncer de mama em tratamento no Hospital Doutor Luiz Antônio em Natal/RN

This work deals with an analysis related to the social worker s practice in the oncology area. It aims to identify demands, work conditions as well as current challenges related to this profession. It considers the specificities of breast cancer and relates it to political decisions in the health sector considering the concept of contemporary capitalism. The study analyzes professional action and the demands presented by breast cancer patients who are currently in treatment in Hospital Dr. Luiz Antônio em Natal-Rio Grande do Norte-Brazil. The methodological procedures considered of documental analysis, semi-structured interviews (with two social workers that work with fifteen breast cancer patients) as well as participant observation; which was done counting with my own professional practice in the oncology area. Thus, the research also discusses the breast cancer issue in the life of the users considering their social-economical, cultural and political determinants. Factors such as age in which the diagnosis was known, the relation user/social workers, number of children, rights of the oncology patient, place where he/she lives, education, civil status, (re)insertion of the professional in the work field, perception of self-esteem and bio-psycho-social representation of breast cancer in the lives of these women, all of which were dealt with in this research