Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.

Alfabetização e letramento : o discurso e as compreensões de professores da educação infantil

A inquietação fundamental desta investigação foi entender como as professoras da educação infantil se expressam e compreendem a alfabetização e letramento. As categorias eleitas foram alfabetização e letramento, educação infantil e discurso. O referencial teórico teve como principais autores: Ferreiro (1985, 1987, 1988, 1993, 2003), Kramer (1995, 2008, 2010), Soares (1998, 2001, 2002, 2003, 2004, 2006, 2008, 2010), Machado (2004), Oliveira (2005), Rosemberg (2002, 2003), Zabalza (1998), Fairclough (2001, 2008), Iñiguez (2004), Orlandi (1994, 2005), Dijk (2004) e Henry (1997). A investigação foi conduzida com cem professoras da educação infantil, e dez professoras que lecionam no Infantil II, última etapa da educação infantil, em seis instituições de ensino da cidade de Garanhuns, Pernambuco, Brasil. Procedeu-se à aplicação de um questionário adaptado e validado às professoras de todas as etapas da educação infantil e uma entrevista semiestruturada às professoras do Infantil II. A análise dos dados quantitativos foi realizada por meio do programa SPSS 18.0; enquanto a análise dos dados qualitativos foi orientada pela análise de discurso na linha francesa. Os resultados evidenciaram a relevância, dada pelas professoras, aos processos de alfabetização e letramento na educação infantil. Todavia emergiu da opinião e do discurso de algumas professoras, apesar dessas demonstrarem afinidades com os conceitos e aplicabilidade dos processos de alfabetização e letramento, insegurança, dificuldade e contradições ao refleti-los, ora como processos distintos ora como imbricados entre si.

Educação ambiental na perspectiva da sustentabilidade no ambiente do projovem urbano

A preocupação central dessa pesquisa foi compreender se dá o ensino da Educação Ambiental na perspectiva da sustentabilidade, no cotidiano da sala de aula no Projovem Urbano na região metropolitana do Recife, Pernambuco, Brasil. A pesquisa foi desenvolvida com 110 alunos de ambos os sexos, de escolas públicas da RMR e matriculados no curso do Projovem e 10 professores que lecionam nesse projeto. Para isso aplicamos o questionário adaptado com os alunos e com os professores utilizamos uma entrevista semi-estruturada. Na realização da Análise dos dados quantitativos utilizamos o Software Package for Social Sciences – SPSS versão 18.0 e na elaboração dos gráficos o Software Microsoft Excel 2007; enquanto a análise dos dados qualitativos foi orientada pela Análise do Discurso – AD. Os resultados demonstram que apesar de A Educação Ambiental e a Sustentabilidade serem um tema recente, já está fazendo parte das salas de aulas objetivando a formação de cidadãos conscientes das suas atitudes para com o meio ambiente. Podemos verificar que ainda faz necessário o investimento cada vez mais na educação para que possamos formar cada vez mais cidadãos a fim de mantermos uma relação harmoniosa entre o homem e a natureza, possibilitando com isso um ambiente sustentável para a presente e futuras gerações. Com base na pesquisa, podemos verificar que ainda é pouco o investimento em palestras, reuniões e eventos voltados para os professores, para que os mesmo possuam mais conhecimento para aplicar de melhor forma de acordo com a necessidade da comunidade em que a escola está inserida com o intuito de promover sempre a EA e a sustentabilidade, além de proporcionar um melhor ambiente para a comunidade, com a minimização dos problemas enfrentados pelos mesmos, como é a questão do lixo, que não é apenas uma questão ambiental, mas também de saúde, já que o mesmo pode transmitir várias doenças através dos insetos, roedores e outros.

Saberes docentes mobilizados no ensino de EJA e sua relevância na vida cotidiana do aluno

A preocupação central desta pesquisa foi compreendermos quais os saberes docentes que o professor de EJA mobiliza na organização do seu trabalho em sala de aula e a relevância desses saberes no cotidiano do aluno de Escolas Estaduais da cidade de Garanhuns, Pernambuco, Brasil. A pesquisa foi conduzida com 100 discentes da EJA que estudam em quatro escolas da referida cidade e com oito docentes que lecionam nas referidas Instituições. Procedeu-se à aplicação de um questionário validado e adaptado aos discentes e uma entrevista semi-estruturada aos docentes dessa modalidade. A análise dos dados quantitativos foi realizada por meio do programa SPSS; enquanto a análise dos dados qualitativos foi orientada pela análise de discurso. Os resultados evidenciaram a falta de formação profissional específica dos docentes para trabalhar com a EJA, bem como a necessidade de uma política educacional voltada para essa modalidade de ensino, visto que, apesar de a maioria dos professores recorrerem aos diferentes saberes adquiridos em sua trajetória, a educação de jovens e adultos ainda expressa um reflexo de exclusão e ideologia apresentando bastante dificuldade. Assim, sugere-se que muito se tem a evoluir para que toda a potencialidade utilizada a favor do ensino de jovens e adultos obtenha sucesso, tanto para construção das práticas pedagógicas de seus docentes quanto para a facilitação do processo de ensino-aprendizagem com os alunos.

O portefólio como instrumento de reflexão na disciplina de desenho A do Ensino Secundário

A temática apresentada é resultante da prática de ensino supervisionada no Ensino Secundário em Artes Visuais e tem como finalidade aprofundar questões que envolvem a autorregulação das aprendizagens para o desenvolvimento do pensamento reflexivo dos alunos. A importância do paradigma reflexivo está cada vez mais presente nas práticas educativas dos nossos tempos, remetendo para um novo conceito de ensino e de avaliação no processo de ensino-aprendizagem, de acordo com um ensino cada vez mais centrado no aluno. Seguindo a intemporalidade do pensamento freireano são desenvolvidas práticas de avaliação tendo por base a integração do portefólio como instrumento de aprendizagem progressiva para a prática reflexiva dos alunos na disciplina de Desenho A. Este projeto de investigação participativa pretende analisar informações qualitativas e quantitativas de forma a reconhecer o contributo e o benefício da dimensão reflexiva ao longo do processo de ensino-aprendizagem no desenvolvimento pessoal e cognitivo do aluno.

Young caregivers in the context of the HIV/AIDS pandemic in sub-Saharan Africa

Against a background of rising adult mortality and morbidity in the context of the HIV/AIDS pandemic in sub-Saharan Africa, this paper provides both quantitative and qualitative evidence for the existence of a largely neglected group of young people with increased responsibility for caregiving. Using questionnaire surveys, focus groups, storyboards and in-depth interviews in three studies across Southern and Eastern Africa some young people in Lesotho, Tanzania and Zimbabwe are found to devote considerable time and energy to caring for sick members of their households. Examination of the tasks carried out by these youngsters finds them to be burdened beyond usual familial and societal expectations of children's 'normal' contributions to the reproduction of households via domestic chores and suchlike. It is concluded that these young people can be described as 'young carers'. The three studies are presented to illuminate different sociospatial aspects of caregiving by young people. First, using qualitative data from Lesotho the range of caring tasks young caregivers; perform for care recipients - usually a grandmother, parent, or sibling - is identified. Second, the impact caregiving responsibilities have on children's primary school attendance is examined using survey data from Tanzania. Third, the wider negative and positive impacts of caregiving including loss of friends and gaining of emotional maturity for young carers and their households is explored with in-depth individual interviews from Zimbabwe. Finally, suggestions are made for further research to deepen understanding of the geographies of caring within the context of the population geographies of the HIV/AIDS pandemic in sub-Saharan Africa and beyond. Copyright (c) 2006 John Wiley & Sons, Ltd.

The influence of project complexity on estimating accuracy

With the rapid development in technology over recent years, construction, in common with many areas of industry, has become increasingly complex. It would, therefore, seem to be important to develop and extend the understanding of complexity so that industry in general and in this case the construction industry can work with greater accuracy and efficiency to provide clients with a better service. This paper aims to generate a definition of complexity and a method for its measurement in order to assess its influence upon the accuracy of the quantity surveying profession in UK new build office construction. Quantitative data came from an analysis of twenty projects of varying size and value and qualitative data came from interviews with professional quantity surveyors. The findings highlight the difficulty in defining and measuring project complexity. The correlation between accuracy and complexity was not straightforward, being subjected to many extraneous variables, particularly the impact of project size. Further research is required to develop a better measure of complexity. This is in order to improve the response of quantity surveyors, so that an appropriate level of effort can be applied to individual projects, permitting greater accuracy and enabling better resource planning within the profession.

Effective livelihood adaptation to climate change disturbance: scale dimensions of practice in Mozambique

Natural resource-dependent societies in developing countries are facing increased pressures linked to global climate change. While social-ecological systems evolve to accommodate variability, there is growing evidence that changes in drought, storm and flood extremes are increasing exposure of currently vulnerable populations. In many countries in Africa, these pressures are compounded by disruption to institutions and variability in livelihoods and income. The interactions of both rapid and slow onset livelihood disturbance contribute to enduring poverty and slow processes of rural livelihood renewal across a complex landscape. We explore cross-scale dynamics in coping and adaptation response, drawing on qualitative data from a case study in Mozambique. The research characterises the engagements across multiple institutional scales and the types of agents involved, providing insight into emergent conditions for adaptation to climate change in rural economies, The analysis explores local responses to climate shocks, food security and poverty reduction, through informal institutions, forms of livelihood diversification and collective land-use systems that allow reciprocity, flexibility and the ability to buffer shocks. However, the analysis shows that agricultural initiatives have helped to facilitate effective livelihood renewal, through the reorganisation of social institutions and opportunities for communication, innovation and micro-credit. Although there are challenges to mainstreaming adaptation at different scales, this research shows why it is critical to assess how policies can protect conditions for emergence of livelihood transformation. (C) 2008 Elsevier Ltd. All rights reserved.

Attitudes of landscape professionals towards naturalistic versus formal urban landscapes in the UK

The last 30 years have seen a tide of interest sweeping across Europe in the development of nature in cities, and an increasing amount of landscape development in urban areas has involved the use of 'naturalistic' styles. This is an increasing attempt to find ways for urbanism and nature to co-exist. However, there have been considerable discussions among professionals regarding the advantages and disadvantages of 'naturalistic' styles in urban areas. This research examines professional attitudes to 'naturalistic' landscape styles in Britain, in contrast to more traditional, formal landscape styles, and aims to find out whether the interest in natural landscapes is really a fashion among landscape professionals. A self-administered postal survey was carried out using both quantitative and qualitative data collection techniques and analysis. The survey included 500 professionals from parks and recreation departments of local authorities, private landscape practices and conservation trusts, and resulted in a satisfactory response rate of 53 %. The results of this study suggested that professionals recognise most of the values attached to naturalistic landscapes in urban areas. However, possible benefits that natural areas may have for urban people are not attached to naturalistic landscapes alone. The study also revealed that the naturalistic style is highly popular among conservation trusts but is less so among professionals from local authorities and private landscape practices who seem to appreciate both styles and believe that these styles are not separable from each other and should co-exist in an urban environment. (C) 2006 Elsevier B.V. All rights reserved.

Hitting emissions targets with (statistical) confidence in multi-instrument Emissions Trading Schemes

A means of assessing, monitoring and controlling aggregate emissions from multi-instrument Emissions Trading Schemes is proposed. The approach allows contributions from different instruments with different forms of emissions targets to be integrated. Where Emissions Trading Schemes are helping meet specific national targets, the approach allows the entry requirements of new participants to be calculated and set at a level that will achieve these targets. The approach is multi-levelled, and may be extended downwards to support pooling of participants within instruments, or upwards to embed Emissions Trading Schemes within a wider suite of policies and measures with hard and soft targets. Aggregate emissions from each instrument are treated stochastically. Emissions from the scheme as a whole are then the joint probability distribution formed by integrating the emissions from its instruments. Because a Bayesian approach is adopted, qualitative and semi-qualitative data from expert opinion can be used where quantitative data is not currently available, or is incomplete. This approach helps government retain sufficient control over emissions trading scheme targets to allow them to meet their emissions reduction obligations, while minimising the need for retrospectively adjusting existing participants’ conditions of entry. This maintains participant confidence, while providing the necessary policy levers for good governance.

A study of students' metacognitive beliefs about foreign language study and their impact on learning

This article reports on an investigation into the language learning beliefs of students of French in England, aged 16 to 18. It focuses on qualitative data from two groups of learners (10 in total). While both groups had broadly similar levels of achievement in French in terns of examination success, they dffered greatly in the self-image they had of themselves as language learners, with one group displaying low levels of self-eficacy beliefs regarding the possibility of future success. The implica tions of such beliefs for students' levels of motivation and persistence are discussed, together with their possible causes. The article concludes by suggesting changes in classroom practice that might help students develop a more positive image of them selves as language learners.

Changing Standards? Children's awareness and knowledge of features of written standard English at ages 10-11

This paper reports the findings of a small-scale research project, which investigated the levels of awareness and knowledge of written standard English of 10- and 11-year-old children in two English primary schools over a six-year period, coinciding with the implementation in the schools of the National Literacy Strategy (NLS). A questionnaire was used to provide quantitative and qualitative data relating to: features of writing which were recognised as standard or non-standard; children's understanding of technical terminology; variations between boys' and girls' performance; and the impact of the NLS over time. The findings reveal variations in levels of recognition of different non-standard features, differences between girls' and boys' recognition, possible examples of language change, but no evidence of a positive impact of the NLS. The implications of these findings are discussed both in terms of changes in educational standards and changes to standard English.

Psychological response to later life widowhood: coping and the effects of gender

The study examined the effects of psychological response and gender on coping with late life widowhood. Forty-six men and 46 women (55 years +) were interviewed about their experiences of widowhood. Participants were classified as to whether they were coping well or less well. Data were analyzed using grounded theory, content. analysis, and three-way loglinear analyses. Loglinear analyses revealed three-way interactions for Gender, Coping, and Response. Men who report feeling upset or selfish are more likely to be coping, as are women who report being comfortable alone. There were two-way interactions between Coping and Response and Gender and Response. Participants who talk to their dead spouse are more Rely to be coping than those who do not. Those who "keep themselves to themselves" are more likely not to be coping than those who do not. Gender differences, were found in psychological response. Differences were also found between those who coped and those who coped less well. The study has enabled the synthesis of quantitative and qualitative data to present a more complete view of late life widowhood than has previously been possible. In addition, the article draws attention to the importance of distinguishing between the effects of bereavement and those of widowhood.

Securing provision for children with autistic spectrum disorders: the views of parents

An original questionnaire was designed to seek the perspectives of parents about the process of securing appropriate educational provision for their child with autism spectrum disorder. In total, 738 responses were analysed using both quantative and qualitative data. Although a broad range of opinion was evidenced and a clear majority of families were happy with the end decision of placement, most families were significantly less happy with the process to determine that provision. Most families found this process difficult to navigate and frustrating. This caused a high level of stress for a significant proportion of families. Implications for practice are discussed.