Estratégias de enfrentamento de pessoas vivendo com AIDS frente à situação da doença

The Acquired Immune Deficiency Syndrome (AIDS), considered today one chronic nature of the disease due to the advent of antiretroviral therapy (TARV), brings to individuals living with this disease, difficulties related to social interaction and adaptation to new physical condition and the routines imposed by the treatment. This reality has a strong impact on the lives of these people in order of overcoming them use coping strategies, Coping. In this context, the aim of this study was to characterize the epidemiological, clinical and life habits of people living with AIDS and analyze the coping strategies used with the situation of the disease, according to sociodemographic, clinical and life habits. This is a cross-sectional study with a quantitative approach. The sample consisted of 331 people registered at the clinic of the Hospital Giselda Trigueiro (HGT), located in Natal / RN, who had scheduling for outpatient medical consultation from January to August 2014. The study was approved by the Ethics Committee the Federal University of Rio Grande do Norte with the Presentation of Certificate for Ethics Assessment (CAAE), paragraph 16578613.0.0000.5537. The data of social characterization showed predominance of men (52%), young people (42%) coming from the capital (58%), mulatto (53%), single (56%), heterosexual (79%), poor (68 %). With regard to clinical aspects it has been found that most held the first HIV testing for less than five years (60%) had signs and symptoms of AIDS before the examination (90%) were hospitalized (90%) started ART for less than five years (60%) believe they have good knowledge of the disease (75%) and believe that their health has improved (92%). For lifestyle, it became clear that most do not consume alcohol (71%), do not smoke (88%) and do not use illicit drugs (92%) and never used condoms before diagnosis (62%) and only 192 (58%) use the currently codon. With regard to the reference was higher coping focused modes of emotion, although the problem solving has been the second most common. The mean scores of women, workers, religious and never abandoned the treatment were higher for all factors. Having a partner, living with family members and support in the treatment had higher average scores for various factors, coinciding in the confrontation, withdrawal and social support. As for the leisure and physical exercise also dominated the modes focused on emotion as was seen in the correlation between the time of treatment, education and family income and IEEFL factors, although with low intensity. The profile of the study population confers with national characteristics, suggesting feminization, internalization, pauperization, heterosexual, increased CD4 cell count and viral load reduction during treatment and maintaining healthy lifestyle habits. Coping strategies used were more focused on emotion. In this context, it is understood that the identification of these strategies can facilitate care planning, encouraging such persons to adapt to stressors with the situation of the disease

Diagnósticos de enfermagem do domínio nutrição em pacientes submetidos à hemodiálise

The study aimed to analyze the nursing diagnoses of the nutrition domain from NANDA International in patients undergoing hemodialysis. This is a transversal study conducted in a university hospital in northeastern Brazil, with 50 hemodialysis patients. The data collection instrument was an interview form and a physical examination, in digital format, applied between the months of December 2013 to May 2014. Data analysis was divided into two stages. In the first, defining characteristics, related factors and risk factors were judged as to their presence by the researcher, according to the data collected. In the second stage, based on data from the first, diagnostic inference by experts was held. The results were organized in tables and analyzed using descriptive and inferential statistics for the diagnoses that showed higher frequencies than 50%. The project was approved by the Ethics Committee responsible for the research institution (protocol number 392 535), with Certificate Presentation to Ethics Assessment 18710613.4.00005537 number. The results indicate a median of 7 (± 1.51) nursing diagnoses of the nutrition domain per patient. Six diagnoses with greater frequency than 50% were identified, namely: Risk for electrolyte imbalance, Risk for unstable blood glucose level, Excess fluid volume, Readiness for enhanced fluid balance, Readiness for enhanced nutrition and Risk for deficient fluid volume. The defining characteristics, related and risk factors presented an average of 34.78 (± 6.86), 15.50 (± 3.40) and a median of 4 (± 1.93), respectively, and 11 of these components had statistically significant association with the respective diagnoses. Were identified associations between adventitious breath sounds, edema and pulmonary congestion with the diagnosis Excess fluid volume; Expressed desire to increase fluid balance with the nursing diagnosis Readiness for enhanced fluid balance; It feeds regularly, Attitude to food consistent with the health goals, Consume adequate food, expresses knowledge about healthy food choices, expresses desire to improve nutrition, expresses knowledge about liquid healthier choices and following appropriate standard supply with diagnosis Readiness for enhanced nutrition. It is concluded that the diagnosis of the nutrition domain related to electrolyte problems are prevalent in customer submitted to hemodialysis. The identification of these diagnoses contributes to the development of a plan of care targeted to the needs of these clients, providing better quality of life and advance in the practice of care

Uma escola e muitos sentidos: um estudo com os sujeitos jovens da EJA na Escola Estadual 15 de Outubro

Work that aims to understand the meanings attributed to school knowledge by young students of the EJA State School 15 October, located in the Natal’s North Zone. Young people were elected as the focus of interest for having a numerical expression increased in groups of adult education EJA, but above all, they demand for new issues and specific to school. For the research, we used methodologically the Comprehensive Interview organized by Kaufmann (2013), making use of its own analytical and organization of information, captured through semi-structured interviews and on-site observation. Whereas the meaning ascribed to it in relation to the school knowledge conditions the way to experience the school, sought the theoretical constructions of Bernard Charlot (2000; 2005), the understanding of knowledge as a relation of the subject with you, with each other and with the world, so we know beyond the object content. Analytical work incorporates also the contributions of Marc Augé (1994, 1997) with respect to the understanding of meaning as a social construction. Reflections were also made in light of Michel de Certeau (2012), in that it allows you to take the students as active subjects and producers of survival tactics in life and at school. From the speech of students, seized three units of meaning, namely: the learning considered most important by young students, which make up a set of ethical and moral values; the school as a guarantee of "a better future", in which young people seek to ensure a job in adulthood, however, from a "magical relationship" with knowledge, in that the target of young students is more the certificate completion of the level of education they attend, which is not necessarily associated with school learning. The third core seized sense is the school as a place of socialization, that is, a space where you can meet with friends to talk. There is therefore a relationship with knowledge that is prestigious for the youth of adult education EJA; there is an objective expectation of these students about the school; and they do "use" of the institution to "meetings" that are not necessarily with the curricular knowledge. Consider, therefore, these questions which hold school sense of reframing, is part of an effort to understand the subject of adult education EJA and helps to think ways to ensure continuity and their success in the institution.

Estudo do domínio segurança/proteção da NANDA internacional em pacientes de unidade de terapia intensiva

The study aimed to analyze the field of nursing diagnoses safety / protection of NANDA International present in patients in the Intensive Care Unit. This is a crosssectional study in intensive care complex of a university hospital in northeastern Brazil. The research took place in two stages. The first step was to collect data through an interview form and physical examination, with 86 patients admitted to the unit, during the months of December 2013 to May 2014. Spreadsheets were built in Microsoft Office Excel 2010 Software in which were marked by the researcher of this study, the presence or absence of defining characteristics, related factors and risk factors of the 31 studied diagnoses. In the second stage, held between July and August 2014, the sheets were sent to three diagnosticians, previously trained to perform the diagnostic inference. Data were analyzed using descriptive and inferential statistics for the diagnoses that showed higher frequencies than 50%, using IBM SPSS version 20.0 for Statistic Windows.O project was approved by the 440/414 and Presentation Certificate for Ethics Assessment number 22955113 .2.0000.5292. The results indicated the presence of 29 field of nursing diagnoses safety / protection in hospital clientele in the Intensive Care Unit, of which five were present in 100% of patients, namely: Risk of contamination, injury risk, falls risk,risk of allergic response and risk of trauma. Diagnoses that presented more frequently than 50% were: Risk of infection, dry eye risk, poisoning risk, vascular trauma risk, impaired skin integrity, impaired dentition, bleeding risk, risk imbalance in body temperature, Risk perioperative positioning injury, impaired tissue integrity, peripheral neurovascular dysfunction Risk, Risk adverse response to contrast media with iodine, shock Hazard and Risk of aspiration. For these analyzes, we identified 35 risk factors, 11 defining characteristics and three related factors showed statistically significant association with the studied diagnoses. For diagnostics: Risk of contamination, injury risk, falls risk, allergic response risk, trauma Risk, Risk of infection, dry eye risk and risk poisoning there was no association with any of their risk factors. We conclude that most of the area of nursing diagnoses safety / protection feature is prevalent in critically ill patients, with special attention to the risk diagnoses. There was a significant association between these diagnoses and its components. It is noteworthy, therefore, that the lifting of this profile contributes relevant clues to the inference of the priority nursing diagnoses domain safety / protection in the study population, supporting the practice of nursing and stimulating knowledge on the subject.

Acompanhamento coletivo do crescimento e desenvolvimento infantil: participação de mães/cuidadores

This study aimed to analyze the participation of mothers/caregivers from the perspective of the health care model that directs the collective monitoring of child growth and development. This is an exploratory and descriptive research with qualitative approach, carried out in two Family Health Units located in the city of Natal/RN. Data were collected between August and September 2014, through participant observation and semi-structured interview technique, with mothers of infants seen at follow-up visits collective child growth and development. A total of 13 mothers were included who met the following inclusion criteria: being a mother/caregiver responsible for the care of children who have attended one or more meeting of collective monitoring of child growth and development. Exclusion criteria was established: users outside the area covered by the Health Unit Family and who did not use the National Health System as the primary health care service. For the treatment of the collected material, the content analysis was used, thematic Bardin. The study followed the ethical and legal principles governing the scientific research on human subjects recommended by Resolution nº. 466/2012 of the National Health Council and its realization occurred with the approval of the project in the Research Ethics Committee of the Federal University of Rio Grande do North, which was approved by Opinion Embodied nº. 719 949, of June 27, 2014, and Certificate Presentation of Findings Ethics No 32510514.7.0000.5537. Although not conceptualize theoretically mothers demonstrated that collective consultations of child growth and development are actions aimed at health surveillance model, since most pointed monitoring your child to actions that can be measured. Even with that, it was established the existence of health promotion actions by reporting the exchange of experience and leadership of the subjects in collective action, factor facilitated by the link established between users and professionals and users. In this action there is the induction of permanent horizontal relationship where we seek to combine popular knowledge to scientific knowledge in order to promote the integral care for the child. However, it is still possible to find professionals who directs its assistance only to pathological processes and fail to create comprehensive care alternatives. In addition, there is still embezzlement in multi that should provide care to the child population. This factor may be related to their professional training, and thus an issue that can last for a few years. We conclude that it is necessary to incorporate alternatives and models of care that support overcoming limitations and enhancing the health of the population, involving it in the prospect of a better quality of life and therefore health.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

A atuação do enfermeiro no combate à dengue e a febre chikungunya: estudo comparativo nos municípios de Parnamirim e Santa Cruz/RN

The research aimed to analyze the role of nurses in the Family Health Strategy (FHS) in the control of Dengue and Chikungunya fever in the cities of Parnamirim and Santa Cruz. It is exploratory and descriptive nature of research, with a qualitative approach, which was developed with nurses of the Family Health Strategy in the municipalities of Parnamirim and Santa Cruz. All research process followed the ethical standards laid out research in Resolution No. 466/2012 of the National Health Council about research involving human beings. Data collection was performed using a semi-structured questionnaire with open and closed questions, organized into three parts: the profile of respondents, knowledge of the disease (transmission, prevention, control) and description of practices. The actions performed by nurses are punctual performed when there is growing disease of the number of cases in order to try to reduce the number of cases. The principal methodology used for them is to talk and guidelines resulting from campaigns and home visits, using leaflets and social networks. Regarding knowledge of nurses in the city of Santa Cruz on Dengue Fever and Chikungunya, is clearly some gaps. Nursing professionals know recognize a suspected case of dengue, but get confused when trying to explain to the Chikungunya fever, exhibiting the same symptoms of dengue. Although everybody had participated in a training on Chikungunya Fever and Dengue, a very limited knowledge of nurses regarding the clinical management. It is suggested that further studies are developed on the ground a few nurses have accepted to participate in the study, so that we can identify strategies, interventions, activities and nursing actions that are consistent with the reality of working in favor of coping Aedes epidemics aegypti that have positive impact on reducing the infestation rates and may be suitable and applied in other regions.

A atuação do enfermeiro no combate à dengue e a febre chikungunya: estudo comparativo nos municípios de Parnamirim e Santa Cruz/RN

The research aimed to analyze the role of nurses in the Family Health Strategy (FHS) in the control of Dengue and Chikungunya fever in the cities of Parnamirim and Santa Cruz. It is exploratory and descriptive nature of research, with a qualitative approach, which was developed with nurses of the Family Health Strategy in the municipalities of Parnamirim and Santa Cruz. All research process followed the ethical standards laid out research in Resolution No. 466/2012 of the National Health Council about research involving human beings. Data collection was performed using a semi-structured questionnaire with open and closed questions, organized into three parts: the profile of respondents, knowledge of the disease (transmission, prevention, control) and description of practices. The actions performed by nurses are punctual performed when there is growing disease of the number of cases in order to try to reduce the number of cases. The principal methodology used for them is to talk and guidelines resulting from campaigns and home visits, using leaflets and social networks. Regarding knowledge of nurses in the city of Santa Cruz on Dengue Fever and Chikungunya, is clearly some gaps. Nursing professionals know recognize a suspected case of dengue, but get confused when trying to explain to the Chikungunya fever, exhibiting the same symptoms of dengue. Although everybody had participated in a training on Chikungunya Fever and Dengue, a very limited knowledge of nurses regarding the clinical management. It is suggested that further studies are developed on the ground a few nurses have accepted to participate in the study, so that we can identify strategies, interventions, activities and nursing actions that are consistent with the reality of working in favor of coping Aedes epidemics aegypti that have positive impact on reducing the infestation rates and may be suitable and applied in other regions.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.

Gestão da segurança alimentar evolução da certificação Codex Alimentarius para a implementação da ISO 22000:2005

O efeito conjugado das imposições da grande distribuição e dos consumidores cada vez mais exigentes levou os intervenientes do sector alimentar a considerarem a certificação dos seus produtos e/ou sistemas de produção por referenciais específicos. Todas as organizações que intervêm na cadeia alimentar têm a responsabilidade de colocar no mercado produtos alimentares cujas condições de higiene e segurança estejam devidamente garantidas. O trabalho desenvolvido no presente Projecto consistiu na preparação da implementação da norma NP EN ISSO 22000:2005 na empresa Cores Doces, Lda, dedicada ao comércio de doçaria. Tendo já o sistema HACCP implementado, a certificação através da norma de gestão da segurança alimentar NP EN ISSO 22000:2005 era um objetivo estratégico da administração da empresa uma vez que é este o referencial de segurança alimentar que melhor se adapta à realidade e objetivos da empresa e seus parceiros. O plano de trabalhos teve como objetivo fazer a transição entro o sistema HACCP (hazard Analysis and Critical Control Points) já implementado e certificado, para a implementação e certificação segundo os requisitos da norma NP EN ISSO 22000:2005. Para o efeito foram numa primeira fase identificadas as principais diferenças entre os dois sistemas de gestão da segurança alimentar. Esta análise permitiu diagnosticar as alterações processuais a implantar e os documentos a elaborar para a constituição da estrutura documental do sistema segundo a ISO 22000:2005. As principais alterações efetuadas foram a nível do Planeamento e Realização de Produtos Seguros, nomeadamente a análise de risco. Numa segunda fase foram apresentadas as alterações na empresa perante a transição para a ISSO onde se deu destaque aos aspetos relacionados com a responsabilidade da gestão, a compatibilização com os outros sistemas de gestão que possam ser criados na empresa (qualidade, ambiente, segurança e saúde); onde se fez igualmente a correspondência entre o Codex e a ISSO com destaque para o capítulo 7 na Norma ( Planeamento e Realização de Produtos Seguros), explorando os restantes capítulos que permitem introduzir na organização um ciclo de PDCA (Planear, Realizar, Avaliar e Corrigir). Finalmente foi elaborado um auxiliar de transição do sistema HACCP para a ISSO 22000 que possa servir de ferramenta para outras organizações.

La clasificación de fenómenos de interlengua fónica en la evaluación de dominio de ELSE : El caso del CELU

En este trabajo retomamos algunas de las cuestiones abordadas en Pacagnini (2007, 2011, 2013) en relación con la evaluación de la pronunciación, entonación y fluidez en la prueba oral correspondiente al Certificado de Español Lengua y Uso (CELU), del Consorcio Interuniversitario Argentino. En particular, continuaremos con el análisis de aspectos tales como la problemática de la caracterización y jerarquización de los "errores" desde la perspectiva del evaluador (sobre todo en los casos en los que estos no corresponden ni a la L1 ni a la L2 del candidato, al extremo de dificultar la asignación clara de un nivel de proficiencia en los ítems evaluados). Asimismo, abordaremos un punto álgido a la hora de adjudicar puntaje de acuerdo con las grillas descriptivas y bandas holísticas: la clasificación de los fenómenos percibidos (fundamentalmente fonotácticos o prosódicos) como problemas de "fluidez" o de "pronunciación y entonación". En relación con esto último, intentaremos responder a los siguientes interrogantes: ¿Es posible evaluar la fluidez de manera independiente? En tal caso, ¿cómo podemos cuantificar efectivamente la fluidez?