Reestruturação do setor industrial e transformação do espaço urbano de Campina Grande PB : a partir dos anos 1990

The central objective of this thesis is studying the changes in the industrial sector of Campina Grande-PB, in the years 1990, about the size of that space and urban sector. The hypothesis that guides this work is that there was a reconfiguration and industrial space in recent years, the result of the restructuring of productive capital and, secondarily, public policies - economic, urban etc. - implemented in the municipality in the years 1990. This reconfiguration industrial meant thepredominance of certain productive segments of the industry and the shift towards urban-industrial areas (industrial districts). This work is guided in these two axes to explain the changes in the industrial campinense and its consequent impact on the urban development of Campina Grande. It is understood by reconfiguration industrial changes in industrial structure, namely the preponderance of one or more productive segments on the other, changing the scenario of production, employment and the number of establishments. In this study, are considered as institutional structures of support and assistance to industry, the various institutions that directly and indirectly, contribute to the development of productive activity. These structures are the first to undergo institutional changes, physical and policies because of intrinsic connection with the industry. The institutional structures contribute to the development of industrial activity and urban development. In Campina Grande, these institutions are important for facilitating the development of certain segments. In this work, sought to identify the current configuration industrial campinense, explaining how the restructuring of production transformed the industry, modifying the urban space in Campina Grande - PB, to direct itself to specific urban areas, from the early 1990

Reforma administrativa e gestão de políticas sociais em Mossoró: a falácia dos atores institucionais e sociais

The thesis entitled The administrative reform and social political management in Mossoró: the institutional and social staff's falacy. Comprehends a moment of apprehensiveness and analysis in the reestrcturing process of the city, whose process will show the formation of strategies and deployment of its relation with the social political affectiveness. It represents a single moment in the approach of such a kind of experience in the city. The analysis starts from the third mandate of the Mayor Rosalba Ciarlini Rosado, during the quadriennium 2001/2004, for being the time in which the public management got materialized, such as in the operational way of the social politics. For that, we delimitate this study in two distinct moments: the first one refers to the reform elaboration from the creation of the additional law nº 001/2000 GP/PMM: the second one refers to a practical reform from the social and institutional staff's speech. Within that scenary it was seen that the approaching, though partially, the State Reform and, consequently, the master plan of the state apparatus, which were made of theoretical matrices of such a project locally. However, that is a complex experience, that required the use of field and documental research for the proposed investigation and at the same time, prove the guiding hypothesis of it, what means a grouping of areas like: education, healthy, and social development in only one department City Citizenship Department that is able to materialize a new intitutional arrangement, according to the management principles in the public administration at the govern local level, configuring a reform and not just an institutional adequacy. In that context, it got necessary to apprehending the institutional and social actors' falacy as a way to prove or not the presented hypothesis. Among the first staff, we have the mayor's direct leaders and advisors' perception that express the politcal administrative aspects of the reform and, in the second, the perception of the political view of what has changed concerning the management of the social politics

Identidade rural e agricultura familiar :O Pronaf B sob a ótica dos beneficiados

This work has for objective to analyze the perception of benefited of Pronaf B Programa Nacional de Fortalecimento da Agricultura Familiar, in relation to the results that are presented concerning this program. For this, it is presented hypothesis of that the familiar agriculturists, fit in the norms of credit of Pronaf B, have a peculiar perception on the end item of this program, produced from inherent characteristics to the agricultural reality where they live. Ahead of this, I broke myself of estimated of that the searched familiar agriculturists are more socially vulnerable to the inaqualities the agricultural areas. For this research, they had been used, mainly, theoretical reflections of studious of the campesinato, familiar agriculture and of researchers of the impacts of Pronaf B in the agricultural way. The empirical data of the research had been gotten, through the application of questionnaires with the benefited ones and interviews with the mediators of this program in the two searched cities, Apodi and Antônio Martins, in the Rio Grande do Norte, who proportionally withholds the biggest contract number of Pronaf B in the state. The conclusion of the research ratifies the initial hypothesis of that the perception on the results of Pronaf B for benefited its is peculiar, and points stops beyond the economic results, such as: the rise of auto-esteem; the rescue of the citizenship feeling and as impact in autoconsumo of the families of the agriculturists benefited for Pronaf B

O corredor cultural: espaço de materialização da exclusão social em Mossoró-RN

In contemporary society, social exclusion is an actual and pertinent theme, because it presents itself as a challenge to management and planning of the public policies. In this perspective, the thesis entitled "The Cultural Corridor: space materialization of social exclusion in Mossoró-RN" is a moment of apprehension and analysis of the local reality from the urban policy implementation that emphasized an enterprising model, which has, as the concrete space to urban renovation manifestation, the cultural complex called cultural corridor. Because of the investigation and the directional hypothesis, it is possible to say that the urban development policy implemented in Mossoró, starting from the 1990 decade, based in the model of modernizing/enterprising management, has been causing an intensification of a society parcel exclusion from the city public space, since this public policy didn't prioritized job market increasing, as well as population incomes improving, poverty and social inequality reduction, at the same proportions it promoted geographic space reorganization with directional actions to build the "spectacle city"

Desenvolvimento e políticas públicas: uma avaliação do PRONAF nos assentamentos de reforma agrária do Rio Grande do Norte

The research DEVELOPMENT AND PUBLIC POLICY: AN EVALUATION OF PRONAF IN THE SETTLEMENTS AGRARIAN REFORM OF RIO GRANDE DO NORTE aimed to evaluate the effectiveness of the National Program for Strengthening Family enhancerelement od development in rural settlements od Rio Grande do Norte. The methodological approach consisted of the completion of desk research and literature on development issues, policies, and rural credit and field research through semi- structured interviews with managers and technicians who work with the program and conducting focus with farmers settles who accessed the PRONAF the period from 2000 to 2006. The survey results confirm the central hypothesis of this work, that acces to PRONAF A is not causing efetivations relevant in the lives of farm workers settlers in Rio Grande do Norte. In the setllements where efetivations these occur, they are short of what the program intends to carry out and rely on a set of conditionalities that are beyond the operational frameworks of the same. Such questions point to the need to revise the program in order to estabilish adjustments that in practice the approach of the proposed objectives. For this purpose it is necessary to invest in factor that contribute to the program has a positive effect not only to increase income, but to contribute to the autonomy of the resettled farmers, expanding its capabilities and increased the power of choise with respect to life who wish to take

Ambiente institucional no crédito rural :avanços e retrocessos

This work aims to study the institucional environment for the implementation of financing policies directed to familiar agriculture. The central hypothesis is that, although all changes occured in the credit norms, in order to reduce the existing obstacles for the access of outsiders, the same institucional arrangement remains which gave support to the modernization - crystallizer of strengthening structures of this exclusion. The most relevant pressuposition is that the poor agriculturists are the most displayed to the institucional limitations. The concepts of institucional arrangements and environments used in this work had been constructed with support of the institucional school, contemplating itself the economic dimension, the organizational sociology and political science. In the relation of the institucional changes with the state performance, the theorist reading was important that reflect on the relative autonomy of the State and studious of the Brazilian State. The empirical part consisted of a research which had been applied questionnaires with benefited and non-benefited agriculturists with PRONAF B, in thirteen cities of Rio Grande do Norte. In each city, interviews with four of its main mediators had been carried out. The research results had ratified the hypothesis of the work of that the conception of the public policies does not take in account the institution role in the behavior and the choices of the individual and collective agents, inferring itself that this policy, as others, lacks of mediation that exceed the rationality of legal landmarks

Estado desenvolvimentista e o Nordeste :o BNB na busca de um modelo de desenvolvimento regional

This research tried to follow up with the way of intervention that a developing State promotes it regional development, once its action departs from a quantitative conception until its acting focused in maintenance, like the strategy of local development input in the Northeastern of Brazil in the 90 s. particularly, the attention was focused onto Banco do Nordeste which, between 1995 and 2002, achieved a organization changing process to get fit itself to the new conception of development and State, that advocates the maintenance and the participation of the society in its accomplishment, becoming itself the main agent of the Federal Government in the Region. By taking over the strategy of local development, Banco do Nordeste starts, at least in speech, to be less of a bank to become more of a development agent , representing some development and hope to overcome the social and economical inequalities of the Region. The hypothesis that surrounds this essay is that this reorientation experienced at Banco do Nordeste is related to three factors: timing; the Institution of a project of international technical cooperation with PNUD; the unrest of an employees group, who used to fight for the acting increase of the Bank to beyond the credit acting; and, above all, the juncture created in Ceara from the second half of the 80 s, expressed, mainly, for the political rise of a group of businessmen, who took over and modernized the standards of public management in the State, transforming the cearense experience into reference in Brazil and the world. The research was developed from information got through the use of semi-structured interviews and documental research and, as complementary resource, field observation. The interviews were done with BNB managers between 1995 and 2003, some of them current administrators (2003-2006), plus one of CAPEF directors and the present president of AFBNB. The research revealed that strategic place taken by BNB in the period studied did not come to represent a rupture in its organizational culture, being strongly attached to factors that allows its operation. When some of these elements stopped existing, it was observed a retracing in the pattern of state intervention in the Region. This conclusion restates the vision of State that guided this thesis, identified as relationships field, of different interests; space where social conflicts are established; incarnated through the institutions

Padrões de coexistência e utilização do hábitat por duas espécies de Herpsilochmus (Aves: Thamnophilidae)

How ecologically similar species are able to coexist has always generated great interest in the scientific community. Classical niche theory predicts that species coexistence is only possible when they segregate in at least one dimension of the ecological niche, thus leading to ecological differentiation among species. However, recent work has shown that species that are more similar in some ecological traits are the ones more prone to be able to coexist (environmental filter). The knowledge of how these forces act shaping ecological communities can reveal co-existence strategies, providing important information for management and conservation of the species. This study tested these hypotheses using a pair of coexisting species of Herpsilochmus, H. pectoralis and H. sellowi. In this study I use high resolution (50 x 50 m) ecological niche models to Identify which environmental factors best predict species occurrence. Next, I calculate the overlap in habitat use by species and build null models to test the hypothesis of spatial niche segregation. In addition, I obtain the selectivity parameters of habitat use to test whether the species H. pectoralis (larger body size) is less selective than H. sellowi (smaller body size) as stated in the literature for other species. The results reject the ecological equivalence among species, revealing that the species of Herpsilochmus explore the habitat differently, having different environmental niches. The hypothesis of environmental filter was not observed in my analysis, the observed overlap in habitat use among species was lower than expected by chance. Evidence that Herpsilochmus are spatially segregating reinforces the hypothesis of interspecific competition as the predominant force in the selection of microhabitat of the species. However, more data and experiments are necessary to state categorically that the observed pattern is a result of current or past competition

Atuação dos profissionais de enfermagem durante o processo transfusional na UTI de um hostital universitário

Prospective descriptive study with quantitative approach, which aimed to analyze the relationship of the knowledge of Nurses and conduct assistance during the process of transfusion, to patients in the ICU of a university hospital in Natal-RN. The sample consisted of 27 professionals from the nursing staff (5 nurses and 22 nursing technicians), climbing in the ICU during the period of data collection. Data collection was through a questionnaire and structured form of observation, in addition to consulting the diary. The results were organized in SPSS 15.0, tabulated, cathegorized and analyzed by descriptive and inferential statistics. The results show a young population, aged between 21 and 32 years (63.0%), female (85.2%). Among those surveyed were the main type of stock, mostly technical, nursing (ρ= 0006), which have little time to experience - up to 2 years (ρ= 0008), did not know the DRC in 153 (ρ= 0019), held greater number of pipelines care in blood (ρ= 0018), the non-participation in training and feel informed about the process of transfusion, showed no significant differences. As for officials, highlighted only the time to experience more than 2 years, carrying out fewer procedures and feel informed about the blood. As for the pipes during the transfusion process, I found that the majority of pipes observed in both the stock and the staff were inadequate, with predominance in the first, both in the pursuit of conduct regarding the shortfall. The averages of inappropriate conduct, predominantly developed by stock, were higher in all stages for appropriate conduct. Analyzing the knowledge about the disease process, the stock market were those who had lower scores of knowledge in three stages. As the relationship between the pipes care and knowledge, we see that at all stages of the process of transfusion inadequate knowledge of the averages were higher, taking a significant difference in the stages pre-transfusion (ρ= 0012). When analyzing the average of pipes behind, we see that in inappropriate conduct were significantly higher (ρ= 0031), who had searched in inadequate knowledge. As for the frequency of total procedures performed, we found a significant predominance (ρ= 0049) of inappropriate conduct (88.9%) of which 81.5% were developed by professionals who had inadequate knowledge, showing moderate correlation (r = 0,516) and odds ratio of 2,750 times the development of inappropriate conduct in trade with inadequate knowledge. We conclude that the professionals surveyed, especially the technicians of nursing stock, showed serious deficiencies with regard to the development of pipelines and knowledge of the transfusion process, showing the inadequacy to develop this therapy. Facing the foregoing, we accept the alternative hypothesis proposed in the study, because we show that the inadequacy of knowledge about the process of transfusion influence in inappropriate conduct implemented by the nursing staff in ICU.

Avaliação da dor oncológica: estudo comparativo com pacientes internados em um hospital de referência em Natal/RN

Quasi-experimental study, with prospective data, comparative with quantitative approach, performed in a reference hospital, aiming to identify the effectiveness of the Numerical Rating Scale (NRS) and McGill Pain Questionnaire, used simultaneously, to evaluate a group of patients with oncologic pain (Experimental Group); to identify the effectiveness of the Numerical Rating Scale (NRS) to evaluate a group of patients with oncologic pain (Control Group); to identify the resolution of pain according to prescribed medication, considering the result of the rating scales, and to compare it between the two groups of patients in the study. The population consisted of 100 patients, with both the experimental and control groups being composed of 50 people, with data collected from February to April 2010. The results show that in the experimental group, 32% of the patients were aged 60 to 69, 80% were female; 30% had a primary tumor in the breast, 58% had metastasis, and on 70% the disease was localized. In the first pain evaluation, 26% identified it as light; 46%, moderate; and 28%, severe; with an average of 5.50. In the second pain evaluation, 2% reported no pain; 70%, light; 26%, moderate. and 2%, severe, with an average of 3.30. On those with moderate pain, 60% used non-opioid medicine, 25% under severe pain were medicated with non-opioids and 41.67% with weak opioids. Regarding the Pain Management Index (PMI), 44.0% were rated as "-1". In the control group, 28% were aged 40 to 49, and 54% were male; 20% had primary tumor in the breast and genital-urinary system, consecutively; 56% presented metastasis; on 64% the disease was localized. In the first pain evaluation, 14% considered it light; 42%, moderate; and 44%, severe; with an average of 6.26. In the second pain evaluation, 18% did not signal pain; on 38% pain was light; 40%, moderate; and 4%, severe; with an average of 3.0. Regarding medicine therapy, 71.43% with moderate pain used non-opioids, 22.73% with severe pain used non-opioids and 27.27% weak opioids. Considering PMI, 42% were rated "-1"; and 42%, rated "0". We conclude that, despite the importance of pain as the 5th vital sign, it is still under-identified and under-treated by professionals. Nevertheless, studied oncologic patients had a tendency to report pain more easily when evaluated with the NRS instrument than with the combined use of NRS and MPQ. We believe, however, that the combination of these two instruments represents a more effective evaluation of pain, as it allows comprehension of its quantitative and qualitative aspects. We recommend, however, the replication of this study on a larger population, for a longer span of time, and consequently generating more evaluations, so this can confirm or deny the hypothesis that NRS and MPQ can, together, better evaluate pain on the oncologic patient

Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Fatores associados à efetividade da doação de órgãos e tecidos para transplantes

The transplantation of organs and tissues presents itself as an important therapeutic option, both from a medical standpoint, the social or economic. Thus, the identification of variables that can interfere in the effectiveness of organs and tissues donation for transplantation needs to be investigated adequately, because it stands before increasing index of chronic and degenerative diseases in the population, what makes the waiting list for transplantation grow disproportionately and patients come to death without the opportunity of realization the treatment due to a lack of donors. In this context, has defined as objective of this study evaluate the factors associated with the effectiveness of organs and tissues donation for transplantation. It is a evaluative research, quantitative, prospective, with longitudinal design, developed at Central of Catchment, Notification and organ donation for transplant, Organ Procurement Organization and in six accredited hospitals to collect and transplantation of organs and tissues, in Natal/RN, between august 2010 and february 2011, after the approval of the Research Ethics Committee, under No. 414/10 and CAAE 007.0.294.000-10. The probabilistic sample without replacement was composed of 65 potential donors. It was used as an instrument of data collection a structured script non-participant observation of checklist type. Data were analyzed using descriptive statistics and presented in tables, charts, graphs and figures. For this, was used Microsoft Excel 2007 and statistical program SPSS version 20.0. To check the level of significance was chosen by applying the chi-square test (χ2) and Mann Whitney and caselas for less than five, it is considered the Fisher exact test. It was adopted as the significance level p-value <0.05. Among the surveyed it was observed that most of the individuals were male (50,8%), in the age group 45 years (53,8%), mean age of 42,3 years, minimum 5 and maximum 73 years (± 17,32 years). Single / widowers / divorced (56,9%), with up to completed elementary school (60,0%) in the exercise of professional activity (86,2%), catholic (83,1%) and residents in metropolitan region of Natal (52,3%). Was obtained donation effectiveness of 27,7%. There was no statistical significance between structure and effectiveness of the donation, but were observed inadequacies in physical resources (36,9%), materials (30,8%), organizational structure (29,2%) and human resources (18,5%). In the process, the maintenance phase (p= 0.004), diagnosis of brain death (p= 0.032), family interview (p≤ 0.001) and documentation (p= 0.001) presented statistical significance with effectiveness. Thus, it is accepts the alternative hypothesis of the study, in which is evidenced that the adequacy of the factors related to structure and process is associated to effectiveness of organs and tissues donation for transplantation. In this way, the effectiveness of organ and tissue donation ends in an essential way the rapidity and accuracy with which the donation process is conducted, requiring appropriate structure, with appropriate physical and material resources and skilled human resources to optimize the reduction of time and the suffering of those waiting for an organ or tissue transplant queued in Brazil

Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Assistência de enfermagem e o risco para úlceras de pressão medido pela Escala de Braden em unidade de terapia intensiva

The problem facing the incidence of pressure ulcers (UP) in the hospital environment especially in the intensive care unit (ICU), although it is an old and frequent event in our professional practice, it is not notified in the researches as much as it should be. We observed a tendency to invest in therapeutical and in studies about the production of sophisticated new bandages. Few, however, are the investments in research on preventive measures in order to prevent or at least slow down the development of lesions. In this sense, the study aimed to analyze the correlation between nursing care and the risk of developing UP measured by the Braden scale in ICU patients. This is a descriptive study of longitudinal quantitative approach. The project obtained a favourable opinion from the Ethics Committee of HUOL (no 486/10). Data collection was carried out in the Hospital of Unimed in Natal during six months in 2011. The sample was of 32 patients hospitalized in ICU for over four days. The results were processed in SPSS 15.0 for descriptive statistics and inferential statistics. We identified that, only 9.4% of our sample developed UP, being predominantly male, elderly people aged above 60 years, Caucasian, with diagnostic hypothesis at the time of hospitalization of sepsis, were clinical patients, who presented hemodynamic instability, using orotracheal tube (TOT), enteral probe (SNE), vesical probe delay (SVD) and had values of albumin and hemoglobin levels below normal. In addition, these patients had a longer hospital stay, longer usage of TOT, SNE, SVD, increased use of sedation and drain than those who did not develop UP and were all at risk for developing these injuries second Braden scores. 66.7% of the lesions developed were located in the sacral region, limiting the degree I and all patients that developed were considered serious, 100.0% of them have evolved since the death. Small were the differences between the averages of Braden scores between patients with and without UP, 11,9+2,4 against 12,4+2,6 with p = 0.627. The clinical aspects of the patients in the study were instrumental in the development of UP, once, these findings were statistically significant through the Mann-Whitney test, and appropriateness of nursing conduct was decisive for the prevention of pressure ulcers in critical patients, since many were those classified as at risk (28) and few who have developed lesions (03)

Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study