O conforto do idoso em pós-operatório na perspectiva do enfermeiro

Objetivou-se identificar o cuidado realizado pelo enfermeiro para o conforto de pacientes idosos em pós-operatório. Especificamente objetivou-se: 1) Identificar a perspectiva dos enfermeiros sobre os desconfortos nos contextos físico, psicoespiritual, ambiental e sociocultural evidenciados em idosos no pós-operatório; 2) Verificar as características definidoras e os fatores relacionados inseridos ao diagnóstico de enfermagem conforto prejudicado, identificados pelos enfermeiros no idoso em pós-operatório; 3) Identificar as intervenções de enfermagem para promoção do conforto ao idoso em pós-operatório realizadas pelos enfermeiros no seu cuidar. Trata-se de uma pesquisa exploratória, descritiva, de abordagem quantitativa, desenvolvida em um hospital universitário do Município de Natal/RN, Brasil. A população foi constituída pelos 30 enfermeiros que trabalhavam em unidades de internação cirúrgica e terapia intensiva e que prestavam atendimento à pacientes idosos em pós-operatório. Consideraram-se critérios de inclusão: ter tempo mínimo de seis meses de atividade no setor e fazer parte da escala de serviço no período da coleta dos dados. Como critérios de exclusão: estar de licença ou férias no momento da coleta de dados. Toda população formou o grupo de sujeitos do estudo. A coleta de dados foi concretizada em maio e junho de 2014 utilizando um questionário autoexplicativo, composto por quatro partes: I - Caracterização dos enfermeiros; II - Necessidades de conforto do idoso no pós-operatório; III - Diagnóstico de Enfermagem; IV - Intervenções de enfermagem. O projeto foi aprovado pelo Comitê de Ética em Pesquisa (CEP) da Universidade Federal do Rio Grande do Norte, sob CAAE25976613.7.0000.5537. Os dados foram tabulados no Statistical Package for the Social Sciences (SPSS) 20.0 e apresentados utilizando-se frequências, percentuais e medidas de tendência central. Os resultados mostram que 96,7% dos enfermeiros conceituaram conforto como sinônimo de bem-estar. Houve maior frequência do desconforto dor (100%), ruídos excessivos (56,7%), sensação de deslocamento do ambiente residencial (76,7%) e ansiedade (93,3%). Os enfermeiros evidenciaram como sinais e sintomas que caracterizam o desconforto do idoso após cirurgia, principalmente: dor (75,9%), inquietação (58,6%), sinais vitais (41,4%) e ansiedade (34,5%). O principal fator relacionado foi o efeito secundário relacionado ao tratamento (88%). As principais intervenções realizadas foram: ouvir atentamente (100%) e controle da dor (100%). Estas foram igualmente analisadas como prioritárias para esta ação de cuidado, na porcentagem de 76,7% e 66,7%, respectivamente. Conclui-se que os enfermeiros identificam os desconfortos que afetam os idosos no pós-operatório na diversidade dos contextos estudados, com uma ênfase maior aos desconfortos físicos e em especial, a dor. Além disso, possuem uma percepção ampliada sobre os possíveis sinais e sintomas apresentados pelos idosos em pós-operatório quando estão desconfortáveis, uma vez que evidenciam outras 12 características não previstas no Diagnóstico de Enfermagem Conforto prejudicado e também identificam os fatores relacionados a estes desconfortos. Entretanto, apesar de afirmarem que realizam intervenções para amenizá-los e as registrarem, estes dados não podem ser afirmados que se trata de um padrão da prática destes profissionais, uma vez que não foi realizado a observação do cuidado prestado a esta clientela nem avaliação dos prontuários.

A Experiência como ordenação da realidade: uma estratégia orgânica para a educação científica

Knowledge is understanding. According to the philosopher Gaston Bachelard our immediate contact with the reality is only worth as confusing and provisional data. This phenomenological contact requires inventory and classification. For this reason our first reading on any phenomenon is limited to a basic levels of reality. Elements such as dynamics, functioning or detailed characteristics of what is observed can only be accessed at higher levels of reality, explains the physicist Werner Heisenberg. The ideas woven by these two great intellectuals oxygenates the notion that a well-made thinking does not require only observation and description of the nature, but assigns value and meaning to the knowledge. Based on these ideas and on the cognitive horizon brought by the complexity sciences, this research aims to nurture a reflection on our understanding of the world built from a rational perspective of experience, as an organic sequence of research. This arguments, over the study, describes how the experience is able to oxygenate a well-made thinking, as the concept created by Edgar Morin and expanded by Conceição Almeida. I argue that the experience as a path of investigative research allows one to ventures in the shadows of the unknown to access upper layers of reality. The experience is, therefore, an organic strategy for a well-made thinking - A nutritious mud that oxygenates, regulates, repairs and configures the quality of understanding. As a thread to discuss this ideas I've used my professional journey over a year and a half as a Natural Sciences' teacher on the Federal University of Rio Grande do Norte, where I could see how experiences helped on breaking a simplified understanding of the world. I chose to work with the research problems developed by 398 students over these three semesters. The problems were essential to the questioning of the phenomena that once seemed obvious or uninteresting, bringing out operational reasons and dynamics of the observed structures. Experience, in this sense, is the founder of dynamic thinking, as the need to deconstruct the phenomena's first impressions, assigning value and meaning to gestated knowledge.

Validação do conteúdo do diagnóstico de enfermagem proteção ineficaz para pacientes submetidos à hemodiálise

Methodological study, in order to validate the content of the nursing diagnosis protection ineffective in patients undergoing hemodialysis. The research took place in two stages, namely: concept analysis and content analysis of the instrument by experts. T he first step was operationalized through an integrative review of the databaes LILACS, CINAHL, PubMed, Scopus and Cochrane, with the key words protection and hemodialysis, in October and November 2013. The sample consisted of 32 articles, which were analyz ed by a c areful reading to identify the sections that correspond ed to the defining attributes , antecedents and consequences of protection in patients undergoing hemodialysis. T he interpretation for the diagnosis of effective protection was made by transpos ing the components of the diagnosis (definition, defining characteristics and related factors) to the denial form . In the second stage, we elaborated an instrument with the components of the nursing diagnostic s studied and proceeded to the analysis conduct ed in April 2014 by 22 specialists in nephrology and in the terminology of the NANDA International, selected by means of th e Lattes Platform . We used the binomial test to assess the proportion of experts who rated each item as appropriate, considering a si gnificance level of 5%. The project was approved by the Ethics Committee of the institution responsible for the research, an opinion on num b er 387 837 and CAAE 18486413.0.0000.5537. The results show that the proposal for the nursing diagnosis of ineffectiv e protection in patients undergoing hemodialysis is: definition - the same as that presented in the NANDA International Taxonomy II, location - domain safety / protection and class injury. Related factors are: Absence of routine vaccines; Non - adherence to care related to vascular access; Non - adherence to infection control measures; Non - adherence to prescribed diet; Non - adherence to drug therapy; Presence of comorbidities; Drug abuse; Immune disorders; Extremes of age; Abnormal blood profiles; Drugs that red uce immunity; and side effects and adverse treatment - related. The defining characteristics are: Presence of invading the bloodstream; Nutritional disorders; Increase in the number of hospitalizations; Uncontrolled dry weight; Infected vascular access; Vasc ular inadequate access; Increased blood pressure; fever; Bleeding disorder; Disability immunity; fatigue; weakness; itching; and maladaptive response to stress. It follows that the identification of the defining attributes, antecedents and consequences inc reased the wealth of vocabulary, allowing the construction of theoretical and empirical definitions for a broader understanding of the concept protection. Furthermore, the study contributed to the enrichment of nursing specific body of knowledge, as well a s in the direction of nursing care for patients undergoing hemodialysis.

Acolhimento na estratégia saúde da família: o que dizem os usuários?

The objective of the National Humanization Policy (NHP) is to humanize relations between professionals and users. It is guided by the proposal of expanded clinic and proposes the embracement as a strategy for its existence. The embracement requires qualified hearing, the provision of adequate technologies and the establishment of relations for better solving health problems of users. The objective of this study was to evaluate user satisfaction of the Family Health Strategy (FHS) regarding the embracement from the perspective of qualified hearing and improved relations in the city of Recife- PE. In this quantitative, qualitative, evaluative and cross-sectional study, 297 users of the services offered by the FHS were interviewed in six health districts of the city. For data collection, the Satisfaction Rating Scale of users with Mental Health Services - Satis-BR- abbreviated and adapted to the subject embracement was used. Quantitative data were analyzed by using the software Statistical Package for Social Science (SPSS) 17.0, calculating the absolute and relative frequencies. Qualitative data were analyzed by content analysis of Bardin with the elaboration of thematic categories. The results indicate that most users are satisfied with the embracement offered by the teams. About 66% reported being very or fairly heard by professionals; 80.2% reported to have obtained some or much help when searched for embracement; 64.6% indicated that the embracement is friendly or very friendly. Regarding ambience, 55.9% of users demonstrated indifference and dissatisfaction with comfort and appearance; regarding general facilities of the service, 69.4% reported as regular to awful. Three thematic categories were revealed by the speeches: satisfaction with embracement, dissatisfaction with the ambience, and suggestions for improvements in embracement and service. This study contributed to the understanding that both the hearing and relations are present in the embracement of the city and also to demonstrate that the ambience is a possible weakness in the opinion of the users.

Promoção da alimentação saudável na atenção primária à saúde: contribuição para construção coletiva do saber-fazer

The recognition of the food as determinant and health-disease process etching requires new explanations and interventions of the food and nutrition policy action and demand health care model based on the completeness of the actions and focused on health promotion. This study, characterized as research-action of interventionist character, sought to develop strategies to support the transverse insertion of healthy eating promotion in professionals practices a core of support for the health of the family and a family health strategy Unit in the city of Natal, capital of Rio Grande do Norte, from the analysis of perceptions and work processes of these teams. Several methodological strategies were adopted: Dialectical Hermeneutical Circle, direct observation, reflective and Thematic Meetings Workshop "Rethinking the educational practices for promoting healthy eating". For data logging, search diaries - SD were used and moments. The analysis of procedural form occurred in conjunction with research participants, in constant movement of reflection-action-reflection, based on hermeneutics-dialectic. About the results, in relation to the promotion of health, showed the following insights: health promotion and disease prevention-related harms; health promotion related to quality of life and well-being, in its various dimensions; health promotion as a responsibility of the State; health promotion related to the actions of health education; health promotion as an expression of efficaciousness and accessibility to health services. Regarding healthy nutrition, predominated the perceptions relating to nutritional aspects. With regard to food and nutritional education - FNE, it was observed a predominance of perception of FNE as information, guidance and knowledge transfer for changes of dietary practices. As regards the working process, it was observed that among the actions for health promotion, educational activities predominate, such as lectures, conversations, groups that mostly occur in fragmentary form, without joint planning teams, varying according to the professionals and the moment of work in which they are carried out. The results pointed to the need for reorganization of the work processes, in the context of intra-and intersectoral coordination and the construction of new technologies, such as: Health project of the territory – HPT, Unique Therapeutic Project- UPT, Expanded Clinic and educational practices, Shared with active teaching and learning methodologies. From the results we believe that it is necessary to "thought reform", from changes in vocational training and strengthening of the permanent education spaces, whereas the complexity that involves feeding, food and nutrition education and health promotion. The reformation of thought must be articulate and closely tied to the production of knowledge and practices that encourage intersectoral approach, the transversality, dialogue and democratic and supportive attitude, based on the collective construction of know-how. We hope that this study can contribute with reflections and initiatives that encourage building practices that promote healthy eating in primary health care, in terms of completeness of the care and the attainment of food security and nutrition.

Concepção de ser humano subjacente à discussão sobre saúde na psicologia: uma proposta de orientação heideggeriana

A reading method (Cervo & Bervian, 1983) was applied to select psychology publications on health. The rejection of the biomedical model is a recurring theme in these publications. Its point of view is that the model is reductionistic because it emphasizes (1) the disease (2) as a body dysfunction and by consequence health is understood as the absence of disease. The implications of the biomedical model for health are biological materialism and physiological mechanicism. Psychology publications counterpoint to biomedicine is to include attention to life contexts and consider the role of individual behavior and lifestyle in the health-disease process. Those thoughts about the nature of health imply a conception of man, especially when some articles claim that Descartes’ ideas are the ground to biomedicine development. Psychology publications reviewed highlight health characteristics related to a different view of the human mode of being. The thesis presented develops an understanding that Martin Heidegger’s Dasein Analytic is a conception of human being consistent with the selected psychology works’ view of health. It means psychology’s discussion about what is health is based on an implicit approach to the human being, one that allows the rethinking of health. The heideggerian Dasein is a vision of man in tune with the comprehension of health presented in the selected publications. It is understood that the manner a human phenomenon is conceptualized is related even implicitly to a conception of man. To take into account health’s contextual aspects like society, environment, and culture call attention to the man world relationship to which Heidegger calls being in the world. To highlight the role of behavior on one’s own health makes a point of the relationship man has with her/his own being, which Heidegger calls mineness.

Matriciamento em saúde mental: atuação de núcleos de apoio à saúde da família

In the context of break with psychiatric hospitals, the Brazilian Psychiatric Reform is a historical process of reformulation of knowledge and mental health practices. In this way, the Centers of Support for Family Health (NASF) have been acting in the supply of matrix support in mental health. So, the present research aims to analyze the actions which the NASF is taking for the matrix support in mental health in the city of Natal/RN. This is a kind of research descriptive, exploratory and qualitative. The data collection, was made by a direct observation of the professional pratices and semi-structured interviews with health professionals NASF's. The Data were analyzed according to thematic analysis technique, with the support of the content analysis method, which is a way to investigate clusters of meanings which make up the communication of the investigated object. Three analytical categories were organized by this method, whose titles were inspired in two theories in the health field called “Health to Paidéia” and “Expanded Clinic”. The name of the categories are: 1. “Mental illness in brackets: working dimensions of the Centers of Support for Family Health interfaces with the concrete subject”, which is about the work process of NASF; 2. “Freedom and engagement in the arrangement of matrix support in mental health”, which explore the matrix support limitations in mental health in Natal/RN from the professionals interviewed at the NASF’s; 3. “Between the desire and interest: influence of expert orientation in mental health in Psychosocial Care Network” (RAPS), which is related to matrix support in mental health, as an organizational arrangement responsible to ensure intersectoral and comprehensive care, strategies inside of context of the constitution of RAPS. We can extract and say that the actions of NASF teams in the brazilian city called Natal/RN, still not part of a structured link with health care networks, as happens with the absence of discussions and lack of professionals in the matrix support. In addition, there is a difficulty to do an specialized orientation in mental health because of the lack of human resources in this area and of the insufficient number of the replacement services for psychiatric hospital pratices, bringing up the discussion about the consolidation and expansion of RAPS in fact investigated.

Degradação de paracetamol empregando tecnologia oxidativa avançada baseada em fotocatálise heterogênea usando irradiação artificial e solar

In this work, the oxidation and mineralization of paracetamol, based in an advanced oxidative process promoted by heterogeneous photocatalysis, was evaluated. The action of two photocatalysts (titanium dioxide, and a composite based on the association between titanium dioxide and zinc phthalocyanine dye) was studied. First of all, experiments in laboratory scale were performed using as radiation font a 400 W high pressure mercury lamp. The mineralization of paracetamol, promoted by both photocatalysts, was evaluated working with 4L of solution containing 10 mg L-1 of paracetamol and 100 mg L-1 of photocatalyst. To find the best experimental conditions, the influence of hydrogen peroxide concentration and pH was evaluated for the reactions. The best results for the reactions in laboratory scale was obtained using 33,00 mg L-1 of hydrogen peroxide in natural pH (6,80). Under these conditions, 100% oxidation was reached in just 40 minutes of reaction using TiO2 P25, while the mineralization was 78%. Using the composite, the mineralization was 63% in 2 hours of reaction and a oxidation of almost 100% was reached after 60 minutes. A CPC reactor (compound parabolic concentrator) was employed in the expanded work scale, using the sun as irradiation source. In this case the experiments were performed using 50 L of aqueous solution containing 10 mg L-1 of paracetamol and 100 mg L-1 of photocatalyst. The assays were done at pH 3,00 and natural pH (6,80). The used concentration of hydrogen peroxide was 33,00 mg L-1, adopted after laboratory scale studies. The reaction at pH 3,00 shows to be more advantageous, since under natural pH (6,80), the use of deionized water was necessary to prepare the solutions, probably because the deleterious action of carbonate ions, known hydroxyl radical scavengers. Using solar irradiation, the reaction mediated by the composite was more efficient when compared with the assays under laboratory scale since the composite presents the advantage of promoting a better use of visible radiation. Under these conditions, the mineralization increased from 40% to 56% under pH 3,00. At natural pH the oxidation occurred more slowly and the mineralization decreased from 56% to 50%. Thus, the use of pH 3,00 will be more interesting in real scale applications, even if it is necessary the pH correction before the discard of the treated effluent to the environment.

La Unión Europea y el regionalismo latinoamericano: un balance

El apoyo a la integración y el regionalismo es uno de los rasgos distintivos del diálogo político y cooperación entre la UE y América Latina y el Caribe. Este artículo examina la racionalidad, objetivos e instrumentos de apoyo de la UE al regionalismo y la integración latinoamericana y, en particular, los incentivos generados por los Acuerdos de Asociación y el papel de la cooperación regional y subregional. Aunque han sido instrumentos efectivos, la falta de cohesión interna de los grupos regionales de América Latina y los problemas de coherencia de políticas de la UE han limitado su impacto y efectividad. A partir de las enseñanzas extraidas de esa experiencia, se propone una estrategia ampliada de apoyo para el nuevo ciclo de programación de la cooperación de la UE del periodo 2014-2020.

Esgotamento do padrão de acumulação de capital e política econômica brasileira: do II PND aos anos 2000

This work aim to show that the reach to the limits of capital accumulation, which is showing its first signs since the 60 s, has and still is exercising great importance in Brazilian economic policies. In the first chapter, we establish a reference to what is understood as the limit of capital accumulation after World War II and how the accumulation process drives itself to its own limits. In the following chapters, we detach the importance of the reached limit to the most relevant moments of Brazilian economic policy. Since the IIPND, when the first signs of influence raise in Brazilian economy, passing through the stabilizing attempts during the 80 s and 90 s and the emergence of the pro-market State in Brazil, until the 00 s, when macroeconomic prudence took shape and delimited the conduction of the country s economic policy, we will show how the limit of capital accumulation has played an important role.

Diversity and television in Argentina: the case of the Audiovisual Technology Hub Programme

This paper describes and analyses the Audiovisual Technology Hub Programme (Programa Polos Audiovisuales Tecnológicos - PPAT), which has been implemented in Argentina between 2010 and 2015 as part of the public policy of former administration of Cristina Fernández de Kirchner. The main goal was to promote a television industry that reflects the cultural diversity of Argentina by dividing the national territory in nine into nine audiovisual technology hubs, where national public universities acted as centres that gathered a range of regional stakeholders. Considering the 18 TV seasons that were produced for television between 2013 and 2014, the text analyses the diversity of sources and genres / subgenres and its restricted marketing. The article closes with a brief set of conclusions about this initiative.

La música en el desarrollo de la espiritualidad y la religiosidad. Una aproximación al Cristianismo y al Budismo

La música puede afectar al individuo en todos sus niveles –físico, mental y espiritual–. El presente artículo se centra en el papel que ésta desempeña en el desarrollo de la vida espiritual y trascendental. Para ello, realizaremos un repaso histórico de su evolución estética y social, abordaremos dicho fenómeno a nivel fisiológico y presentaremos sus aplicaciones clínicas y sociales. Seguidamente y a modo de ejemplo de las concepciones de pensamiento occidental y oriental, trataremos la forma en que el cristianismo y el budismo conciben la música dentro de su doctrina. Finalizaremos con algunas reflexiones sobre el tema.

« "Le gênant", c‟est qu‟Olivier ne sera pas seul ». Le problème de l‟adjectif substantivé thématisé en français

Nous étudions dans cet article les tournures du type « Le gênant, c’est qu’Olivier ne sera pas seul », lesquelles sont fréquemment décrites, d’un point de vue formel, comme des structures de type article/adjectif substantivé. Après avoir analysé les propriétés morphosyntaxiques de notre tournure, nous montrons qu’en réalité on ne saurait parler d’adjectif substantivé par un article, dans la mesure où ni l’adjectif ne devient un substantif, ni l’article ne fonctionne comme un véritable article. Ce dernier, en effet, peut être défini comme un « article-démonstratif neutre ». Nous sommes dans cette perspective amené à repenser le schéma de l’article de la psychomécanique du langage, et à proposer du tenseur binaire guillaumien une vision élargie que l’on peut représenter par un schème trimorphe.

La Seguridad Energética y la Estrategia Global de Seguridad de la Unión Europea

El presente artículo plantea una definición ampliada del concepto de seguridad energética, yendo más allá del concepto clásico establecido por la Agencia Internacional de la Energía, incorporando cuestiones relativas a la eficiencia energética, la aceptabilidad del modelo energético y los retos que impone el cambio climático, pero sin perder de perspectiva las exigencias y las dinámicas competitivas económicas globales. Sobre la base de este concepto ampliado, se examina la evolución de la seguridad energética en el marco de la Unión Europea, con una atención particular a cómo se concibe la seguridad energética en la Estrategia Global de Seguridad de 2016.