Terapia ocupacional e a educa����o para a interprofissionalidade em resid��ncias multiprofissionais em sa��de

A forma����o em servi��o realizada pelo programa de Resid��ncia Multiprofissional em Sa��de (RMS) �� uma estrat��gia educativa que visa a mudan��a do perfil dos profissionais da sa��de para atua����o no Sistema ��nico de Sa��de (SUS). Dentre as profiss��es que comp��em as resid��ncias, a terapia ocupacional foi eleita como foco deste estudo com o objetivo de conhecer e refletir sobre os desafios e tend��ncias do processo de educa����o profissional e interprofissional na perspectiva de tutores, preceptores e residentes terapeutas ocupacionais. A metodologia eleita foi a abordagem qualitativa com realiza����o de entrevistas e an��lise de conte��do para a elabora����o dos resultados e discuss��o. Foram realizadas 17 entrevistas em tr��s programas de RMS de diferentes munic��pios do estado de S��o Paulo com cen��rios educativos realizados na aten����o hospitalar e na aten����o b��sica. Duas categorias emp��ricas foram identificadas nos resultados: (i) \"Resid��ncia multiprofissional de sa��de como dispositivo de mudan��a\" dividida em duas subcategorias: \"Trabalho em equipe\" e \"Trabalho na perspectiva do SUS\" e (ii) \"Singularidades na forma����o do terapeuta ocupacional em RMS\" agrupada nas subcategorias: \"Particularidades da inser����o profissional do terapeuta ocupacional nos cen��rios educativos\", \"Produ����o de identidades e a fragmenta����o da atua����o do terapeuta ocupacional nas RMS\" e \"Terapia ocupacional e as pr��ticas colaborativas e interprofissionais no SUS\". A pesquisa permitiu conhecer o potencial de mudan��as dos programas de RMS em rela����o �� forma����o dos residentes e �� dissemina����o de pr��ticas em sa��de, colaborativas em equipe e sob a perspectiva do SUS. Os resultados apontaram a singularidade do processo formativo de terapeutas ocupacionais nas RMS que sofrem impactos pela insuficiente contrata����o de profissionais nos servi��os, pelo desconhecimento do papel profissional do terapeuta ocupacional e pela fragmenta����o da atua����o profissional nos cen��rios de pr��tica; experi��ncias que geram inseguran��a de residentes e profissionais quanto aos limites da atua����o profissional e interprofissional no trabalho em equipe. O foco da terapia ocupacional nas atividades e cotidianos das pessoas no processo do cuidado em sa��de e a media����o do cuidado de pessoas com defici��ncia e transtornos mentais foram identificados como contribui����es da terapia ocupacional para as pr��ticas colaborativas e interprofissionais no SUS. Conclui-se que o potencial de mudan��as dos programas para a atua����o dos residentes como futuros profissionais est�� diretamente relacionado com as estrat��gias pedag��gicas desenvolvidas nos cen��rios educativos. A forma����o de terapeutas ocupacionais nas RMS depende das caracter��sticas dos cen��rios educativos, no que se refere a sua organiza����o e intera����o interprofissional pr��-existente, �� sufici��ncia do n��mero de preceptores, �� consolida����o de fluxos assistenciais e ao (re)conhecimento da Terapia Ocupacional pelos demais profissionais dos servi��os. Por fim, os participantes afirmaram a import��ncia da RMS para a aprendizagem de saberes e pr��ticas - pr��prios da profiss��o, comuns aos profissionais de sa��de e constru��dos em equipe de forma colaborativa - com o prop��sito da qualifica����o do cuidado em sa��de

Madres y enfermeras: el modelo de cuidados a la infancia en la colecci��n ��Al servicio de Espa��a y del ni��o espa��ol�� (1938-1964)

Objetivos: El estudio se plantea profundizar en el an��lisis del discurso del r��gimen franquista que se dirigi�� a la poblaci��n femenina, especialmente a las madres y a las enfermeras, en relaci��n con los cuidados a la infancia. M��todos: Se analiz�� la colecci��n ��Al Servicio de Espa��a y del Ni��o Espa��ol�� (1938-1964), publicada por el Ministerio de Gobernaci��n, mediante un an��lisis del contenido de las monograf��as que se ocupaban del los cuidados a la infancia. Discusi��n y conclusiones: El r��gimen franquista conden�� el trabajo fuera del hogar de las mujeres y promovi�� una pol��tica pronatalista. Las mujeres fueron consideradas ignorantes y por tanto culpables de la elevada mortalidad infantil. Su acci��n se orient�� a capacitar a todas las mujeres (que alg��n d��a llegar��an a ser madres) en el cuidado de los ni��os. Fue obligatoria la ense��anza de la puericultura a las ni��as en todos los niveles. Se fomento la lactancia materna con un discurso culpabilizador (la mujer que no lacta es una semimadre). Con todo, a pesar de todas estas iniciativas pronatalistas, la realidad social se impuso y la natalidad disminuy��, y tambi��n lo hizo la mortalidad infantil debido a la mejora de las condiciones de vida, al mismo tiempo que se produjo un fuerte aumento del uso del biber��n y del trabajo femenino fuera del hogar.

Simultaneous implementation of the Bachelor, Masters and PhD degrees in nursing in the Universidad Jaume I. Castell��n de la Plana, Spain

We present an experience in Nursing Education, accredited and implemented under the Spanish University System Reform in a Public University (Jaume I, Castell��n) which had no previous nursing studies. The academics offered included all three educational levels (Bachelor, Master's and Doctorate), with an integrated theoretical-practical-clinical teaching methodology for the Bachelor Degree, competence acquisition in research in the Master's degree, and a doctorate formed by lines of research in the field of Nursing. Studies are accredited by the National Agency for Quality Assessment, which were authorized by the Spanish Ministry of Education and implanted between 2009 and 2011.

Poder y exclusiones formativas en Ciencias de la Salud. Propuestas de mejora en la atenci��n al paciente desde la complementariedad

Introducci��n: La importancia de los procesos de salud-enfermedad-atenci��n es un hecho universal ejecutado a trav��s de diferentes modelos. Occidente propone el modelo Biom��dico, cuyos logros se ven limitados por la exclusi��n que realiza a las variables socio-culturales del enfermar. Objetivo: Una reflexi��n sobre las posibilidades de mejora que permitan una asistencia cercana al holismo, determinante no s��lo de una mayor profesionalidad sino tambi��n de la conformaci��n de una aut��ntica identidad enfermera, constituye el objetivo esencial. Metodolog��a: Para intentar dar una respuesta s��lida nos aventuraremos a la lectura de dos autores cl��sicos de la talla de Foucault y Gramsci, largamente referenciados en el ��mbito de la Antropolog��a m��dica, permiti��ndonos sugerir una l��nea en la b��squeda de motivos y soluciones sobre la problem��tica que nos envuelve. Desarrollo: Una v��a razonable se vislumbra en el aporte que las formas de atenci��n complementarias posibilitan. En este sentido, la Enfermer��a actual debe buscar una vuelta a su ethos del cuidado, alej��ndose as�� de los preceptos deterministas que la han condenado a la subalternidad. Conclusiones: Un cambio en los patrones formativos se constituye como eje b��sico que determine una mejora real en los procesos de atenci��n y permitan el derecho b��sico de una atenci��n de calidad.

Notebook of Moses Appleton, 1794-1837 (inclusive)

Contains notes taken by Moses Appleton (1773-1849) on anatomy lectures delivered at Harvard by John Warren (1753-1815). Other lecture topics included midwifery and surgery. Also includes a transcript of an examination given by Warren to his students on anatomy and surgery, as well as exams given by Harvard Professor Benjamin Waterhouse (1754-1846) and Harvard Professor Aaron Dexter (1750-1829) on the theory and practice of physic, and chemistry, respectively. There are additionally patient case notes and transcriptions of notes and correspondence from physicians Appleton consulted, and a list of operations Appleton performed between 1796 and 1828, primarily repairing dislocated joints and fractured bones. Also includes obituaries of citizens of Waterville, Maine, from 1807 to 1837.

Disfagia no doente com AVC : preval��ncia e determinantes

Introdu����o: O acidente vascular cerebral (AVC) assume em Portugal elevadas taxas de morbilidade e reinternamento hospitalar. A disfagia surge como uma complica����o frequente deste evento neurol��gico, com ��ndices de morbilidade elevados pelo risco de desnutri����o, desidrata����o e aspira����o broncopulmonar. O diagn��stico e a sua monitoriza����o no processo de reabilita����o do doente s��o a����es fundamentais na preven����o de aspira����es alimentares, redu����o do internamento hospitalar e na efic��cia da reabilita����o do doente. Objetivo: Identificar e avaliar o grau de disfagia na pessoa com AVC e analisar a rela����o entre esta, e as vari��veis socio-demogr��ficas e cl��nicas no sentido de poder melhorar futuramente os cuidados de enfermagem de reabilita����o. M��todos: Trata-se de um estudo n��o experimental, transversal, descritivo-correlacional de car��ter quantitativo, que foi realizado numa amostra n��o probabil��stica por conveni��ncia, constitu��da por 25 doentes com diagn��stico de AVC, internados na Rede Nacional Cuidados Continuados Integrados (RNCCI), em unidades de Convalescen��a e Reabilita����o. O instrumento de colheita de dados integra uma se����o de caracteriza����o s��cio-demogr��fica e cl��nica e duas escalas: Escala Gugging Swallowing Screen (GUSS) e ��ndice de Barthel, a fim de avaliar a disfagia e a funcionalidade, respetivamente. Resultados: A amostra apresenta uma m��dia de idade de 76,8 anos, sendo 68% do sexo feminino e 32% do sexo masculino. Verific��mos que 68% dos participantes apresenta mais de dois antecedentes cl��nicos e apenas 24% dos participantes n��o apresenta disfagia. Dos restantes, 12% apresenta disfagia grave, 36% moderada e 28% disfagia ligeira. A ��rea de les��o parece influenciar a degluti����o, demonstrando a Art��ria Cerebral M��dia (ACM) e Art��ria Cerebral Posterior (ACP) como ��reas de maior sensibilidade. Denotou-se que quanto maior o grau de depend��ncia, maior gravidade de disfagia. Conclus��o: Doentes com AVC isqu��mico apresentam disfagia, com gravidade relacionada com a ��rea vascular. A exist��ncia de v��rios antecedentes cl��nicos pode gerar perturba����es na degluti����o do doente. De igual modo, quanto maior for a depend��ncia funcional do doente, maior �� o grau de disfagia e o risco de aspira����o pulmonar. Palavras-chave: AVC; Disfagia; Reabilita����o.

Exploring Interprofessional Education: Through the values of the students and the eyes of exemplary faculty

Thesis (Ph.D.)--University of Washington, 2016-06

After hours medical ward duties in a teaching hospital

In many Australian hospitals a medical officer is available for urgent review of in-patients outside normal working hours. Current practice in nurse-initiated requests for medical officer involvement out of hours may adversely affect patient outcome as well as medical and nursing resource use at these times. Of 10 523 nurse-initiated requests for out-of-hours review recorded by medical officers at our hospital in 2002-2003, the most frequent reasons for the requests were medication review, IV fluid orders, IV resite, venesection and pathology review, none of which are related to acute changes in clinical condition. Requests for routine review of medication and fluid orders were found to be rarely essential and often inappropriate. Medical officer activity was highest before midnight and least after midnight, suggesting most requests are fulfilled in the evening. Several strategies to reduce inappropriate out-of-hours requests were identified. Routine tasks could be completed by primary treating unit staff before going off-duty. IV cannulation and venesection may be performed by appropriately trained phlebotomists or skilled advanced practice nursing staff. Meticulous ordering of 'as required' analgesia and night sedation would reduce unnecessary requests. Clinical protocols for nurse-initiated adjustment of drugs with variable dosing may also decrease inefficiencies. This would leave the ward cover medical officers more available for their primary function of urgent patient review.

The information specialist in the clinical team: Building expertise in evidence-based healthcare

The Clinician Development Program (CDP) is an initiative of Queensland Health���s Quality Improvement and Enhancement Program. At the Royal Brisbane & Royal Women's Hospital Health Service Districts, evidence-base practice (EBP) is an important CDP area in which several projects were carried out in 2002. This paper describes one such project. A medical librarian was invited to accompany the clinical team on morning rounds in the Medical Assessment & Planning Unit (MAPU). The librarian conducted information skills training in the ward and helped clinicians to answer questions directly related to patient care. Questions not answered during the round were followed-up, usually within 48 hours, and responses emailed to the consultant who led the rounds. At the project���s conclusion the librarian was invited to continue as a member of the MAPU clinical team, thus acknowledging the valuable role an information specialist can play in incorporating research evidence into patient care. Clinical librarianship (CL) creates a space, albeit a contentious one, for the health librarian at the bedside. This paper describes an Australian CL project and attempts to demystify the role of an information specialist in EBP. It also highlights some of the challenges facing librarians and clinicians attempting to embed EBP in clinical settings.

Reducing patient mortality in hospitals:the role of human resource management

Developing effective health care organizations is increasingly complex as a result of demographic changes, globalization, and developments in medicine. This study examines the potential contribution of organizational behavior theory and research by investigating the relationship between systems of human resource management (HRM) practices and effectiveness of patient care in hospitals. Relatively little research has been conducted to explore these issues in health care settings. In a sample of 52 hospitals in England, we examine the relationship between the HRM system and health care outcome. Specifically, we study the association between high performance HRM policies and practices and standardized patient mortality rates. The research reveals that, after controlling for prior mortality and other potentially confounding factors such as the ratio of doctors to patients, greater use of a complementary set of HRM practices has a statistically and practically significant relationship with patient mortality. The findings suggest that managers and policy makers should focus sharply on improving the functioning of relevant HR management systems in health care organizations as one important means by which to improve patient care. Copyright �� 2006 John Wiley & Sons, Ltd.

The experiences and perceptions of fathers attending the birth and immediate care of their baby

Fathers in the United Kingdom (UK) usually attend the birth and immediate care of their baby. They also have an increasing presence during complicated and preterm childbirth, newborn resuscitation and early neonatal unit(NNU) care. However, there is limited evidence about the effect of these experiences on them. The aim of this study was to gain an understanding of the experiences of fathers encountering these situations. The study consisted of three phases and was undertaken in one National Health Service trust in the UK. Qualitative semi-structured interviews using a phenomenological approach were undertaken with 20 first-time fathers present at the delivery, resuscitation and/or admission of their baby to the NNU. Direct observations were made of 22 normal and complicated deliveries and initial newborn care and qualitative semi-structured interviews using the critical incident approach were undertaken with 37 health care professionals (HCPs). The study generated qualitative and quantitative data that were analysed accordingly. The findings show that most fathers were involved for at least some of the time and often spontaneously initiated their involvement. Their most important need was for information. They were usually more concerned about their partner, irrespective of the baby?s need for resuscitation and NNU care. To facilitate their involvement, fathers needed guidance and support from HCPs, particularly delivery suite midwives. Most HCPs recognised the needs of fathers and ways in which they could be helped to connect with their experience. However, these needs were not always met, usually because of inadequate staffing levels, a lack of resources or a mother-centred philosophy of care. The findings suggest the service often determines the extent to which fathers are involved. It is anticipated that these findings will inform HCP education and training and the development of both policy and health education thereby enhancing the quality of care provision for fathers.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ���death rattle���, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ���noisy breathing��� for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.