804 resultados para Education. Nursing. Associate. Nurses Aides. Patient care planning. Nursing process
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Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.
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Background: Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child's disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children's nurses trained in the intervention method. Methods/Design: This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents' preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses. Discussion: Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children's nurses, which will facilitate implementation if the intervention proves to be effective. Trial registration: Clinical trials NCT02332226 (December 11, 2014).
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Dagens samhlle blir allt mer mngkulturellt. Det stller hgre krav p bde omvrdnaden och sjukskterskan. Sjukskterskans eventuella brist p kompetens om kulturskillnader kan skapa kulturkrockar, missfrstnd och felaktig omvrdnad. Syftet med studien var att underska vilka frvntningar ldre invandrare frn frre detta Jugoslavien har i mten med sjukskterskan i Sverige samt hur sjukskterskans kompetens kan skiljas frn underskterskor, sjukgymnaster och arbetsterapeuter. Metod: Studien r kvalitativ med en induktiv ansats och baseras p sex intervjuer med ldre invandrare som ursprungligen kom frn fd. Jugoslavien. Personlig kontakt togs med informanterna om deltagande i underskningen genom serbiska/bosniska/kroatiska/makedoniska. Frfattaren informerade om studien och att de som ville delta kontaktade frfattaren. Insamlat material analyserades systematiskt med innehllsanalys. Resultat: Det som framkom att de ldre invandrarna frvntade sig i mtet med sjukskterskan presenteras i fljande fem kategorier; Att f bekrftelse fr uttalade behov; Empatisk kontakt; Kommunikation och dialog i mtet; Respekt fr sina vrderingar och syn p hlsa och Trygghet. Slutsatsen: omvrdnad av ldre patienter med en annan kulturell bakgrund krver bda kulturell kompetens och professionellt frhllningsstt. Sjukskterskan behver kunna identifiera patientens vrdbehov och i detta fallet ven verg de sprkliga barrirer och n patienten och frst deras behov.
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To promote community care coordination and advanced care planning. Seamless communication and execution of individual patient care choices across the healthcare continuum.
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La actividad fsica regular desempea un papel fundamental en la prevencin y control de los desrdenes musculo esquelticos, dentro de la actividad laboral del profesor de educacin fsica. Objetivo: El propsito del estudio fue determinar la relacin entre los niveles de actividad fsica y la prevalencia de los desrdenes musculo esquelticos, en profesores de educacin fsica de 42 instituciones educativas oficiales de Bogot-Colombia. Mtodos. Se trata de un estudio de corte transversal en 262 profesores de educacin fsica, de 42 instituciones educativas oficiales de Bogot - Colombia. Se aplic de manera auto-diligenciada el Cuestionario Nrdico de desrdenes msculos esquelticos y el Cuestionario IPAQ versin corta para identificar los niveles de actividad fsica. Se obtuvieron medidas de tendencia central y de dispersin para variables cuantitativas y frecuencias relativas para variables cualitativas. Se calcul la prevalencia de vida y el porcentaje de reubicacin laboral en los docentes que haban padecido diferentes tipo de dolor. Para estimar la relacin entre el dolor y las variables sociodemogrficas de los docentes, se utiliz un modelo de regresin logstica binaria simple. Los anlisis fueron realizados en SPSS versin 20 y se consider como significativo un valor p < 0.05 para el contraste de hiptesis y un nivel de confianza para la estimacin de parmetros. Resultados: El porcentaje de respuesta fue del 83.9%, se consideraron vlidos 262 registros, 22.5% eran de gnero femenino, la mayor cantidad de docentes de educacin fsica se encuentraon entre 25 y 35 aos (43,9%), frente a los desrdenes musculo esquelticos, el 16.9% de los profesores reporto haberlos sufrido alguna vez molestias en el cuello, el 17,2% en el hombro, 27,9% espalda, 7.93% brazo y en mano el 8.4%. Los profesores con mayores niveles de actividad fsica, reportaron una prevalencia menor de alteraciones musculo esquelticas de 16,9 % para cuello; 27.7% para dorsal/lumbar frente a los sujetos con niveles bajos de actividad fsica. La presencia de los desrdenes se asoci a los aos de experiencia (OR 3.39 IC95% 1.41-7.65), a pertenecer al gnero femenino (OR 4.94 IC95% 1.94-12.59), a la edad (OR 5.06 IC95% 1.25-20.59), y al atender ms de 400 estudiantes a cargo dentro de la jornada laboral (OR 4.50 IC95% 1.74-11.62). Conclusiones: En los profesores de Educacin Fsica no s encontr una relacin estadsticamente significativa entre los niveles de actividad fsica y los desrdenes musculo esquelticos medidos por auto reporte.
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El Sndrome de Agotamiento Profesional (SAP), es comn en los trabajadores de la salud, particularmente en los expuestos a altos niveles de estrs en el trabajo e incluye el agotamiento emocional, despersonalizacin y baja realizacin personal. Se considera que los mdicos residentes presentan una mayor prevalencia del sndrome que los mdicos debido a que se encuentran en entrenamiento, perodo en el cual estn sometidos a alta carga laboral debido a las largas horas de trabajo, horarios irregulares, privacin de sueo, intensas demandas emocionales, as como la presin de dominar un gran conocimiento clnico. Objetivo. Determinar la prevalencia del Sndrome de Agotamiento Profesional o Burnout en la poblacin de mdicos residentes. Metodologa. Se realiz una bsqueda de artculos en la base de datos electrnica Pubmed, seleccionando aquellos publicados entre los aos 2001 al 2016, tanto en idioma ingls como en espaol, a texto completo y enfocados en estudios en mdicos residentes. Resultados. Los hallazgos sugieren que el Sndrome de Agotamiento Profesional o Burnout es altamente prevalente, que vara de acuerdo a la residencia que se est realizando, encontrando un promedio del 50% con un rango de 27% a 75% entre las diferentes especialidades de la poblacin estudiada y, en consecuencia, puede constituir un problema de salud que amerita atencin en cada Institucin, esto a pesar de que la prevalencia pueda variar de un lugar a otro y en las diferentes especialidades. Conclusiones. El SAP o Burnout constituye un problema de salud entre la poblacin de mdicos residentes, lo que sugiere la conveniencia de disear medidas para su prevencin como informar en la induccin al programa de residencia sobre el riesgo de la aparicin del sndrome y sus sntomas, consultar tempranamente ante signos de alarma, adecuar el sistema de vigilancia epidemiolgica para que incluya esta condicin especfica y ajustar o disminuir la carga laboral entre otras.
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La automedicacin no responsable se ha convertido en un problema de salud pblica global en las ltimas dcadas, por sus consecuencias individuales (por ejemplo, la intoxicacin) y colectivas (por ejemplo, la resistencia microbiana a los antibiticos). Las intervenciones orientadas a este comportamiento han sido aisladas y muy diferentes. Aunque se tiene evidencia de que su aplicacin puede traer beneficios en diferentes poblaciones, no se hall en la literatura una compilacin sistemtica de dichas intervenciones. El objetivo de la presente revisin es sistematizar la literatura cientfica sobre las diferentes alternativas de intervencin del comportamiento individual de automedicacin no responsable. En cuanto al mtodo, la revisin de literatura involucr la bsqueda sistemtica de automedicacin e intervencin en las bases de datos acadmicas internacionales con contenidos de psicologa, suscritas por la Biblioteca de la Universidad del Rosario. Como resultado se encontr que las intervenciones orientadas al comportamiento de automedicacin no responsable se pueden clasificar en dos grandes grupos: (a) intervenciones regulatorias, con direccin arriba hacia abajo, que suponen una accin de los Estados nacionales por medio de sus legislaciones o de entidades internacionales (por ejemplo, Organizacin Mundial de la Salud); y (b) intervenciones educativas, con direccin abajo hacia arriba, que suponen acciones con individuos y comunidades con el fin de ensear acerca del uso adecuado de los medicamentos. Se concluye acerca de la necesidad de complementar ambos tipos de intervencin, los cuales, si bien demuestran resultados positivos, aisladamente son insuficientes para contrarrestar integralmente este fenmeno creciente y complejo.
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The rate of diagnosis and treatment of degenerative spine disorders is increasing, increasing the need for surgical intervention. Posterior spine fusion is one surgical intervention used to treat various spine degeneration pathologies To minimize the risk of complications and provide patients with positive outcomes, preoperative planning and postsurgical assessment are necessary. This PhD aimed to investigate techniques for the surgical planning and assessment of spine surgeries. Three main techniques were assessed: stereophotogrammetric motion analysis, 3D printing of complex spine deformities and finite element analysis of the thoracolumbar spine. Upon reviewing the literature on currently available spine kinematics protocol, a comprehensive motion analysis protocol to measure the multi-segmental spine motion was developed. Using this protocol, the patterns of spine motion in patients before and after posterior spine fixation was mapped. The second part investigated the use of virtual and 3D printed spine models for the surgical planning of complex spine deformity correction. Compared to usual radiographic images, the printed model allowed optimal surgical intervention, reduced surgical time and provided better surgeon-patient communication. The third part assessed the use of polyetheretherketone rods auxiliary to titanium rods to reduce the stiffness of posterior spine fusion constructs. Using a finite element model of the thoracolumbar spine, the rods system showed a decrease in the overall stress of the uppermost instrumented vertebra when compared to regular fixation approaches. Finally, a retrospective biomechanical assessment of a lumbopelvic reconstruction technique was investigated to assess the patients' gait following the surgery, the implant deformation over the years and the extent of bony fusion between spine and implant. In conclusion, this thesis highlighted the need to provide surgeons with new planning and assessment techniques to better understand postsurgical complications. The methodologies investigated in this project can be used in the future to establish a patient-specific planning protocol.
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O artigo explora a possibilidade de integrao no processo de aprendizagem rede de servios de sade do subsistema de sade indgena integrante do Sistema nico de Sade e colabora com o processo de formao profissional na rea da sade. Enfatiza tambm que a concepo pedaggica e as metodologias de ensino-aprendizagem so temas importantes para o desenvolvimento das competncias dos novos profissionais da sade. Com isto, o objetivo deste artigo apresentar, atravs da anlise descritiva, o contexto em que se desenvolve o processo preparatrio para o estgio optativo "Projeto Huka-Katu - a FORP-USP no Xingu", ressaltando os aspectos cognitivos presentes na proposio de aes voltadas para a ateno primria. Considera-se ainda que as competncias requeridas para o trabalho do cirurgio-dentista na ateno bsica sade se constituem em um suporte (base) para a construo do SUS, sendo que estas competncias devem atender as necessidades de articulao da prtica e da educao, em uma perspectiva do cuidado sade.
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INTRODUO: A tuberculose na Repblica da Guin-Bissau no apresenta bons indicadores de sade, assim como na maioria dos pases em vias de desenvolvimento. OBJETIVO: Estudar na Repblica da Guin-Bissau e nas suas Provncias, a situao epidemiolgica da doena no perodo de 2000 a 2005. MTODO: Realizou-se levantamento de dados secundrios junto ao Programa Nacional de Luta Contra Lepra e Tuberculose, no perodo de 2000 a 2005, e anlise de relatrios anuais da Capital e das Provncias da Guin-Bissau, para o clculo de coeficientes e taxas dos indicadores. RESULTADOS: O nmero de casos de tuberculose manteve-se estvel no perodo de 2000 (1.959 casos) a 2005 (1.888 casos). O percentual de casos pulmonares variou de 96,0 a 98,8%, dos quais 55% eram bacilferos. Em 2005 o coeficiente de prevalncia foi de 142,4/100.000, o de incidncia 131,3/100.000 e o de mortalidade, 16,8/100.000 habitantes. A maior concentrao de casos ocorreu na regio da Capital. A taxa de cura variou entre 46,5% em 2000 e 69,6% em 2005, e a de abandono de tratamento de 29,8% em 2000 para 12,1% em 2005. CONCLUSO: Os indicadores do Plano Estratgico Nacional devem ser melhorados, sobretudo no que diz respeito busca ativa de casos, descentralizao do atendimento aos doentes, implantao da estratgia DOTS e necessidade de um sistema de informao e notificao eficientes.
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O PROFAE (Projeto de Profissionalizao dos Trabalhadores da rea de Enfermagem) foi uma iniciativa importante na educao profissional. Os objetivos do estudo foram descrever o perfil dos egressos do curso de tcnico de enfermagem dos centros de formao da Secretaria de Estado da Sade de So Paulo e conhecer os reflexos do curso para a atuao na profisso e a mobilidade no mercado de trabalho. A coleta de dados foi realizada por meio de questionrio respondido por 216 egressos e por quatro grupos focais com egressos e enfermeiros supervisores. Os respondentes foram, em sua maioria, mulheres com mdia de 42,2 anos. O curso foi bem avaliado, destacando-se o apoio institucional e as resolues do Conselho Regional de Enfermagem (COREN) como impulsionadores da procura por ele. Os egressos percebem ter maior iniciativa e preparo terico aps o curso. Na rea, a funo mais exercida atualmente ainda a de auxiliar de enfermagem, o que gera insatisfao, pois, especialmente nos servios pblicos, no existem cargos de tcnicos.
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HIV-infected patients are at risk for vaccine-preventable infections. The Brazilian National Immunization Program provided recommendations for this population. However, the vaccine coverage reached by this program is unknown. This study aimed at evaluating the vaccine coverage of HIV-infected adults followed at Hospital das Clinicas, University of Sao Paulo School of Medicine. Data were collected on age, gender, mode of HIV transmission, Centers for Disease Classification 1993 classification (CDC/93), antiretrovirals, CD4 count, HIV viral load, and immunization charts, from April 2003 to August 2004. We interviewed 144 randomly selected patients, 74% male; mean age, 39.95 years; CDC classification: A, 40.6%; B, 19.6%; and C, 39.9%. Most of patients were undergoing highly active antiretroviral therapy (HAART; 86.8%). Mean CD4 count 442.6 cells/mm(3). Viral load less than 400 copies per milliliter in 59.4% of patients. Only 36.1% of patients were adequately immunized for diphtheria/tetanus, 54.9% for pneumococcus, 24.3% for flu, and 76.9% for hepatitis B. In relation to live attenuated vaccines, 5 patients received measles, mumps, and rubella vaccine and 7 patients yellow fever vaccine. Two patients were vaccinated against yellow fever despite CD4 less than 200 cell/mm(3). We verified poor vaccine coverage in HIV-infected patients. Vaccination campaigns and incorporation of vaccine rooms in sexually transmitted disease (STD)/AIDS clinics could improve this situation.
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The aim of this study was to examine the incidence and factors associated with the severity of liver fibrosis in 234 coinfected patients in Brazil. Patients were cared for in our clinic, from 1996 to 2004. Eligible patients were defined as patients with documented HIV and hepatitis C virus (HCV) infections and had previously undergone a liver biopsy. Patients with persistently normal alanine aminotransferase (ALT) were also included. The variables selected for study were age, gender, risk category, history of high alcohol consumption, CD4(+) T cell count, antiretroviral therapy usage, HCV genotype and duration of HCV infection. Stage of fibrosis was scored as follows: F0, no fibrosis; F1, portal fibrosis with no septa; F2, portal fibrosis with few septa; F3, bridging fibrosis with many septa; and F4, cirrhosis. The liver fibrosis stage was F3 in 39 (16.6%) and F4 in 20(8.5%) patients. Among patients with normal ALT, the liver fibrosis stage was F3-F4 in three patients (5.6%). Predictors of severe liver fibrosis (17344) by multivariate analysis were age (older patients) and genotype 3 (genotype I odds ratio [OR], 0.28; 95% confidence interval [0], 0.12 0.65). In summary, in the present study severe liver fibrosis was found in 25% of our patients and was associated with an age of more than 38 years at the time of liver biopsy as well as, HCV genotype 3. No differences were found with respect to CD4(+) T cell counts although patients with a CD4(+) T cell count greater than 50 were excluded.
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Esophageal ulcer (EU) represents an important comorbidity in AIDS. We evaluated the prevalence of EU, the accuracy of the endoscopic and histologic methods used to investigate viral EU in HIV-positive Brazilian patients and the numerical relevance of tissue sampling. A total of 399 HIV-positive patients underwent upper gastrointestinal (UGI) endoscopy. HIV-positive patients with EU determined by UGI endoscopy followed by biopsies were analyzed by the hematoxylin-eosin (HE) and immunohistochemical (IH) methods. EU was detected in 41 patients (mean age, 39.2 years; 23 males), with a prevalence of 10.27%. The median CD4 count was 49 cells/mm(3) (range, 1-361 cells/mm(3)) and the viral load was 58,869 copies per milliliter (range, 50-77,3290 copies per milliliter). UGI endoscopy detected 29 of 41 EU suggestive of cytomegalovirus (CMV) infection and 7 of 41 indicating herpes simplex virus (HSV) infection. HE histology confirmed 4 of 29 ulcers induced by CMV, 2 of 7 induced by HSV, and 1 of 7 induced by HSV plus CMV. IH for CMV and HSV confirmed the HE findings and detected one additional CMV-induced case. UGI endoscopy showed 100% sensitivity and 15% specificity for the diagnosis of EU due to CMV or HSV compared to HE and IH. HE proved to be an adequate method for etiologic evaluation, with 87% sensitivity and 100% specificity compared to IH. The number of samples did not influence the etiologic evaluation. The data support the importance of IH as a complementary method for HE in the diagnosis of EU of viral etiology.
