Intervenções de enfermagem na prevenção da pneumonia associada à ventilação mecânica

Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-cirúrgica

Glimpses of our national parks /

Two editions of this publication were issued in 1916 by the Department of the Interior. The 3d and subsequent editions are brought up to date and issued by the National Park Service.

U.S. Postal Service : a primer on postal worksharing : report to congressional requesters /

"GAO-03-927"

Draft work system design handbook : a guide for integrating technology with human and organizational factors.

"3-91."

'Looking good, feeling better': Consumption, Control and the Aesthetics of Exclusivity in the Service Encounter

The majority of ‘service’ literature has focused on the production side of service work (i.e. employees and management), while treating the role of the customer and/or consumer as secondary (Korczynski and Ott, 2004). Those authors who have addressed the role consumption plays in shaping and maintaining individuals' self- identity have tended to overemphasize the dominance of consumer culture in shaping ‘our consciousness’ (Ritzer, 1999), with little in the way of empirical evidence to support these assertions. This paper develops the conceptualization of service work and consumer culture literature, by placing more emphasis on the customer in the service encounter. Using an ethnographic study of a ‘high class’ department store, this paper addresses employee and customer identity and the nature of managerial, employee and customer control within this ‘exclusive’ context. Of particular interest is how employees and customer’s ‘embody’ this control. Using Bourdieu’s (1986) conception of class and habitus, the concept of exclusivity goes beyond the management /service worker dyad by providing a means of investigating identity control by the organization over both customers and service workers. However, an organization’s exclusivity is not a closed normative pursuit of control, and shows this enterprise is part of a contested terrain, while revealing the ambiguity and ‘openness’ of control practices and pursuits. In order to uphold the ideal of exclusivity, management, service workers and customers must all engage in a precarious quest for establishing and maintaining a sense of control and/or identity. This paper demonstrates the continuing contradiction between bureaucratic practices of control and consumer culture, and highlights the need for research that investigates the context -dependent nature of control in service-related and consumer studies.

Perspectives on gender, migration and transnational work: joint work of social reproduction and care in Southern Europe

This paper presents the "state of the art" and some of the main issues discussed in relation to the topic of transnational migration and reproductive work in southern Europe. We start doing a genealogy of the complex theoretical development leading to the consolidation of the research program, linking consideration of gender with transnational migration and transformation of work and ways of survival, thus making the production aspects as reproductive, in a context of globalization. The analysis of the process of multiscale reconfiguration of social reproduction and care, with particular attention to its present global dimension is presented, pointing to the turning point of this line of research that would have taken place with the beginning of this century, with the rise notions such as "global care chains" (Hochschild, 2001), or "care drain" (Ehrenreich and Hochschild, 2013). Also, the role of this new agency, now composed in many cases women who migrate to other countries or continents, precisely to address these reproductive activities, is recognized. Finally, reference is made to some of the new conceptual and theoretical developments in this area.

Comunicação proxêmica: ações, reações e sensações de enfermeiros hospitalares

A comunicação proxêmica, dentre outros aspectos, compreende o estudo social dos espaços, das relações interpessoais e de todas as variáveis que dizem respeito à interação entre os seres humanos. É importante o estudo e a aplicação da comunicação proxêmica no cotidiano do trabalho de enfermeiros, para que esta seja compreendida e empregada de maneira producente no processo relacional dos trabalhadores em todos os momentos de sua prática, em especial, do cuidado. Estudo aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Rio Grande (CEPAS), sob o número 23116.003684/2012-4, com o objetivo de analisar a comunicação proxêmica no trabalho de enfermeiros hospitalares. Estudo de abordagem qualitativa, de cunho descritivo, onde a coleta de dados ocorreu por meio de observações não participantes e entrevistas semipadronizadas com 10 enfermeiros da unidade de terapia intensiva e serviço de pronto atendimento de um hospital universitário no Sul do Rio Grande do Sul, mediante assinatura do Termo de Consentimento Livre e Esclarecido. Os dados foram analisados através da Análise Qualitativa de Conteúdo estabelecida por Mayring, de onde emergiram categorias apriorísticas provenientes dos fatores proxêmicos preconizados por Edward Hall: Postura-sexo, Eixo Sociofugo-Sociopeto, Fatores Cinestésicos ou Cinésicos, Comportamento de Contato, Código Visual, Código Térmico, Código Olfativo e Volume da Voz. Os dados foram interpretados a partir das concepções de Hall ( 16 de maio de 1914 – 20 de julho de 2009 †) e as ideias de diversos autores do universo científico. Este processo resultou em dois artigos. No primeiro artigo “A prática da comunicação proxêmica no manejo do cuidado no trabalho de enfermeiros hospitalares” percebeu-se que, embora os enfermeiros reconheçam a importância do toque, do contato físico, para a prestação de um cuidado holístico e humanizado, os fatores cinésicos/cinestésicos e comportamento de contato, estão associados à avaliação e ao diagnóstico. Com relação às questões térmicas e olfativas os profissionais omitem em suas reações os constrangimentos oriundos das sensações desagradáveis que o toque na pele ou os odores dos pacientes podem causar. Já no segundo artigo intitulado “A comunicação proxêmica na prática de enfermeiros hospitalares”, verificou-se que apenas um dos sujeitos do estudo não estabeleceu contato visual com o paciente. A maioria dos sujeitos empregou um tom de voz normal nas interações com os pacientes. O sexo não influenciou na postura dos interlocutores, como demonstrou o fator postura-sexo e as posições dos enfermeiros ao executar as tarefas diárias, entre face a face e lateralizada, e nenhum dos sujeitos posicionou-se de costas durante as interações, como pode-se perceber através do estudo do eixo sociofugo-sociopeto. O estudo também promoveu reflexões a respeito da comunicação proxêmica e da importância de sua incorporação ao trabalho dos enfermeiros.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation

AIMS AND OBJECTIVES: The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. BACKGROUND: Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. DESIGN: A pre-post design was used. METHODS: The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. RESULTS: From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. CONCLUSION: The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. RELEVANCE TO CLINICAL PRACTICE: HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Ocularcentric labour : ‘you don’t do this for money’

Building on the tradition of emotional labour and aesthetic labour, this study of fitness workers introduces the concept of “ocularcentric labour” (the worker seeking the adoring gaze of the client as the primary reward). It is a state in which labour’s quest for the psycho-social rewards gained from their own body image shapes the employment relationship (both the organization of work and the conditions of employment). We argue that for many fitness workers the goal is to gain access to the positional economy of the fitness centre to promote their celebrity. For this they are willing to trade-off standard conditions of employment, and exchange traditional employment rewards for the more intrinsic psycho-social rewards gained through the exposure of their physical capital to the adoration of their gazing clients. Significantly, with ocularcentric labour the worker becomes both the site of production and consumption.

The challenge of integrating climate change adaptation and disaster risk management : lessons from bushfire and flood inquiries in an Australian context

Emergency management and climate change adaptation will increasingly challenge all levels of government because of three main factors. First, Australia is extremely vulnerable to the impacts of climate change, particularly through the increasing frequency, duration and/or intensity of disasters such as floods and bushfires. Second, the system of government that divides powers by function and level can often act as a barrier to a well-integrated response. Third, policymaking processes struggle to cope with such complex inter-jurisdictional issues. This paper discusses these factors and explores the nature of the challenge for Australian governments. Investigations into the 2009 Victorian bushfires, the 2011 Perth Hills bushfires, and the 2011 Brisbane floods offer an indication of the challenges ahead and it is argued that there is a need to: improve community engagement and communication; refocus attention on resilience; improve interagency communication and collaboration; and, develop institutional arrangements that support continual improvement and policy learning. These findings offer an opportunity for improving responses as well as a starting point for integrating disaster risk management and climate change adaptation policies. The paper is based on the preliminary findings of an NCCARF funded research project: The Right Tool for the Job: Achieving climate change adaptation outcomes through improved disaster management policies, planning and risk management strategies involving Griffith University and RMIT. It should be noted from the outset that the purpose of this research project is not to criticise the actions of emergency service workers and volunteers who do an incredible job under extreme circumstances, often risking their own lives in the process. The aim is simply to offer emergency management agencies the opportunity to step back and rethink their overall approach to the challenge they face in the light of the impacts of climate change.

Promoting posttraumatic growth in police recruits : preliminary results of a randomised controlled resilience intervention trial

Recent research has demonstrated that the same experiences that may elicit symptoms of post-traumatic stress disorder (PTSD) in emergency service personnel can also provide a catalyst for positive personal changes such as posttraumatic growth (PTG). In this research newly recruited police officers (N = 412) participated in a randomised control trial of a program specifically designed to promote mental health. On entry to the academy, new recruits were randomly allocated, by classrooms, to either a treatment as usual condition (i.e., existing psychoeducation program) or to the intervention group. The Promoting Resilient Officers (PRO) program is a resilience building intervention adapted from an earlier resilience building program in collaboration with the police service. The PRO program also includes additional components on trauma and PTG. The current research included the participants who had experienced trauma prior to or during the research period (N = 246). It was hypothesised that participation in the PRO program would increase levels of PTG and lower levels of PTSD when compared to recruits in the control condition. Using multilevel modelling and post-hoc analyses, results indicated there were significantly higher levels of PTG across multiple dimensions when compared to the control group. There was no effect on PTSD symptoms with both conditions showing a floor effect. The research indicated the potential value of developing interventions that elicit reflections on the potential for positive as well as negative outcomes of experiencing traumatic and other highly challenging events.

Organisational belongingness mediates the relationship between sources of stress and post-trauma outcomes in fire-fighters

Previous research with emergency service workers has examined the relationship between operational and organisational stress and negative indicators of mental health, and generally found that organisational stress is more strongly related to pathology than operational stress. The current study aimed to create and test a model predicting both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) simultaneously in a sample of fire-fighters (N = 250). The results found that the model demonstrated good fit for the data. In contrast to previous research operational stress was directly related to PTSD symptoms, while organisational stress was not. Organisational stress was indirectly related to PTG, through the mediating role of organisational belongingness. This research identified organisational belongingness as a good target for psychosocial interventions aimed at promoting positive adaptation following the experience of trauma in emergency services.

A dinâmica da demanda por serviços de saúde no município de Piraí, RJ, do ponto de vista da medicalização

Apesar da definição da Estratégia de Saúde da Família (ESF) como porta de entrada preferencial do sistema de saúde e estratégia de reorganização da assistência, os usuários do SUS, vêm demonstrando historicamente preferência pelo serviço de urgência/emergência hospitalar. Neste contexto, o campo do presente estudo é a cidade de Piraí e seus habitantes, que desde 2002 contam com 100% de cobertura da ESF, modelo que dá ênfase: à lógica territorial na assistência, no cuidado continuado e transversal, no vínculo e no acesso facilitado pelo acolhimento humanizado e escuta qualificada; ocupando o centro da rede de serviços atuando como ordenador e coordenador do cuidado. Avaliando os dados de produtividade (com foco nas consultas médicas) hospitalar e da ESF notamos que a busca por assistência médica hospitalar, tem aumentado exponencialmente, e pode-se perceber que a grande maioria destes usuários se apresenta ao serviço com demandas de atenção básica, o que é considerado ilógico e contraditório na visão de gestores e profissionais. A prática profissional tem me levado a um processo de reflexão sobre as expectativas dos usuários ao procurarem o sistema de saúde (principalmente a ESF), sobre os caminhos que cada um deles constrói diante de uma questão de saúde e como se dá a tomada de decisão em busca da resolutividade da questão. Dessa forma, o objetivo deste trabalho é compreender como se constrói essa demanda; que critérios estão envolvidos na tomada de decisão desses usuários ao optarem pelo serviço de emergência como porta de entrada preferencial; mesmo em um município que oferece um serviço estruturado, pautado nas diretrizes da ESF e com uma cobertura que alcança toda a sua população. Acreditamos que o processo conhecido como medicalização da vida, que descreve o processo pelo qual problemas não médicos são definidos e tratados como problemas médicos, usualmente em termos de doenças e desordens (CONRAD, 2007); influencie na construção dessa demanda. Quanto a metodologia, foram realizadas entrevistas semiestruturadas, com usuários do SUS, residentes no município e que buscaram espontaneamente o serviço de urgência/emergência hospitalar. Verificou-se que a imagem que o usuário faz dos serviços de saúde se relaciona principalmente com o tempo de espera pelo atendimento, o acesso (interpretado principalmente como a certeza/incerteza do atendimento) e a acessibilidade. Os usuários frequentemente se referem à organização das unidades da ESF com o significado de barreiras ao acesso (principalmente pela necessidade de agendamento) e demonstram ter em relação às USF uma imagem de grande limitação de recursos humanos (quase exclusivamente em relação ao médico) e materiais. Por outro lado, prontos-socorros e hospitais se apresentam para eles, por várias razões, como espaços de acesso garantido. É importante ressaltar que o processo de medicalização da vida aparece como parte importante da engrenagem que move a construção dessa demanda.

Configurações do estado de exceção no romance Ensaio sobre a cegueira de José Saramago

O romance Ensaio sobre a cegueira, do escritor português José Saramago, publicado em 1995, revela profundas críticas à estrutura da sociedade hodierna, bem como sua política. Em vistas desse fato, a presente dissertação investiga as relações políticas e filosóficas presentes no romance, estabelecendo como arcabouço teórico as pesquisas do filósofi italiano Giorgio Agamben sobre o estado de exceção na série de volumes Homo Sacer, que segue a trilha deixada por Michel Foucault sobre os dispositivos de poder e saber na sociedade contemporânea. A pesquisa ora apresentada revela uma leitura do estado de exceção enquanto uma estrutura de exclusão da vida nuaatravés de uma via biopolítica que encontra no romance do escritor português um intenso questionamento sobre o homem moderno descolado de si mesmo