Risco ocupacional no contexto hospitalar

O presente estudo tem como objetivo conhecer as representações sociais sobre o risco ocupacional construídas por trabalhadores da saúde no contexto hospitalar. Trata-se de um estudo exploratório fundamentado no referencial teórico da Teoria das Representações Sociais realizado com duzentos e vinte trabalhadores da saúde pertencentes ao quadro permanente de um hospital público na cidade do Natal- RN. Os dados foram coletados através da Entrevista semi-estruturada e da Técnica da Associação Livre de Palavras. Na análise das informações utilizou-se o software Evoc 2000 e o Alceste. Os resultados indicam condições de trabalho desfavoráveis com desgaste físico e mental ao trabalhador da saúde, e, patologias pouco reconhecidas como ocupacionais em sua origem. Pode-se observar que as representações sociais construídas pelos trabalhadores da saúde, revelam o nível de conscientização desses trabalhadores referentes às consequências do ambiente de trabalho para sua saúde, referindo-se ao processo de trabalho hospitalar, como múltiplo e complexo pela dimensão tecnológica e pelos aspectos físicos, psíquicos e cognitivos

Infecção hospitalar associada ao uso de cateter venoso central e a quebra de protocolos pelos profissionais de saúde na UTI de um hospital universitário em Natal/RN

This is a study descriptive cross-sectional and quantitative approaches, which aimed to analyze the association between hospital infection rate for insertion, maintenance of central venous catheter and the breakdown of protocols (rules and routines) by health professionals assisting patients in the ICU of a university hospital in Natal / RN. The process of data collection was through observation with structured form, refers to medical records and structured questionnaires with health professionals. The results were organized, tabulated, categorized and analyzed using SPSS 14.0. The characterization of the subjects was performed using descriptive and inferential statistics, taking into account the nature of the variables, with analysis of variance (ANOVA) and Spearman correlation test, it was a discussion of the information obtained, considering the mean, standard deviation, coefficient of variance and standard error. The variables that showed a higher level of correlation were treated with the application of significance tests. As the results, 71% of participants were female and 29% male, age ranged from 18 to 85 years (52.6 ± 22.5). The insertion, there was a variation from 0 to 5 errors (1.2 ± 1.4), during maintenance, the average was 2.3 ± 0.9 errors, ranging from 0 to 4. During the insertion and maintenance of CVC, patients who had been an infection ranging from 2 to 9 mistakes (4.2 ± 1.7), since those who did not show the variation goes from 0 to 5 errors (2, 8 ± 1.5). The correlation coefficient between the risk of infection throughout the process and the risk of infection at the insertion showed strong and significant (r = 0.845 p = 0.000) and in relation to risk of infection in maintenance was moderate and significant (r = 0.551 p = 0.001). The mistakes made by professionals in the procedures for insertion and maintenance of the catheter, associated with other conditions, shown as a risk factor for the of IH

Centro de Informação sobre Medicamentos - CIM: avaliação da informação prestada

Providing information about medication, an essential function of pharmaceutical practice to ensure rational drug use, is an important activity of hospital pharmacy services. The Drug Information Center of Onofre Lopes University Hospital (DIC-HUOL) initiated its activities in 1979 with the first Clinical Pharmacy Service in Brazil. The aim of this study was to assess information provided by DIC-HUOL, describing the profile of passive information offered by the center. A retrospective cross-sectional study was conducted to identify the profile of information requests (IR). One hundred percent of the IR received by the DIC between January 2008 and December 2009 were used. The results were divided by year to determine the influence of the restructuring process that occurred in 2008 and 2009. The study at DIC-HUOL showed a mean of 5.5 IR/month in 2008 and 20.3 IR/month in 2009; the mean of the last year is comparable to that of other Brazilian DIC. Most of the IR were made by medical residents (22.7%) in 2008 and by pharmacists (32.5%) in 2009. The significant use of the DIC by medical residents may be due to its location in a university hospital. The most recurrent types of IR concerned issues related to pathway/mode of administration (16.8%) and drug stability (13.1%) in 2008 and 2009, respectively. Requests were made verbally in 100% of the cases in 2008 and 78.8% in 2009, owing to the fact that most of the DIC users were professionals from the hospital itself. Time elapsed between request and response was not reported in 83.3% and 21.3% of the cases in 2008 and 2009, respectively. The most widely used bibliographic source during the two years was MICROMEDEX®, with 41.9% and 39.2%, respectively. The restructuring process had a positive influence on the DIC-HUOL, exhibiting similar parameters to those of other Brazilian DIC, but some of these parameters must be improved to achieve international standards

Hemogasometria e variáveis cardiopulmonares após administração do butorfanol em cães anestesiados pelo desfluorano sob ventilação espontânea

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação da função renal de cães sob dois protocolos para administração da cisplatina

OBJETIVO: Avaliar a função renal de cães sadios, sob dois protocolos para administração de cisplatina. MÉTODOS: Todos os animais foram submetidos a três sessões de quimioterapia com cisplatina (60mg/m², iv) a intervalos de 21 dias. Foi realizada fluidoterapia com solução de cloreto de sódio a 0,9%, (25mL/kg/hora,iv), durante duas horas e, após administração de cisplatina, por mais uma hora. Os animais do grupo 2 receberam furosemida (2mg/kg, iv) 20 minutos antes da administração da cisplatina. A avaliação da função renal foi feita por exame clinico, urinálise, concentrações séricas de uréia e creatinina, clearance de creatinina, excreção fracionada de sódio e de potássio e razão proteína: creatinina urinária. As avaliações foram feitas imediatamente antes e 1, 2, 5, e 21 dias após cada uma das três sessões de quimioterapia. RESULTADOS: Mantiveram-se dentro da normalidade, não sendo detectados sinais de lesões ou insuficiência renal. Os animais que não receberam furosemida sofreram aumento gradativo nas concentrações séricas de creatinina e diminuição no clearance da mesma. CONCLUSÃO: O regime de fluidoterapia empregado mostra ser efetivo em minimizar a ação nefrotóxica da cisplatina e benefício adicional importante é obtido pela administração de furosemida.

Participação administrativa processual na administração pública dialógica

The dissertation, which is based on the deductive method, by using general concepts of the theory of the administrative participation in the administrative process, addresses the importance of strengthening administrative and procedural activities of citizen involvement in public administration for the administrative consolidation of democracy in Brazil. The emergence of Administrative Law has particular importance for the understanding of its institutions and, of course, for the different fields of public administration. The authoritarian profile of this area of law still exists as a clear recollection of their origin, mainly based on a relationship of superiority of the state over the individuals. Indeed, does not even modern constitutionalism could print a true democracy administrative, since the constitutions were not properly observed by the Government. Furthermore, only the process of constitutionalization of administrative law legal relations took a more democratic profile. That is, the creation of an environment of dialogue with civil society is a recent achievement of the Brazilian government. As the administrative process involves dilemmas and solutions of state action, because it is revealed the expression government, the strengthening of institutions and principles related to the administrative procedure is important for role in making a more participatory relationship between state and citizen. Thus, administrative participation can be considered not only a mechanism of control and legitimacy of state action, but also for improvement and reduction of administrative costs, as a requirement of the principle of efficiency. The objective of this investigation is to assert as the administrative legal relation, the administrative legality, the administrative jurisdiction, the processuality administrative, the consensuality administrative and administrative justice, together with administrative participation, can contribute to a more democratic role of the Public Administration and, therefore, more dialogic and consolidator of the fundamental rights of citizens. Therefore, we highlight the importance of the administrative process and administrative participation as mechanisms for improving public policy and thus as a means of reducing administrative costs mediate the state

Infusão contínua de lidocaína em diferentes taxas no controle de arritmias induzidas pela administração de adrenalina em cães anestesiados com isofluorano

Avaliaram-se os efeitos da infusão de diferentes doses de lidocaína sobre o ritmo cardíaco, em cães anestesiados com isofluorano que receberam doses crescentes de adrenalina. Foram utilizados 10 cães, cada qual anestesiado quatro vezes, respeitando-se um intervalo de duas semanas. A indução anestésica foi realizada com propofol, 8mg/kg, e a manutenção com isofluorano a 1,5 CAM. Os animais foram distribuídos em quatro grupos, que receberam bolus de lidocaína, 1mg/kg, seguido pela infusão de lidocaína nas taxas de 50μg/kg/h (G50), 100μg/kg/h (G100) e 200μg/kg/h (G200). O grupo-controle (GC) recebeu bolus e infusão de NaCl a 0,9%. As variáveis foram mensuradas 30 minutos após a indução, e em seguida, iniciadas as infusões. Após 10 minutos do princípio dos tratamentos, colheram-se novamente os dados e iniciou-se a infusão de adrenalina, 1μg/kg/min. em intervalos de 10 minutos, realizou-se nova colheita de dados e acrescentou-se 1μg/kg/min na taxa de infusão de adrenalina, até atingir 5μg/kg/min. Comparativamente ao GC, ocorreu redução do aparecimento de batimentos de origem não sinusal e bloqueios atrioventriculares de segundo grau nos grupos tratados com lidocaína. Concluiu-se que a associação de lidocaína à anestesia com isofluorano diminuiu o aparecimento de irregularidades no ritmo cardíaco.

Planejamento tributário: Critérios e limites para a desconsideração dos atos e negócios jurídicos pela administração fiscal

Tax planning is a subject that has been increasing in relevance in Tax Law. This current dissertation s objective is to approach the criterion and limits for the disqualification of law acts and business through the Tax Administration. Law acts and business resulted from the conduct of contributors that seek to diminish the growing raise of the tax load, using some means to reduce their burden and increase the possibilities of success in an economical activity, without violating the law in the persecution of paying fewer burdens. On the other hand, the tax administration, through its organs, hoping the increase of burden collection to withstand some determined sectors of the State, with a clear purpose to stop the contributor organizing his activity and structuring it as efficiently as possible, came up with a preliminary draft which left Complementary Law 104, from 10.02.2001, enacted, that inserted the unique paragraph of the National Tax Code, article 116, authorizing the disregard, by the administrative fiscal authority, of Law acts and business practiced to dissimulate the occurrence of burden gain or the nature of obligated incorporating elements, observing the procedures to be established in common law . Our goal is to identify the criteria and limits to disregard law acts and business through the tax administration, pointing out some possible means of action by the tax administration that qualifies it to disregard the contributor s acts and business, just claiming that a saving in the tax costs was made by the contributor s act

Narrativas infantis: o que nos contam as crianças de suas experiências no hospital e na classe hospitalar

This dissertation focuses on the narratives of children hospitalized with chronic diseases. The overall goal is to deduce, from the look of the child health care, hospital class contributions to the process of school inclusion. The research is part of the qualitative ethnographical approach and is based on the principles and research methods (auto)biographical in education and schooling in hospital. Participated in the investigation 05(five) children, aged between 06 (six) and 12 (twelve) years of age, treated at the Center for Children s Onco-Hematology, Varela Santiago Children s Hospital in Natal-RN. The corpus used for the analysis comprises five (05) narrative interviews, 03 (three) drawings made by children as well as records in the researcher s field diary. The sources were collected during the months of August 2010 to February 2011. The analysis revealed that the inclusion of the hospital class, and ensure the right to education, contributes to the construction of strategies for coping with illness and hospitalization, as it promotes autonomy, comfort, playfulness and self-knowledge, the rand the world, easing the stress of hospitalization. The figure of the teacher took the class hospital in the voices of children, a reliever and minimizing the role of double exclusion that cause illness and hospitalization, showing the contributions to (re) construction of identity and subjectivity constitution strengthened. The children interviewed said that the hospital class leave the hospital more cheerful. The playfulness and learning experiences in the hospital are seen by children as actions that go beyond the physical treatment of the disease, since it provides them with acceptance and understanding of hospitalization and illness, to give them affective security and emotional. In conclusion, the narratives of children confirm that the service class hospital ensures continuity of schooling, but they reveal, namely, that this service provides them socialization among peers and with adults, strengthening the emotional, social and cognitive biopsychosocial perspective of attention

Vivendo e aprendendo no ambiente hospitalar: Percepções de crianças sobre a doença

This study focuses on the child within the hospital environment. Its purpose is to describe children s perceptions of their illness and time in hospital and to identify their main hardships during treatment. This study has a qualitative nature and is theoretically and methodologically supported by the creative and sensitive method developed by Cabral (1998), studies by Piaget, Vygotsky and Wallon on child development, and studies conducted by Pinto (2005), Collet (2004), Chiattone (2003), Silva (2002), Lima et.al (1999) on in-patient children. For this study, 13 children between the ages of 7 and 12 at a public hospital institution specialized in child care in the city of Natal, Rio Grande do Norte, were interviewed. As a criterion for taking part in this study the children would have to have been in hospital for over three days and be fully capable of physically and emotionally interacting with the researcher at the time the interview took place. Analysis drew on the study of the empirical material made up of interviews and a field diary where notes had been entered for the children s reactions, expressions and gestures. Results show that there is some understanding, on the part of these children, of their illness, with their parents as the main informants. They accept being in hospital because they need treatment, but they realize that life becomes different especially on account of the constraints resulting from the illness and the hospital itself. The main hardships during treatment are: lack of recreational activities in the evenings and on the weekends within the hospital environment; absence of family members, especially brothers and sisters; and lack of explanation on the part of health professionals regarding some procedures as these are being carried out. Our conclusion is that children perceive illness and the hospital environment as something that changes the rhythm of their lives bringing on them perturbations, fears and anxieties. Hence, we suggest that professionals working with in-patient children should be especially prepared to deal with these children and their parents, aiming at bringing down fears and anguishes, clear their doubts and, in addition, advise the parents in respect of their children s treatment while in hospital and after hospital discharge. The hospital environment should also be cheerful and colorful and have a toy room under the coordination of persons especially prepared for that purpose

Sofrimento psíquico: representações sociais dos enfermeiros em ambiente hospitalar

We believe that the dissatisfaction arising from the lack of belief in the possibilities of change in the workplace, which cause difficulties to achieve professional results in the professional psychological distress that currently fits into the context of mental health. This is a qualitative, descriptive and representational research aiming to discover how the professional nurses represent the very psychological distress from work in the hospital environment. Aided and supported by specific objectives of identifying factors that generates this suffering and strategies for defense and confronting these professionals in the hospital. 22 nurses participated in this research, officials of the University Hospital Onofre Lopes, located in the city of Natal / RN, with length of service in the institution more than one year and less than five, and they accepted, by signing the Term of Free and Informed Consent, participate in the study. We use plurimethodological approach: a questionnaire, a semi-structured interview and the design-story with a theme adapted from Trinca with the support of the Theory of Social Representations and that nurses do in their psychological distress of the Central Core. We reviewed the data from the results generated by the ALCESTE software, based on hierarchical categorization downward, leading seven classes used as categories: Work process: completeness vs. incompleteness; labor contradiction of the nurse; qualitative aspects of interpersonal relationships; hospital surveillance: Challenges, muteness and neglect; Expectations, conflicts and feelings in the work process; Leisure: the other side of the work process, and Suffering generating aspects of in the work process. We consider the analysis of quarters generated by the program, which SLQ houses in the central core of the representations; the SRQ and the DLQ the intermediaries elements and the DRQ the peripheral elements that nurses do in their psychological distress. We analytically adequate results in the three belonging dimensions of social representations: the Subjectivity, the Intersubjectivity and Trans-subjectivity. We infer that the interpersonal relationship, the extra work, the deviation in the role of nurse show themself as the factors responsible for psychological distress of it. In that sense, the central core of SR of this profession is based on the level of trans-subjectivity and understood as a Social Representation controversy

Atividades profissionais da enfermagem no contexto hospitalar: influências nas relações de trabalho

The present study is based on an analysis of professional work relationships in the nursing team from the task/skills of its members as a contribution to understanding the work process in nursing. It is aimed to identify the skills of the nursing team members through the vision of nurses, technicians and nursing assistants, thus it attempts to find strategies to improve the health assistance to patients. It is a descriptive and analytical study with a qualitative approach grounded in theoretical and methodological framework of Symbolic Interactionism. The research was carried out in the participant work place, a Public Hospital of Reference for the SUS, located in the eastern health district of Natal/RN. Nineteen nursing professionals participated in the study, which seven was nurse and twelve nursing technician. As procedure to collect data we used an unstructured interview accompanied by a standard topic guide which was recorded and later transcribed. The content analysis was chosen as the main methodology to analyze the discussion, which gave rise to thematic categories that were considered relevant based on the theoretical framework of this study, and the interactionist theory. This study was in accordance with the ethical principles of the Resolution nº. 196/96, it has obtained an appropriate consent of the UFRN Research Ethics Committee. The results indicate that the professionals seen the nursing as a profession strongly attached to the health care process and as a profession that acquired a scientific status very recently. Regarding to the nursing functions in the work process in nursing, the professionals they identified the manage/administer category as the main activities developed by these professionals, thus the education and complex care in nursing categories. Concerning to the technicians and nursing assistants functions, it was figured out in the professional s opinion that there is not distinction among the attribution of these categories. The interviewed were unanimous in report that these professionals are more involved in direct patient health care through performance of basic duties in nursing care. Finally, with regard to the work relationship among nursing team members, the majority of those interviewed see this relationship as disharmony and quarrelsome and in general, there is not bond between categories that comprise the process of work in nursing. On the basis of our results we consider the importance of knowing the meaning of nursing given by these professionals; also their skills could be useful as basis to identify problems, which source could be detected in the power relationship, deviations of functions, gap between design (knowledge) and performance (doing) work, besides the loss of the global activities view in the process of nursing work

Viabilidade do processo de enfermagem no contexto hospitalar

The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others.

Balanced scorecard como ferramenta de gestão aplicada a unidade hospitalar privada

In this study the objective is to implant Balanced Scorecard administration for the development of a Strategic Map, for the support of the electric outlet of decisions in the administration of operations of an unit of attendance doctor-hospitalar. The present work presents a case study developed at a private hospital in the State of Rio Grande do Norte. The collection of data was developed after the analysis of the revision of the literature, and he/she had as critical judgement of evaluation used by the following Unit. The work is concluded in the proposition of a strategic map that elevates the return on investment (financial perspective), in the item profitability and growth. In the search of the customer's satisfaction (customer's perspective), that is nothing else than it already exists inside of the Unit in study, just needing to be organized and aligned with the executive picture and the other collaborators. The requirements competitiveness, information, innovation and technology (perspective of the internal processes), they were indispensable to eliminate the re-work, waste and to improve the automation. It is finally, the investment and development of innovation mechanisms, they enlarge important competitive advantage in the processes for creation of value, through the ability, attitude and knowledge (perspective of the learning and growth). As one of the results of this study a strategic map was developed, looked for in Balanced Scorecard, for support in the electric outlet of decisions of the administration of operations of an Unit Doctor- Healthcare

Protocolo multiciclos para automação hospitalar sobre Multicast com IEEE 802.3 utilizando

The concepts of the industrial automation are being incorporated in the medical area, in other words, they also pass to be applied in the hospital automation. In this sense, researches have been developed and have usually been approached several of the problems that are pertinent to the processes that can be automated in the hospital environment. Considering that in the automation processes, an imperative factor is the communication, because the systems are usually distributed, the network for data transference becomes itself an important point in these processes. Because this network should be capable to provide the exchange of data and to guarantee the demands that are imposed by the automation process. In this context, this doctorate thesis proposed, specified, analyzed and validated the Multicycles Protocol for Hospital Automation (MP-HA), which is customized to assist the demands in these automation processes, seeking to guarantee the determinism in the communications and to optimize the factor of use of the mean of transmission