Absenteísmo na equipe de enfermagem e suas implicações para a assistência prestada em unidades de urgência e emergência

Trata-se de um estudo descritivo e exploratório, com abordagem qualitativa dos dados. Objetivou-se analisar a percepção da equipe de enfermagem sobre as condições geradoras de absenteísmo e suas implicações na assistência nas unidades de Urgência e Emergência (UE) das cinco distritais de saúde no município de Ribeirão Preto/SP. Os sujeitos foram profissionais da equipe de enfermagem (enfermeiro, auxiliar e técnico de enfermagem) que atuam nestas unidades. Foram selecionados 2 profissionais de cada categoria, a partir dos critérios de inclusão do estudo, sem considerar sexo, faixa etária e tempo de trabalho no serviço, totalizando 30 participantes. Os dados foram coletados por meio de entrevistas individuais semiestruturadas, conduzidas a partir de um roteiro norteador composto pelas variáveis (Processo de Gestão de Recursos Humanos (RH); Condição de Trabalho em Equipe e Qualidade do Cuidado Prestado) abordadas no estudo. Para análise dos dados utilizou-se análise de conteúdo, modalidade temática. Após análise dos dados, as categorias encontradas foram: TEMA 1 - Gerenciamento, organização e enfrentamento para a operacionalização do trabalho de enfermagem (Subtema 1 - Operacionalização da escala de trabalho frente ao desafio do quantitativo da equipe de enfermagem na unidade de UE; Subtema 2 - Reorganização do trabalho e a perspectiva dos trabalhadores frente à mudança para as 30h/semanais e a terceirização do serviço; Subtema 3 - Tempo de permanência do profissional no serviço; Subtema 4 - Comunicação como ferramenta para desenvolver o trabalho em equipe e gerenciar conflitos); TEMA 2 - Condições impostas ao trabalhador e sua influência no desenvolvimento do trabalho (Subtema 1 - Plano de carreira e salário como estimulantes para desenvolvimento do trabalho; Subtema 2 - Vínculo empregatício: vantagens e desvantagens; Subtema 3 - Educação permanente e sua importância para desenvolvimento do trabalho; Subtema 4 - Influência da estrutura física, materiais e equipamentos no cuidado) e TEMA 3 - Avaliação do serviço e da assistência prestada. No que diz respeito ao quantitativo de enfermagem disposto nas unidades, todos os entrevistados relatam que é um quantitativo razoável e que, em alguns momentos, se sentem sobrecarregados quando ocorrem ausências não previstas. Ao se tratar da terceirização das unidades estatutárias, relata-se que não houve comunicação prévia do evento e é visível a insegurança e frustração por parte dos entrevistados. Ressalta-se que a unidade terceirizada não sofreu mudanças em sua rotina. A rotatividade é presente nestas unidades de UE, sendo maior em determinada unidade e ocorre por inúmeros motivos, dentre eles, aposentadoria, transferência para Unidade Básica de Saúde (UBS), conflitos na equipe e/ou com pacientes, dentre outros. Todos os entrevistados sugerem que a comunicação é fundamental para o desenvolvimento do trabalho em equipe e é através dela que os conflitos possam vir a ser resolvidos. Neste momento, percebe-se, a partir das falas, que a comunicação é diferente entre as unidades e, portanto, existem níveis diferentes de conflitos entre as unidades. O município não possui um plano de carreira efetivo, portanto os entrevistados demonstram desmotivação para buscar novos conhecimentos. Quanto ao salário, estes têm a visão de que é razoável, sendo considerado elevado em relação às demais instituições de saúde do município, porém, defasado em relação à categoria profissional. Os profissionais terceirizados relatam uma certa insatisfação por trabalhar da mesma forma que os estatutários, recebendo um menor salário e sem os mesmos benefícios, o que nos leva à categoria vínculo empregatício, onde a estabilidade é abordada com visões positivas e negativas. Ao se tratar da visão negativa, os entrevistados sugerem que muitos colegas não sabem lidar com esse benefício, se ausentando do trabalho ou trabalhando de uma forma não adequada, prejudicando a rotina do serviço. No que tange à educação permanente, temos a diferença mais gritante do estudo, visto que os entrevistados estatutários relatam que não possuem a disponibilização, através da prefeitura, de cursos de atualização, capacitação e constante aprendizado enquanto que os terceirizados relatam atualizações constantes e apoio por parte da instituição com a qual eles estão vinculados. É unânime que todos os entrevistados consideram que a estrutura física, materiais e equipamentos interferem diretamente no cuidado. Ao serem questionados em relação à avaliação do cuidado prestado, eles o consideram bom, podendo ser melhor caso fossem disponibilizadas condições de trabalho mais adequadas. Considera-se o estudo como um possível instrumento de avaliação dos serviços prestados em unidade de UE, bem como das condições de trabalho fornecidas ao trabalhador e sua satisfação profissional

Qualidade de vida dos utentes em unidades de cuidados continuados

Introdução: Entende-se por qualidade de vida a perceção que o indivíduo tem em relação à sua posição na vida, no contexto onde está inserido, tendo em conta seus objetivos, expetativas, perspetivas de vida, relações sociais e cultura de valores. O estudo subordinado ao tema qualidade de vida dos utentes internados em UCC, tem vindo a assumir um caráter importante na sociedade. A RNCCI surge pelo Decreto-Lei n.º 101/2006 de 6 de Junho de 2006, sustentada no âmbito do Ministério da Saúde e do Trabalho e da Solidariedade Social. Esta pretende fornecer cuidados pluridimensionais orientados para a promoção da qualidade de vida com ênfase na reabilitação, na promoção da autonomia e na participação dos utentes e famílias. Objetivo: Conhecer o perfil sociodemográfico e avaliar o nível da qualidade de vida dos utentes das Unidades de Cuidados Continuados de Bragança e Mirandela. Metodologia: Desenvolveu-se um estudo descritivo, transversal, observacional, analítico, numa abordagem quantitativa. Para a recolha dos dados, recorreu-se ao questionário WHOQOL-Bref, para avaliar a qualidade de vida e o Índice Barthel, para avaliar a independência funcional. Resultados e conclusões: Os resultados revelam que os utentes das UCC apresentam, em cada um dos domínios analisados, valores de qualidade de vida baixos. As médias percentuais estão compreendidas entre 50% e 60%, com exceção do domínio físico, cuja média é 37,59% em Bragança e 32,31% em Mirandela.

Cuidados de saúde oral em doentes hospitalizados

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Análise do ponto crítico de controlo (PCC), relativo à medição de compostos polares nos óleos alimentares no processo de fritura, nas unidades de produção da restauração, snacks e pastelaria

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

DISCURSOS E PRÁTICAS COMUNICACIONAIS: SAÚDE NA WEB

Esta dissertação aborda aspectos das práticas comunicacionais no contexto da comunicação de saúde. Como foco, os discursos instaurados nos Portais Nacionais das Sociedades Científicas Cardiol e Diabetes . O recorte temporal centrou-se no período de 1º de setembro a 1º de dezembro de 2008. A metodologia empregada é a qualitativa e deve-se, preferencialmente, ater ao texto, ao conteúdo latente (insinuado) e à linguagem manifesta. Verifica-se, também, a apresentação do layout e alguns tópicos de avaliação da usabilidade das páginas. O estudo é fundamentado na perspectiva da Análise de Discurso francesa (AD). Outras abordagens teóricas interdisciplinares também compõem as reflexões. Observa-se que a proposta de inserção de um discurso de prevenção de doenças e promoção de saúde, em seu sentido mais amplo, e nas atuais discussões, parece promissora para a descrição dessas representações nos diversos estágios de desenvolvimento humano e sociocultural. Há indícios de que a promoção da saúde amplia seu escopo e passa a relacionar vida, saúde, solidariedade, equidade, democracia, cidadania, desenvolvimento, participação e intenção de parceria com todos os indivíduos e segmentos. Os exemplares analisados indicam que nos enunciados, compreendidos como unidades reais da comunicação discursiva, os editores falam pelo especialista caracterizando, assim, também, como gênero científico.(AU)

ANSIEDADE E ESTRESSE DOS PROFISSIONAIS DE ENFERMAGEM QUE TRABALHAM EM UNIDADES DE PACIENTES GRAVES

Permeando o exercício da profissão de enfermagem existem vários fatores que podem elevar os níveis de ansiedade e estresse.

Avaliação do pré-natal na atenção primária à saúde no Rio grande do Norte: visão das usuárias

ABSTRACT This study aimed to evaluate the quality of prenatal Primary Care in Rio G rande do Norte, Brazil in 2012 under the program Improving Access and Quality of Primary Care. The study was cross - sectional, quantitative. Included 156 mothers of children under 2 years who received prenatal care at the health evaluated. We applied a ques tionnaire on profile, minimum queries, regularity of attendance, laboratory tests, vaccination, participation in educational activities, guidance received, clinical and obstetric procedures and prescription Ferrous sulphate and folic acid. The descriptive analysis of the criteria used Humanization Program Prenatal and Birth. The results showed that 92% of mothers had six or more visits; 85% with the same care was professional; 94% subsequent appointments scheduled. As for tests and procedures the percentage s were: Urine 98%; HIV - 96%; VDRL and 88%; 91% glucose; tetanus vaccination 93%; educational groups 56% with 36% participation, knowledge of the delivery location and 59% achievement breast exam 65%, 33% and preventive gynecological 43%; 98% supplemented wi th 96% Ferrous Sulfate and Folic Acid. It was concluded that there were advances in Rio Grande do Norte concerning assistance and there are weaknesses in the educational practices and conducting some minimal clinical examinations.

Metodologia para gerenciamento de projetos em tecnologia da informação baseada no guia PMBOK: um estudo de caso na Secretaria de Estado da Saúde Pública do Rio Grande do Norte

Nowadays the search for growth makes organizations seeking competitive advantages, project management shares this goal, through techniques that assist in the search for an improved management of the various fields of knowledge through a design methodology. The world is driven by projects and the search for ways to better manage activities such as time, cost and term towards the success of a particular project is something constant. A major contribution that IT can make to the health sector is the support for the management area. IT can integrate processes, optimize the interconnection between the various sectors, make hospitals have access to inside information of good quality, as well as support in the healthcare area, sharing pictures, uniting the various aspects of nursing and nursing service. The major challenge faced by the SESAP Information Technology sector at present is in project management in IT , which does not exist makes investments in the area are increasingly difficult due to this deficiency in management develop their own systems without cost additional to the State. This study seeks to build and strengthen the Project Management within the Department of Health through the implementation of a project office that will manage the final result of this work methodology based on PMBOK, and still show the functionality applied to development the state Hospital Management System that will later be installed on all Regional Health Units and proposing measures for the sustainability and development of the sector amid the difficulties of the current public service. Such action will result in a savings of more than R$ 107,000.00 (one hundred seven thousand) regarding spending private software currently used by the assignment of invested by the State of Rio Grande do Norte user licenses, representing more than 5 % of the total budget of the State Department of Public Health of the State

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

Processo de construção do conhecimento a partir do diálogo ensino-serviço na ótica dos profissionais de saúde

INTRODUCTION: In Brazil, the health training policies have been going through deep changes, which are the fruits of the sanitary reform and of the breakage with the biomedical model, still hegemonic. Nevertheless, the paradigm of comprehensiveness is being introduced in health and, in order to consolidate this concept, the training has been gaining new methodological approaches. One can mention the teaching-service interaction (education-health system/citizenship health), whose proposal enables the expansion of the perception of the health-disease process, as well as the warranty of compromises of training in relation to SUS. OBJECTIVE: Understand, from health professionals, the relevance of teaching-service-community interaction, vocational training of students of the Faculty of Health Sciences / UFRN. METHODOLOGICAL PROCEDURES: This study is grounded on qualitative approach. The technique used to obtain research data was the focus group. Two focus groups (FG) were accomplished in two family basic health units of the municipality of Santa Cruz – RN, where there is participation of professionals of the Family Health Strategy. The discussions were performed from a previously elaborated script. The analysis of results was held from the categorical thematic content technique. RESULTS: The study had the participation of 18 health professionals, and 13 (72%) were females. For these professionals, the teaching-service interaction enables the student to understand the model of comprehensive health care, since the contact with the community enhances its perception about the health-disease process, but also enables recognizing the importance of teamwork to comprehensive health care. FINAL CONSIDERATIONS: The results highlight the importance of a policy of reorientation within the context of training so that students have an early contact with the service and therefore develop technical skills within the context in which they are inserted.

Riscos à saúde dos trabalhadores em unidade de alimentação e nutrição de um Hospital Universitário

The Food and Nutrition Units (FNU) are designed to produce food for healthy and/or sick communities and need to be done in a way to ensure the quality of foodstuffs that were produced. In these units, in the working environment, in general, there is excessive noise, heat and physical condition with many adaptations, presence of obstacles, inadequate flows, as well as the ways of the working organization may represent risks for workers health and lead to errors during production and/or distribution of food. The main goal of this study was to analyse the working processes in the Food Production Unit of the university’s hospital and identify the workers' health risk factors, using for this the knowledge of ergonomics, specifically the method of Ergonomic Work Analysis (EWA). After this analysis it was possible to develop proposals that will bring improvements to the working conditions, minimizing health risk factors during the process of meals production. It’s crucial to reassert this method considers the work activity performed in real time and highlights the importance of listening and the engagement of the workers in the changing process. It is a descriptive research with a qualitative approach. In the field research were collected demographics data, employment characteristics of the individuals (age, education, stocking sector, the total length of service and length of service in the industry) and data related to their usual work (task analysis, activity analysis and Analysis of the working environment) in the FNU. The instruments that were used in this study were document analysis, global and systematic observations and semi structured interviews in order to identify the main complaints related to those activities developed by them. The study was based on data for the analysis of Bardin, 2011, so the documents have been selected and including those that treat issues related to risks to workers' health were selected. The result of semi-structured interviews, global and systematic observations took place a confrontation of this material to the theoretical framework, held the inference and the interpretation of results the light of the knowledge of ergonomics and legislation. Issues related to the risks and the perception of workers has crafted a table showing the frequency of responses to the physical, chemical and biological and even the risk of accidents and was made a descriptive analysis. The results of this analysis indicated that the unit in question presents several problems ambience of jobs, both in terms of physical structure, but also in the organization of work. Non-conformities that leads to a favourable environment to the development of disease and injury hazards and compromising the quality of food produced. It is necessary to comply with legislation and that short, medium and long-term measures are taken to ensure the physical integrity of workers and improve the working environment.

Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Plano amostral, ponderação e efeitos do delineamento da Pesquisa Nacional de Saúde Bucal

OBJETIVO: Estimar la prevalencia y la extensión de la caries radicular en la población adulta y anciana de Brasil. MÉTODOS: A partir de los datos de la Investigación Nacional de Salud Bucal (SBBrasil 2010) se examinaron 9.564 adultos y 7.509 ancianos en domicilios de las 26 capitales y en el Distrito Federal y de 150 municipios del interior de cada macro región. Se implementaron criterios de diagnóstico establecidos por la Organización Mundial de la Salud. Para estudio de la prevalencia y de extensión se utilizó el índice de caries radicular y el índice de raíces cariadas y obturadas. RESULTADOS: La prevalencia de caries radicular fue de 16,7% en los adultos y 13,6% en los ancianos; el índice de raíces cariadas y obturadas fue de 0,42 y 0,32 respectivamente, siendo la mayor parte compuesta por caries no tratadas. Se observaron diferencias en la experiencia de caries radicular entre capitales y macro regiones, con valores mayores en capitales del Norte y Noreste. El índice de caries radicular en los adultos varió de 1,4% en Aracaju (SE) a 15,1% en Salvador (BA) y en los ancianos de 3,5% en Porto Velho (RO) a 29,9% en Palmas (TO). Se verificó incremento de caries radicular con la edad y mayor expresividad de la enfermedad en hombres de ambos grupos etarios. CONCLUSIONES: Se identificó una gran variación de la prevalencia y extensión de la caries radicular entre y dentro de las regiones de Brasil, tanto en adultos como en ancianos, y la mayor parte de la caries radicular se encuentra no tratada. Se recomienda la incorporación de este agravio al sistema de vigilancia en salud bucal, debido a su tendencia creciente.

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).