Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.

Diagnóstico de necessidades de competências do agente da psp no atendimento à mulher vítima de violência conjugal

A presente dissertação têm como problemática a violência conjugal sobre a mulher por parte do seu companheiro masculino, e como objeto empírico de investigação, o diagnóstico de necessidades de competências do Agente da PSP para efetuar um atendimento eficaz à mulher vítima de violência conjugal. Em termos específicos pretende estabelecer-se um perfil de competências profissionais, ao nível dos conhecimentos, habilidades e atitudes, que o profissional da PSP deve possuir para efetuar este atendimento com eficácia, dignidade e respeitando todos os aspetos dos direitos destas vítimas. Cientificamente, a realização de um diagnóstico de necessidades de competências conjetura várias etapas que objetivam definir as competências necessárias, as que se encontram em falta, e expor as que atualmente se possuem. Para atingir tal propósito auscultaram-se as visões dos diferentes atores que intervém neste crime através de três amostras distintas, respetivamente, Especialistas, Vítimas e Polícia. Em concreto catorze reconhecidos especialistas nacionais da área da violência doméstica, cem mulheres vítimas deste crime com denúncia efetuada à PSP, e cem profissionais desta Força de Segurança que acuam neste crime. O procedimento que delimita estas etapas anuncia no seu âmago os objetivos específicos. Neste âmbito, pediu-se aos especialistas o delinear das competências necessárias, as vítimas que descrevessem as lacunas do atendimento, e aos Agentes para elencar as competências atuais. Com a triangulação dos dados obtidos foi possível obter o diagnóstico de competências e responder à pergunta de partida: Quais as competências que existem e quais as que se evidenciam como necessárias no Agente da PSP para o atendimento à mulher vítima de violência conjugal? Neste âmbito, Várias questões se levantaram de forma a responder a esta pergunta de partida: Quais as competências necessárias aos Agentes da PSP para efetuarem um eficaz atendimento perante este crime? Será que estas vítimas se encontram satisfeitas com o atendimento dos elementos policiais que responderam à denúncia do crime? Será que estes Agentes se sentem preparados para intervir com competência a este tipo de crime? Ao nível metodológico, após a pesquisa exploratória, utilizou-se uma metodologia transversal, quali-quantitativa e quantitativa, com recolha de dados assente no método de Delphi, com inquéritos por questionários semiestruturados e estruturados e a análise de conteúdo de dados estatísticos. Perante a análise dos resultados, o diagnóstico de necessidades competências efetuado permitiu concluir que existe um conjunto de competências que têm de ser melhoradas, outro que têm de ser adquiridas pelo Agente da PSP, definido por estes e pelas vítimas.

Assessment of the impact of government animal welfare policy on farm animal welfare in the UK

The paper presents the method and findings of a Delphi expert survey to assess the impact of UK government farm animal welfare policy, form assurance schemes and major food retailer specifications on the welfare of animals on forms. Two case-study livestock production systems are considered, dairy and cage egg production. The method identifies how well the various standards perform in terms of their effects on a number of key farm animal welfare variables, and provides estimates of the impact of the three types of standard on the welfare of animals on forms, taking account of producer compliance. The study highlights that there remains considerable scope for government policy, together with form assurance schemes, to improve the welfare of form animals by introducing standards that address key factors affecting animal welfare and by increasing compliance of livestock producers. There is a need for more comprehensive, regular and random surveys of on-farm welfare to monitor compliance with welfare standards (legislation and welfare codes) and the welfare of farm animals over time, and a need to collect farm data on the costs of compliance with standards.

The Acute Care Undergraduate TEaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

The linguistic status of Isotype

It is ironic that Otto Neurath, one of those responsible for the ‘linguistic turn’ in philosophy of the twentieth century, should have been concerned during the last twenty years of his life with developing a ‘pictorial language’. By using simplified pictograms as components, the Wiener Methode der Bildstatistik (later called Isotype) bypassed verbal language to a great extent, creating the potential for universal understanding of biological, social and economic correlations. However, despite its consistency and rigour, Isotype was not a complete language, and Neurath knew that it never could be. This paper will examine the linguistic characteristics of Isotype and describe the deliberate resistance on the part of its creators to develop a full theory behind it.

Developing consensus on hospital prescribing indicators of potential harms amenable to decision support

Aim: To develop a list of prescribing indicators specific for the hospital setting that would facilitate the prospective collection of high severity and/or high frequency prescribing errors, which are also amenable to electronic clinical decision support (CDS). Method: A three-stage consensus technique (electronic Delphi) was carried out with 20 expert pharmacists and physicians across England. Participants were asked to score prescribing errors using a 5-point Likert scale for their likelihood of occurrence and the severity of the most likely outcome. These were combined to produce risk scores, from which median scores were calculated for each indicator across the participants in the study. The degree of consensus between the participants was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or more was achieved. Results: A total of 80 prescribing errors were identified by consensus as being high or extreme risk. The most common drug classes named within the indicators were antibiotics (n=13), antidepressants (n=8), nonsteroidal anti-inflammatory drugs (n=6), and opioid analgesics (n=6).The most frequent error type identified as high or extreme risk were those classified as clinical contraindications (n=29/80). Conclusion: 80 high risk prescribing errors in the hospital setting have been identified by an expert panel. These indicators can serve as the basis for a standardised, validated tool for the collection of data in both paperbased and electronic prescribing processes, as well as to assess the impact of electronic decision support implementation or development.

Challenges in conducting and publishing research on the Middle East and Africa in leading journals

Purpose – The purpose of this paper is to examine the reasons for the lack of research attention paid to the Middle East (ME) and Africa regions. In particular, this study seeks to identify the reasons for and implications of the paucity of ME- and Africa-based studies in high-quality international journals in the marketing field with a specific focus on the challenges in conducting and publishing research on these regions. Design/methodology/approach – The authors conducted a systematic review of the literature on the ME and Africa regions to identify papers published in 23 high-quality marketing, international business, and advertising journals. This search resulted in 301 articles, among which 125 articles were based on primary or secondary data collected from a local source in those regions. The authors of these 125 articles constitute the Delphi study sample. These academics provided input in an effort to reach a consensus regarding the two proposed models of academic research in both regions. Findings – This paper differs from previous studies, where academic freedom emerged as the most important inhibitor to conducting and publishing research. The most frequently mentioned challenges in conducting research in Africa were access to data, data collection issues, diversity of the region, and lack of research support infrastructure. For the ME, the most often described challenges included validity and reliability of data, language barriers, data collection issues, and availability of a network of researchers. Editors’ and reviewers’ low interest and limited knowledge were ranked high in both regions. South Africa, Israel, and Turkey emerged as outliers, in which research barriers were less challenging than in the rest of the two regions. The authors attribute this difference to the high incidence of US-trained or US-based scholars originating from these countries. Originality/value – To the best of the knowledge, no marketing studies have discussed the problems of publishing in high-quality international journals of marketing, international business, and advertising for either region. Thus, most of the issues the authors discuss in this paper offer new insightful results while supplementing previous research on the challenges of conducting and publishing research on specific world regions.

Protein Adsorption onto Polyelectrolyte Layers: Effects of Protein Hydrophobicity and Charge Anisotropy

Ellipsometry was used to investigate the influence of ionic strength (I) and pH on the adsorption of bovine serum albumin (BSA) or beta-lactoglobulin (BLG) onto preabsorbed layers of two polycations: poly(diallyldimethylammonium chloride) (PDADMAC) or poly(4-vinylpyridine bromide) quaternized with linear aliphatic chains of two (QPVP-C2) or five (QPVP-C5) carbons. Comparisons among results for the three polycations reveal hydrophobic interactions, while comparisons between BSA and BLG-proteins of very similar isoelectric points (pI)-indicate the importance of protein charge anisotropy. At pH close to pI, the ionic strength dependence of the adsorbed amount of protein (Gamma) displayed maxima in the range 10 < I < 25 mM corresponding to Debye lengths close to the protein radii. Visualization of protein charge by Delphi suggested that these ionic strength conditions corresponded to suppression of long-range repulsion between polycations and protein positive domains, without diminution of short-range attraction between polycation segments and locally negative protein domains, in a manner similar to the behavior of PE-protein complexes in solution.(1-4) This description was consistent with the disappearance of the maxima at pH either above or below pI. In the former case, Gamma values decrease exponentially with I(1/2), due to screening of attractions, while in the latter case adsorption of both proteins decreased at low I due to strong repulsion. Close to or below pI both proteins adsorbed more strongly onto QPVP-C5 than onto QPVP-C2 or PDADMAC due to hydrophobic interactions with the longer alkyl group. Above pI, the adsorption was more pronounced with PDADMAC because these chains may assume more loosely bound layers due to lower linear charge density.

Byggnadssektorn och framtiden : Session 1, Dalarnas Energi- och klimatseminarium 10 maj 2011

En enkel Delphi-enkät skickades till drygt 100 beslutsfattare och experter inom Dalarnas byggsektor. Enkätdeltagarna tog ställning till 15 framtidsteser om bebyggelsens energiomställning. Enkätutfallet visar att få deltagare tror att energieffektiviseringsmålen kommer att kunna nås i tid. Staten och fastighetsägarna anses vara de viktigaste aktörerna för att förverkliga framtidsteserna. Lite förtroende finns det för frivilliga beteendeförändringar hos brukarna och stor oenighet råder kring renoveringens betydelse för energiomställningen.

Kinesiska affärsetableringar i Sverige : Kartläggning över områden som förbättrar chanserna att lyckas

Aim and starting point: The aim of the Bachelor thesis is to examine and define the paramount knowledge Chinese businessmen need in order to succeed with their establishment in Sweden. The authors also seek to answer what incentives attract Chinese businessmen to come to Sweden, as well as how Chinese establishments in Sweden can be predicted to appear in the future. Results/conclusions: The study outlines key areas in which Chinese businessmen should have knowledge in order to succeed with their establishment in Sweden. The results also gives an indication on how Chinese business establishments in Sweden will appear in the future, into which areas the Chinese mainly invest/establish in, as well as why and how these are done. On the basis of this material the authors generate proposals for educational packages which among others can be sold to Chinese businessmen. Knowledge overview: Here relevant theory connected to the area of study is presented. The knowledge overview presents the Swedish in relation to the Chinese perspective in areas such as: culture, hierarchy, relations, Face, communication, HRM, education, CSR and labour law. The knowledge overview can itself contribute to fostering an understanding of differences between Sweden and China. Method: The area of research has been accessed by a combination of methods. The study is both deductive and explorative. The main channel of information and data collection are in-depth interviews which are used as a deductive starting point, an expert investigation and as a Grounded Theory. As a complement the authors have also conducted a delphi study in which an expert panel answered questions concerning the future of Chinese establishments in Sweden. The deductive and explorative parts have been analyzed individually and have each generated a conclusion. These conclusions have then been interwoven in a synthesis that highlights and creates new knowledge.

Hanns-Josef Ortheil Die Moselreise: Wahrnehmung, Erzählverfahren und Entwicklung im Reisebericht eines Kindes

In der vorliegenden Arbeit geht es um den Reisebericht, den der 1963 11-jährige Autor H.-J. Ortheil von einer Wanderung mit seinem Vater entlang der Mosel anfertigte. Dabei wird  untersucht, wie das Kind die "Fremde" wahrnimmt und mit der ihm vertrauten Heimat vergleicht, welche Erzählstrukturen es verwendet, und wie es sich auf der Reise zu größerer Selbstständigkeit entwickelt.  Das literarische Können des jungen Autors überrascht: Die Moselreise  könnte geradezu als Anleitung für die Methode dienen, die der Autor auch heute noch als "Professor für Kreatives Schreiben" lehrt: "Wie schreibe ich einen spannenden Reisebericht?" 

Sjuksköterskestudenters skattade upplevelser av lärandemiljön före och efter inrättandet av Kompetenscentrum

Bakgrund: Under senare år har allt fler kliniska träningscentra för färdighetsträning etablerats för att möjliggöra en trygg och säker lärandemiljö med simuleringsmöjligheter för studerande och personal. Klinisk färdighetsträning är en viktig del i sjuksköterskeutbildningen vid Högskolan Dalarna (HDa) där lärandemiljön på Kompetenscentrum (KC) kan bidra till en förbättring av lärandemiljön i den kliniska färdighetsutbildningen. Syfte: Syftet med denna studie var att undersöka sjuksköterskestudenters upplevelser via skattning av lärandemiljön för klinisk färdighetsutbildning före och efter inrättandet av Kompetenscentrum. Metod: Studien genomfördes som en enkätundersökning med kvasiexperimentell design. Enkätens baserades på Saarikoski och Leino-Kilpis mätinstrument CLES där frågeställningar om lärandemiljön modifierades med hjälp av Delphimetoden utifrån de tre olika dimensionerna: utbildningsmiljö, relation och lärarens roll. Mätningen före inrättandet genomfördes under hösten 2010 och mätningen efter inrättandet genomfördes hösten 2011. Totalt ingick 266 sjuksköterskestudenter i studien varav 198 (74 %) besvarade enkäten. Resultat: Sjuksköterskestudenter skattade upplevelsen av lärandemiljön mer positiv efter inrättandet av Kompetenscentrum där resultatet visar en signifikant högre skattning i 8 de av de 16 frågorna. Sjuksköterskestudenterna skattade att de upplever att utbildningsmiljön är mer verklighetstrogen, de är mer nöjda med färdighetsträningen samt att den inspirerar dem till att arbeta som sjuksköterska. Att relationen mellan dem och läraren bygger på respekt och att det är en mer positiv atmosfären under färdighetsträningen. Däremot påvisades ingen signifikant skillnad i studenternas upplevelse av den kliniska lärarens roll. Slutsats: Det är uppenbart att lärandemiljö har betydelse för sjuksköterskestudentens integration av såväl teoretiska som praktiska kunskaper vilket medför att färdigheterna förbättras och ger en bra grund för arbetet som sjuksköterska. Strategier bör vidtas för att vidmakthålla och utveckla lärandemiljön på KC samt fokusera ytterligare på integrering av teori och praktik.

Steel Sheet Applications and Integrated Heat Management

Increasing energy use has caused many environmental problems including global warming. Energy use is growing rapidly in developing countries and surprisingly a remarkable portion of it is associated with consumed energy to keep the temperature comfortable inside the buildings. Therefore, identifying renewable technologies for cooling and heating is essential. This study introduced applications of steel sheets integrated into the buildings to save energy based on existing technologies. In addition, the proposed application was found to have a considerable chance of market success. Also, satisfying energy needs for space heating and cooling in a single room by using one of the selected applications in different Köppen climate classes was investigated to estimate which climates have a proper potential for benefiting from the application. This study included three independent parts and the results related to each part have been used in the next part. The first part recognizes six different technologies through literature review including Cool Roof, Solar Chimney, Steel Cladding of Building, Night Radiative Cooling, Elastomer Metal Absorber, and Solar Distillation. The second part evaluated the application of different technologies by gathering the experts’ ideas via performing a Delphi method. The results showed that the Solar Chimney has a proper chance for the market. The third part simulated both a solar chimney and a solar chimney with evaporation which were connected to a single well insulated room with a considerable thermal mass. The combination was simulated as a system to estimate the possibility of satisfying cooling needs and heating needs in different climate classes. A Trombe-wall was selected as a sample design for the Solar Chimney and was simulated in different climates. The results implied that the solar chimney had the capability of reducing the cooling needs more than 25% in all of the studied locations and 100% in some locations with dry or temperate climate such as Mashhad, Madrid, and Istanbul. It was also observed that the heating needs were satisfied more than 50% in all of the studied locations, even for the continental climate such as Stockholm and 100% in most locations with a dry climate. Therefore, the Solar Chimney reduces energy use, saves environment resources, and it is a cost effective application. Furthermore, it saves the equipment costs in many locations. All the results mentioned above make the solar chimney a very practical and attractive tool for a wide range of climates.

Centros de serviços compartilhados como instrumento de gestão regional no setor público

Dissertação apresentada ao Programa de Mestrado em Administração da Universidade Municipal de São Caetano do Sul - USCS