Atitudes dos profissionais de enfermagem relacionadas ao Processo de Enfermagem

Os objetivos do estudo foram descrever a disposi����o sobre o Processo de Enfermagem (PE) e a percep����o de poder cl��nico dos profissionais de enfermagem; analisar associa����es entre atitudes relacionadas ao PE e vari��veis selecionadas. Participaram 1.605 auxiliares de enfermagem e enfermeiros (86,9% mulheres, idade m��dia 44,12 anos; DP=9,55). O escore m��dio no instrumento Posi����es sobre o Processo de Enfermagem (PPE) foi 112,37 (DP=22,28) e no Power as Knowing Participation in Change Tool - vers��o brasileira (PKPCT) foi 281,12 (DP= 38,72). Os escores nos instrumentos foram mais altos para enfermeiros quando comparados aos auxiliares. Houve correla����o positiva moderada entre escores do PPE e PKPCT. Para os auxiliares houve associa����o entre os escores no PPE, sexo e p��s-gradua����o; e entre percep����o de poder e sexo. Para os enfermeiros houve associa����o entre PKPCT e cargo de chefia. Mais estudos devem ser desenvolvidos com vistas a identificar vari��veis potencialmente associadas ao uso do Processo de Enfermagem na pr��tica cl��nica.

N��cleos de Apoio �� Sa��de da Fam��lia: desafios e potencialidades na vis��o dos profissionais da Aten����o Prim��ria do Munic��pio de S��o Paulo, Brasil

Os N��cleos de Apoio �� Sa��de da Fam��lia (NASF) foram criados para ampliar a resolutividade da aten����o prim��ria. A imin��ncia da implanta����o na regi��o oeste do Munic��pio de S��o Paulo, Brasil, motivou a realiza����o de oficinas para elaborar uma proposta de NASF por profissionais da aten����o prim��ria �� sa��de. Utilizamos a an��lise hermen��utica para estudar o material transcrito. As categorias tem��ticas foram: papel, constitui����o, funcionamento, rela����o com a equipes de sa��de da fam��lia e interdisciplinaridade. A expectativa dos participantes foi de que o NASF seja um dispositivo potencializador da integralidade do cuidado, intervindo na cultura dos encaminhamentos desnecess��rios e na articula����o com os outros n��veis de aten����o; al��m de contribuir para a discuss��o da forma����o dos profissionais e de estimular a reflex��o junto aos gestores sobre indicadores de sa��de vinculados exclusivamente ao n��mero de atendimentos, que n��o refletem o impacto das a����es desenvolvidas nem a qualidade do cuidado oferecido �� popula����o adscrita.

O processo de revis��o por pares: uma revis��o integrativa de literatura

OBJETIVO: Avaliar as evid��ncias dispon��veis na literatura sobre o processo de revis��o por pares de artigos cient��ficos na ��rea da sa��de. M��TODOS: Revis��o integrativa de literatura, na qual foram realizadas buscas nas bases de dados da Literatura Latino-Americana e do Caribe em Ci��ncias da Sa��de, National Library of Medicine, Medical Literature Analysis and Retrieval System Online e Cumulative Index to Nursing and Allied Health Literature. Um total de 12 estudos foi analisado. RESULTADOS: Foi demonstrado que existem muitas cr��ticas ao processo em raz��o de sua subjetividade, por��m acredita-se na necessidade dos mesmos. CONCLUS��O: Este processo �� imprescind��vel para a difus��o do conhecimento, sendo uma etapa essencial no julgamento de manuscritos cient��ficos, no entanto, considera-se importante que se fa��am mudan��as no sentido de reduzir a subjetividade para garantir credibilidade ao processo.

A tem��tica ambiental em representa����es e pr��ticas de profissionais de sa��de da fam��lia no munic��pio de Manaus - AM/Brasil

Evid��ncias cient��ficas mostram que mudan��as ambientais antr��picas aumentam riscos de exposi����o a diversas doen��as. Na Estrat��gia Sa��de da Fam��lia - ESF, tarefas com claro enfoque ambiental s��o prescritas indicando ��s equipes de profissionais que considerem esses aspectos em suas interven����es. O objetivo desta pesquisa foi conhecer representa����es e pr��ticas de profissionais de Sa��de da Fam��lia de Manaus (AM) sobre a quest��o ambiental e sua interface com a sa��de p��blica. Os dados foram coletados por meio de observa����o participante e entrevistas semiestruturadas, e a an��lise qualitativa destes deu-se pela An��lise de Conte��do e Triangula����o de M��todos. Resultados da pesquisa revelaram que a maioria dos profissionais n��o compreende o ambiente de forma sist��mica, mesmo tendo declarado que os fatores ambientais t��m grande influ��ncia sobre a sa��de humana; enquanto interven����es, as pr��ticas educativas seguem metodologias tradicionais e s��o centradas na culpabiliza����o do indiv��duo e na simples transmiss��o de conhecimentos pontuais; o relacionamento dos profissionais com a comunidade resume-se ao atendimento individual e/ou coletivo. Concluiu-se que, para a ESF contribuir para o reordenamento do sistema, �� fundamental o redirecionamento desse novo modelo de pol��tica de sa��de para efetivar-se como pr��tica social e ambiental.

Profissionais da Estrat��gia Sa��de da Fam��lia diante de demandas m��dico-sociais: dificuldades e estrat��gias de enfrentamento

Os profissionais da Estrat��gia Sa��de da Fam��lia (ESF) atuam em comunidades onde a complexidade de problem��ticas m��dico-sociais pode lev��-los a sofrer psicologicamente, com preju��zos ao atendimento aos usu��rios e �� consolida����o da ESF como modelo de reorganiza����o da aten����o b��sica no Brasil. Esse estudo investigou as dificuldades e as formas de enfrentamento referidas por profissionais de equipes da ESF frente ��s demandas m��dico-sociais apresentadas pelos usu��rios em seu cotidiano de trabalho. Grupos focais e entrevistas semiestruturadas foram realizados com 68 profissionais de tr��s Unidades de Sa��de da Fam��lia da cidade de S��o Paulo. Tr��fico e uso de drogas il��citas, alcoolismo, depress��o e viol��ncia dom��stica s��o as demandas mais significativas para o grupo estudado. Frente a elas, os profissionais referem forma����o profissional e capacita����o t��cnica insuficientes, sobrecarga e condi����es desfavor��veis de trabalho, com sentimentos de impot��ncia e frustra����o. No enfrentamento das dificuldades, destacam-se as estrat��gias coletivas, especialmente as reuni��es de equipe e apoio matricial, nas quais h�� troca de experi��ncias, conhecimentos e apoio compartilhado. Os resultados indicam que as dificuldades referidas podem deixar os profissionais da ESF em situa����o de vulnerabilidade, tal como os usu��rios por eles atendidos. O investimento no desenvolvimento de compet��ncias, o fortalecimento de estrat��gias de enfrentamento coletivas, assim como maior articula����o com as redes de servi��os e as lideran��as locais, mostram-se necess��rios para que os profissionais de sa��de atuem com menor estresse frente ��s complexas demandas m��dico-sociais presentes em seu cotidiano de trabalho, e assim contribuam na consolida����o da ESF.

C��ncer y tratamiento oncol��gico: Representaciones sociales de la poblaci��n general, el paciente oncol��gico y miembros del equipo de salud

Se realizaron tres estudios cualitativos que tuvieron como prop��sito conocer las representaciones que ha construido la poblaci��n general, los pacientes oncol��gicos y los profesionales de la salud, sobre el c��ncer, la quimioterapia y el trasplante de m��dula ��sea y realizar un an��lisis sobre las semejanzas y diferencias entre ellos. Se realiz�� en la ciudad de Bogot�� (Colombia) con 55 personas: 20 pacientes con c��ncer en proceso de trasplante de m��dula ��sea, 20 personas no diagnosticadas con c��ncer y 15 personas que trabajan en la atenci��n de pacientes con c��ncer. Se realiz�� una entrevista en profundidad con todos los participantes y asociaciones libres, cl��sicas y por sustituci��n sobre las palabras ���c��ncer���, ���quimioterapia��� y ���trasplante de m��dula���. Los datos conseguidos se analizaron a la luz de la Teor��a de las Representaciones Sociales (TRS). El an��lisis de la informaci��n sigui�� la t��cnica de an��lisis cualitativo de contenido para encontrar significados simb��licos y construir, denominar y definir categor��as. Para los tres grupos el c��ncer es una enfermedad terrible, que puede llevar a la muerte. El personal de salud y la poblaci��n general creen que la enfermedad genera terror, angustia y miedo. Los pacientes tienen conciencia de la gravedad y del temor consecuente por una enfermedad que lo cambia todo, produce sufrimiento, dolor, obliga a depender de alguien y puede conducir a la muerte. El personal de salud considera que los pacientes lo pueden vivir como un castigo y la poblaci��n general que puede ser la consecuencia de estilos de vida poco saludables. Para todos, la quimioterapia es un tratamiento para la enfermedad, que por un lado presenta efectos colaterales dif��ciles y visibles y que producen sentimientos negativos de temor y de angustia y al mismo tiempo constituye una opci��n y posibilidad de curaci��n. El Trasplante de M��dula ��sea representa para todos una oportunidad.

Il consenso informato come strumento di esercizio del diritto alla salute per i pazienti stranieri?

L���elaborato propone una riflessione rispetto all���atto giuridico del consenso informato quale strumento garante dell���esercizio del diritto alla salute per i migranti. Attraverso una riflessione antropologica rispetto alla natura, alla costruzione e alla logica dei diritti universali, verranno analizzate le normative nazionali, europee ed internazionali a tutela del diritto alla salute per i migranti; l���obiettivo della ricerca �� indagare l���eventuale scarto tra normative e politiche garantiste nei confronti della salute migrante e l���esistenza di barriere strutturali che impediscono un pieno esercizio del diritto alla salute. L���ipotesi di ricerca si basa sulla reale capacit�� performativa del consenso informato, proposto solitamente sia come strumento volto ad assicurare la piena professionalit�� dell���operatore sanitario nell���informare il paziente circa i rischi e i benefici di un determinato trattamento sanitario, sia come garante del principio di autonomia. La ricerca, attraverso un���analisi quanti-qualitativa, ha interrogato il proprio campo, rappresentato da un reparto di ginecologia ed ostetrica, rispetto alle modalit�� pratiche di porre in essere la firma nei moduli del consenso informato, con particolare attenzione alle specificit�� proprie delle pazienti migranti. Attraverso l���osservazione partecipante �� stato quindi possibile riflettere su aspetti rilevanti, quali le dinamiche quotidiane che vengono a crearsi tra personale sanitario e pazienti, le caratteristiche e i limiti del servizio di mediazione sanitaria, le azioni pratiche della medicina difensiva. In questo senso il tema del ���consenso informato���, indagato facendo interagire discipline quali l���antropologia, la bioetica, la filosofia e la sociologia, si �� posto sia come lente di lettura privilegiata per comprendere le dinamiche relazionali ad oggi esistenti tra professionisti sanitari e popolazione migrante, ancora vittima di diseguaglianze strutturali, ma altres�� come ���innesco potenziale��� di nuove modalit�� di intendere la relazione medico-paziente.

Screening and treatment to prevent sequelae in women with Chlamydia trachomatis genital infection: how much do we know?

Background. An important question for chlamydia control programs is the extent to which finding and treating prevalent, asymptomatic Chlamydia trachomatis genital infection reduces reproductive sequelae in infected women. Methods. We reviewed the literature to critically evaluate evidence on the effect of chlamydia screening on development of sequelae in infected women. Results. Two randomized controlled trials of 1-time screening for chlamydial infection���in a Seattle-area health maintenance organization and a Danish school district���revealed that screening was associated with an ���50% reduction in the incidence of pelvic inflammatory disease over the following year. However, both of these trials had methodological issues that may have affected the magnitude of observed screening benefits and might limit generalizability to other populations. A large, nonrandomized cohort of chlamydia screening among US Army recruits, although limited by lack of outpatient data, did not find a benefit of similar magnitude to the randomized trials. Methodological limitations restrict valid conclusions about individual benefits of screening using data from historical cohorts and ecological studies. We identified no trials directly evaluating the effect of chlamydia screening on subclinical tubal inflammation or damage, ectopic pregnancy, or tubal factor infertility and no studies addressing the effects of >1 round of screening, the optimal frequency of screening, or the benefits of screening for repeat infections. Conclusions. Additional studies of the effectiveness of chlamydia screening would be valuable; feasible study designs may depend on the degree to which screening programs are already established. In addition, better natural history data on the timing of tubal inflammation and damage after C. trachomatis infection and development of more accurate, noninvasive tools to assess chlamydial sequelae are essential to informing chlamydia control efforts.

Correlates of tobacco cessation counseling among Hispanic physicians in the US: a cross-sectional survey study.

BACKGROUND: Physician advice is an important motivator for attempting to stop smoking. However, physicians' lack of intervention with smokers has only modestly improved in the last decade. Although the literature includes extensive research in the area of the smoking intervention practices of clinicians, few studies have focused on Hispanic physicians. The purpose of this study was to explore the correlates of tobacco cessation counseling practices among Hispanic physicians in the US. METHODS: Data were collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians practicing in New Mexico, and who were members of the New Mexico Hispanic Medical Society in the year 2001. Domains of interest included counseling practices, self-efficacy, attitudes/responsibility, and knowledge/skills. Returned surveys were analyzed to obtain frequencies and descriptive statistics for each survey item. Other analyses included: bivariate Pearson's correlation, factorial ANOVAs, and multiple linear regressions. RESULTS: Respondents (n = 45) reported a low level of compliance with tobacco control guidelines and recommendations. Results indicate that physicians' familiarity with standard cessation protocols has a significant effect on their tobacco-related practices (r = .35, variance shared = 12%). Self-efficacy and gender were both significantly correlated to tobacco related practices (r = .42, variance shared = 17%). A significant correlation was also found between self-efficacy and knowledge/skills (r = .60, variance shared = 36%). Attitudes/responsibility was not significantly correlated with any of the other measures. CONCLUSION: More resources should be dedicated to training Hispanic physicians in tobacco intervention. Training may facilitate practice by increasing knowledge, developing skills and, ultimately, enhancing feelings of self-efficacy.

The physician's perception of medical error and its application to the development of an educational training tool.

It is becoming clear that if we are to impact the rate of medical errors it will have to be done at the practicing physician level. The purpose of this project was to survey the attitude of physicians in Alabama concerning their perception of medical error, and to obtain their thoughts and desires for medical education in the area of medical errors. The information will be used in the development of a physician education program.

Learning through Listening: Conversations for Strategic Change in a Healtcare Provider

The aim of this paper is investigate the role of conversation in strategic change so as to enhance both theory and practice in this respect. As an investigation on how conversations shape change processes in practice, we reflect on an interpretive case study in a health care organization. Through an OD project complemented by semi-structured interviews with participants, we gained a set of data and experiences that allows us to inquire into the relationship between conversations and change in more depth.

Connecticut Poison Control Center. 2002 and 2003 Annual Report and Poison Exposure Statistics

The Connecticut Poison Control Center (CPCC) at the University of Connecticut Health Center (UCHC) was established in 1957 under Connecticut General Statute 10a- 132. The CPCC���s main responsibility is to provide 24-hour emergency toxicology management consultations for victims of poisoning, and serve as a source for pharmacology and toxicology-related information. The center monitors the epidemiology of human poisoning and provides surveillance for environmental and occupational chemical exposures, drug abuse, and pharmaceutical interactions and adverse effects. The CPCC performs toxicological research, and provides formal toxicology instruction for allied health professionals, as well as professional and consumer poison prevention education. The CPCC is one of 63 nationwide centers certified by the American Association of Poison Control Centers (AAPCC), and the only poison center in the state of Connecticut. The AAPCC establishes standards of care for poisoning and administers the Toxic Exposure Surveillance System (TESS), a national database of poisoning statistics, to which the CPCC is a contributor.

The effect of the shift from HMO to PPO plans on the prevalence of hospital bad debt in the insured population: A case study in two Houston-area hospitals

In spite of the dramatic increase and general concern with U.S. hospital bad debt expense (AMNews, January 12, 2004; Philadelphia Business Journal, April 30, 2004; WSJ, July 23, 2004), there appears to be little available analysis of the precise sources and causes of its growth. This is particularly true in terms of the potential contribution of insured patients to bad debt expense in light of the recent shift in managed care from health maintenance organization (HMO) plans to preferred provider organization (PPO) plans (Kaiser Annual Survey Report, 2003). This study examines and attempts to explain the recent dramatic growth in bad debt expense by focusing on and analyzing data from two Houston-area hospital providers within one healthcare system. In contrast to prior studies in which self-pay was found to be the primary source of hospital bad debt expense (Saywell, R. M., et al., 1989; Zollinger, T. W., 1991; Weissman, Joel S., et al., 1999), this study hypothesizes that the growing hospital bad debt expense is mainly due to the shifting trend away from HMOs to PPOs as a conscious decision by employers to share costs with employees. Compared to HMO plans, the structure of PPOs includes higher co-pays, coinsurance, and deductibles for the patient-pay portion of medical bills, creating the potential for an increase in bad debt for hospital providers (from a case study). This bad debt expense has a greater impact in the community hospital than in the Texas Medical Center hospital. ^

Texas laboratory healthcare workforce: Meeting the needs in 2015

The purpose of this research was to study groups of students and young professionals in the clinical laboratory science field using exploratory discovery and inductive logic regarding the attitudes of four groups in Texas: (1) 3rd and 4th year college biology students, (2) students currently enrolled in Clinical Laboratory Science/Clinical Laboratory Technician (CLS/CLT) programs, (3) young CLS/CLT professionals (1-2 years post education), and (4) mid-career CLS/CLTs (4-10 years post education). It was also a comparative study looking at these four groups and their attitudes and perception regarding: career selection factors and legislative incentive measures which might attract individuals to an allied health care career, the field of practice and factors needed to keep individuals in the chosen field of practice. ^ The study found that the career is attractive to individuals who enjoy laboratory work and find the various areas in which to choose to work very attractive. Government programs offering grants/scholarships or loan forgiveness programs offered by health care institutions would be beneficial in attracting students to study in the clinical laboratory sciences. Students are unsure if there is a viable career ladder associated with the field and are anticipating the possibility of going on to other fields in the future. ^ While young and mid-career professionals share many of the same points of view on some aspects (skills used, trends) of the CLS/CLT profession there were a few areas were opinions diverged; perceptions of the field itself and if they plan to remain in the profession for the next 5 years. The mid-career professionals had a much more negative outlook on the profession (low salary, no visible career ladder, lack of respect from other health care professionals) and only a small number plan to be in the field within the next 5 years. ^ The lower salaries in the profession as compared to other similar health care careers, lack of a career ladder and lack of respect from laboratory and institutional management and other health care providers are critical missing pieces to the retention of CLS/CLT professionals. ^