As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Carga de trabalho de enfermagem e infecções relacionadas à assistência à saúde na unidade de terapia intensiva

In recent decades, the search for quality care has been widely discussed by the institutions and health professionals. In this context, it is the nurse coordinator of the process of providing nursing staff, reflecting the commitment to quality of care. In this process, it is the appearance of Infections Related to health care and its potential association with the workload in nursing as a valuable indicator of quality of care. Thus, this research contributes to studies to characterize the demand of nursing work to promote a safe healthcare practice. This study aimed to identify the association of nursing workload with the number of cases of Ventilator-Associated Pneumonia, urinary tract infection and central venous catheter infection in the intensive care unit. This is a quantitative research approach, descriptive, cross-sectional and prospective, held at Unimed Hospital in Natal-RN. The study population consisted of all patients treated in the Intensive Care Unit, Hospital for a period of 90 consecutive days in 2011. The convenience sample was compostapelos patients admitted to the ICU during the period of data collection, a total sample of 286 patients. To perform the data analysis software were used: Statistica 6.0, SPPS (Statistical Package for Social Sciences) version 17.0 (2004) and Excel 2007. In the descriptive analysis, we used Measures of Central Tendency and Measures of Dispersion or Variability and the use of nonparametric tests. Of the 286 patients, 88 were from the ICU and 198 ICU II II. Males predominated in the ICU I (51.1%) and female ICU II (57.6%) patients in the ICU I were aged 61-80 years (39.8%) followed by greater than 80 years (39.8%). In the ICU II, most of the patients were aged 61-80 years (38.9%) and then from 41 to 60 years (24.2%). In relation to the class of TISS inlet predominant class II in the two ICUs (59.1%), followed by Class III also in the two units (34.6%). Most patients (70.6%) out of the ICUs belonging to class II TISS. In the ICU I, the average number of forms of the TISS 28 was 6, has in ICU II this value drops to 3.2 forms. The overall mean was 19.9 TISS points in ICU patients I and ICU II.the 17 points in the average hours required to provide adequate nursing care to patients in the ICU I found that is 10 , 7 hours, and the ICU II 9.2 hours. It was found that the time provided by the nursing staff were higher in ICU II, with an average of 19 hours available for nurses in this sector. In the ICU I, which showed higher need of available hours, it was found that the mean value of 12.7 available hours. It was found that only 2.4% of patients had these units Ventilator-Associated Pneumonia, 1.0% were infected central venous catheter and 1.4% of patients had urinary tract infection. Infection associated with health care occurs, on average, on the tenth day of hospitalization. In the ICU II, this average value extends to the twelfth day with an excess of 2.7 hours of nursing care while in ICU I value decays to the ninth day of hospitalization with a deficiency of 12-hour assistance. It is concluded that patients generally showed a need for classification of semi-intensive care and has been assisted in their need to load. As for his association with the Related Infections Health will assist this analysis could not be performed due to the small number of notifications in this period. It is suggested further study how other factors related to infections me a longer period of analysis

Enfermeiros pós-graduados: continuidades e rupturas no cotidiano profissional de hospitais universitários

A presente pesquisa teve como objetivo analisar as transformações do cotidiano profissional do enfermeiro do hospital universitário após a realização do curso de mestrado. Trata-se de um estudo com abordagem qualitativa, realizado no Complexo Hospitalar Universitário da UFRN, composto pelo Hospital Universitário Onofre Lopes (HUOL), Maternidade Escola Januário Cicco (MEJEC), e Hospital de Pediatria Professor Heriberto Ferreira Bezerra (HOSPED) localizados em Natal-RN; e pelo Hospital Universitário Ana Bezerra (HUAB) situado em Santa Cruz-RN. A população foi composta por vinte e dois enfermeiros, com título de mestre em enfermagem, que trabalham nessas instituições. Após encaminhamento e aprovação pelo Comitê de ética em pesquisa, conforme Parecer nº 268.498 e CAAE: 13922713.1.0000.5537, as entrevistas foram iniciadas, utilizando-se um roteiro semiestruturado, organizado em questões orientadas em conformidade com os objetivos do estudo. Do material empírico, emergiram as categorias que foram trabalhadas com base na análise de conteúdo temática, tendo como aporte teórico os estudos de Agnes Heller acerca do cotidiano e os de Paulo Freire sobre educação e mudanças, buscando a possível interlocução entre esses autores. Os resultados demonstram que o cotidiano dos enfermeiros nos hospitais universitários, após cursarem o mestrado, modifica-se a partir da própria motivação em cursálo e do apoio institucional recebido. As continuidades e rupturas apontadas estão distribuídas nas categorias: a inércia da cotidianidade, na qual os enfermeiros relatam a dificuldade em mudar seu cotidiano devido à rotina exaustiva e à falta de apoio; reconhecem mudanças particulares, compreendendo a formação de um olhar crítico/reflexivo/analítico, e a qualificação para o ensino e pesquisa; e as rupturas do cotidiano, que se referem às mudanças ocorridas no serviço, como a melhoria da assistência, pela implantação de resultados; e uma prática diferenciada por ter um profissional qualificado. Portanto, considera-se que a realização do mestrado contribuiu para o crescimento do intelectual e profissional do enfermeiro e, consequentemente, para o serviço, no cotidiano do Complexo Hospitalar Universitário, sendo reconhecido pelos enfermeiros o compromisso com uma maior responsabilidade social. Porém, ainda são necessárias reflexões sobre maneiras de minimizar as dificuldades apontadas, como forma de incentivar essa qualificação

Processo de trabalho na estratégia saúde da família: potencialidades e fragilidades da atuação do enfermeiro

The present study aims to analyze the nurse s work process at Family Health Strategy, considering its basic elements and dynamic, and searching to identify aspects that may constitute strengths and weaknesses in its development. This is an analytical case study, with qualitative approach and theoretical-conceptual mark grounded in Dialectic Hermeneutics. Empirical research fields were the Family Health Units of Natal, RN, Brazil. The subjects are nurses working in this Strategy. Data collection was conducted through semi-structured individual interviews combined with field observation. The research was initiated after approval by the Ethics Committee of Universidade Federal do Rio Grande do Norte, according to the guidelines and rules for research involving humans (Resolution 466/12), ensuring proper ethical precepts. The project was approved by register number 398.929, CAAE 19588813.7.0000.5537. From the 9 interviewed nurses, 8 were female and 1 male, average age of 52 years, average graduation time of 27 years and average time they stayed at the same Family Health territory of 7 years. It was found that it is up to the professional nurse in the Family Health care the important role of taking care of human beings in their life, family and community contexts, producing conditions to meet their needs through therapeutic act in health, using for such purpose both materials and immaterial instruments. It was possible to relate aspects that characterize strengths and weaknesses in the work process of nurses in the ESF, according to the speech of the interviewed workers, including the meanings and contradictions. Among the potentialities observed, it was possible to highlight the wide role of the nurse at Family Health; the perception of nurses about teamwork; the relative autonomy of nurses; the commitment of professionals to work; Humanization as a technology; the presence of other agents at work, such as directors and officers at the primary health units; the professional s experience time and contract type in the case studied. As weaknesses in the work process of nurses at Family Health Strategy, were highlighted the limited skills of the workforce; the difficulty in 10 identifying specific limits of the work of nurses in this scenario; the disturbances that occur in the process, the existing gaps in multiprofessional teams; Structural deficits of the units in the studied case, the low coverage of the Family Health in the county, and the political vulnerability of the work conditions. It is considered necessary to understand the dilemmas experienced in everyday life of nurses at Family Health Strategy as part of multiprofessional teams, facing actual achievement of changes in work processes necessary for the reorientation of health care in Brazil. In accordance, it is necessary to promote proper working conditions and welfare of labor agents which are protagonists the work at the United Health System

Fatores que afetam a satisfação e a fidelidade do consumidor: um estudo com usuários de calçado esportivo (tênis), na Região Sul da cidade de Natal

This paper aims to investigate the factors that influence the satisfaction and fidelity of tennis´s users with the region southern city of Natal, capital of Rio Grande do Norte as the area of analyzing , using the national satisfaction index models as a tool to study. In this study was used the questionnaire as a tool for collecting data based on the new Norwegian customer satisfaction barometer model proposed by Johnson et. al. (2001). The data collection took place during the months of May and June 2008, when 450 tennis´s users were interviewed. The main results obtained by multiple regression analysis and logistic regression showed that the users' satisfaction with the tennis´s brand is influenced by the quality, comfort, material used in the manufacture and price, while fidelity is potentized by the image of the brand and the satisfaction degree with the user's tennis and with the brand of tennis. In relation to user satisfaction with the tennis, that satisfaction is influenced by the quality, comfort, weight and the material used, while fidelity is potentized by the satisfaction with the tennis´s brand, with the possibility of paying the same amount again and the emotional commitment. As the processing of claims there was no direct influence on satisfaction and consumers fidelity due to the low number complaints

Gestão da satisfação e fidelidade do cliente : um estudo dos fatores que influenciam na satisfação e fidelidade dos clientes corporativos de telefonia celular

The competition in the telecommunications industry has grown in Brazil since the privatization, forcing companies that are active in the market to a growing commitment to quality products and services in order to survive. In this context, this work aims to understand the main factors that influence the degree of satisfaction exists in respect of a mobile operator with its corporate customers. The research covered theoretical concepts and analytical models of quality management system and models of indices related to the measurement of customer satisfaction. For the field research was carried out in a practical application of the main approaches based on this thesis by a case study in corporate segment, through a questionnaire applied to 10 consultants and 40 corporate customers of that company. Comparing the results of research with the consultants and corporate clients there is the concern of respondents to the indicators that comprise the constructs of customer satisfaction, commitment calculated, the price index and the handling of complaints, denoting the dissatisfaction of the general assessment for corporate customers with the carrier, against its current expectations. It is concluded that the mobile operator of the telecommunications industry have a big challenge, after ten years of privatization and consequently the period of rapid expansion of customer base and with the depleted, retain corporate customers as highly strategic, thus avoiding that migrate to other companies. We emphasize the need for further research and analysis of different approaches through research and using the same models to specifically evaluate and measure customer satisfaction of mobile enterprise, to adjust the model to the national market. Finally, we suggest the creation of an effective customer loyalty program with a strategy of relationship and specific to the corporate sector of mobile telephony

Modelagem de arranjos institucionais para implementação da diretriz de sistema de gestão de segurança e saúde ocupacional da organização internacional do trabalho ILO/OSH 2001 no brasil

The commitment assumed by Brazil to ILO in order to pursue actions toward the ILO/OSH-2001 adoption in the country poses the issue of modeling the institutional arrangement the set roles and relationship between government, standards organizations, health and safety organizations, professionals and other institutions to deploy the ILO/OSH-2001. This Thesis develop institutional arrangement models based on the current model and also in the ISO 9000 scheme and others. It is studied the US case with OSHA and VPP, the OHSAS 18001 and ANSI/AIHA Z-10, in addition to actual context of the regulating norms NR s. The scenarios developed are put to evaluation on feasibility, potential changes and effects on current MTE auditors work scheme. The main results are five scenarios developed and that the MTE auditors tend to be reactive to the change toward the ILO/OSH-2001.

Gestão da satisfação e fidelidade do cliente :um estudo dos fatores que influenciam a satisfação e a fidelidade no turismo regional

This Thesis presents a contribution to the study of models of customer satisfaction, analyzing the relationship between construct satisfaction and its antecedents and consequences, carrying through a survey with tourists who live in states of northeast region, had used to travel by bus or their own car and used hotel of Natal in the period from march to june at 2004. The theory research is focused in concepts of customer satisfaction and loyalty, quality management system models and customer satisfaction measurement index models. For the field survey was applied a model with questions based on the norwegian customer satisfaction barometer - NCSB considered for Johnson et al., 2001 with 92 tourists. The results gotten for the multiple regression evidence that tourist satisfaction with respect to the hotel suffer fort influences of six drivers of quality and complaints management. However the factors that influencing tourist loyalty with hotel are affective commitment, satisfaction with the hotel and the complaints management

Estratégia de produçãp agroindustrial :um estudo dos fatores que afetam a exportação do mel

This thesis approaches the situation of small and medium Brazilian companies facing the exportation process, focusing honey (Apis Mellifera). The world economy has had growing market internationalization, known as globalization. In this context, the exportation has to be faced as a way to minimize the inner market difficulties and increase the levels of quality and productivity to attend the external markets in a competitive way. A company exportation process is not linked to its dimensions, but connected to the commitment with quality, creativity and professionalism. The search for new productive frontiers has benefited Brazilian beekeeper, mainly the northeast ones. Besides, the claim for products that are free of chemical remains, with a bigger aggregate value has increased every day, and the Apismel Company is benefited for having potential to produce organic honey. This paper approaches a case study realized with Sixty-nine beekeeper from Serra do Mel, RN, that make the Apismel Company and it aims to investigate the competitive factors that affects honey exportation. In order to obtain subsidies to execute the objective of this work, it was chosen a questionnaire as instrument of research. The questionnaire was structured from variables that were considered as directions of competition in honey exportation. The results were tabled in Software (Statistics version 11.0). The descriptive, exploiter and Kolmogorov-Smirnov analyses were used to analyze the obtained results. At the end, this work recommends that the Apismel Company promote capacitating courses and technical consultations at the many villages that make the county, to ripen and add efficiency in handling implementation in order to equilibrate production factors and to attract inner and external markets

Gestão de satisfação e fidelidade do cliente na hotelaria :um estudo sobre os fatores que influenciam a satisfação e a fidelidade do turista internacional no Brasil

The objective of this thesis was studying the factors which contribute to customer s satisfaction and loyalty, focusing the Norwegian model of satisfaction and loyalty of the consumer, applied in the sector of hotel services in Natal/RN, Brazil. The theoretical research was led through the concepts of service quality, customer satisfaction and loyalty, models of quality management systems, national index of customer s satisfaction and methods which evaluate the customer s satisfaction. The field research was carried through from December 1st of 2004 to 24 st, among 381 international tourists who had been housed in the hotels of Natal. The analyses of the data had been made through the descriptive statistics and analysis of multiple regression. The results had evidenced that the main precedents variables of satisfaction had been: hotel s room, staff friendliness, hotel restaurant food and price paid; these are factors which explained, in 56,0% the variation of satisfaction with hotels. In relation to the constructs which had influenced the tourist s loyalty, were founds: tourist s satisfaction, hotel image and affective commitment, which had explained 53.0% of the data variability. The complaint management resulted as a basic factor for the tourist s satisfaction and loyalty

Medição de satisfação e fidelidade do cliente :um estudo com pacientes de clínica particular

This Thesis deals with a study on customer satisfaction and loyalty measurement focusing on a model of factors antecedents of customer satisfaction and loyalty. The model is based on a Satisfaction Index model adopted in Norway developed by Johnson et al.(2001) and the service quality drivers from the literature. It is surveyed a sample of 130 patients of a gynecology clinical. It is used a multiple regression analysis as the main statistical method in order to verify the factors affecting satisfaction and loyalty. The main findings are that the quality model explain 54% of the satisfaction but the whole model explain only 31% of the loyalty. Although the results are consistent with the literature in term of quality as the main driver of the satisfaction and that the satisfaction is not only one factor to explain loyalty, both the quality model to satisfaction and the factors model affecting loyalty should be improved to explain better the satisfaction and loyalty in health care service

Gestão da satisfação e fidelidade do cliente: um estudo em uma instituição de ensino superior

This Master of Science Thesis deals with the customer satisfaction and loyalty focusing on a private higher education institution in Belém city, Brazil. The literature review focuses on costumer satisfaction and loyalty concepts and theory, models of quality managing systems and methodologies of costumer satisfaction measurement. The research was a survey with a random stratified sample of 329 undergraduate students of Business Administration at the Faculdade do Pará , in the morning and the night periods. The data analysis was made through the descriptive statistics and multiple regression analysis. The main findings are that the model was satisfactory and the main factors affecting Satisfaction to the School were Best Professor Didatics (beta=0.297), Courses Contents (beta=0.280), Clerks Sympathy (beta=0.201), and Number of Students in Classroom (beta=0,187) with a adjusted R2 = 0,47. The main factors affecting School Loyalty with an adjusted R2 = 0,43 were School Image (beta=0.383), Affective Commitment (beta=0.255), and Satisfaction with Professors (beta=0,218). The findings suggest also that may be differences between the set of students and those that complain for something

Fatores da satisfação e fidelidade de clientes: um estudo no setor de telefonia móvel celular

This thesis deals with the factors affecting customer satisfaction and loyalty in the mobile phone telecom sector. It is adapted a model proposed by Johnson et al. (2001) of quality and loyalty antecedent factors. It is conducted a survey with a sample of 385 customers of mobile phone telecom sector in Teresina city, a capital of a Northeastern State of Brazil, and descriptives and multiple regression statistical analysis. The main findings related to satisfaction are that quality and service price are the significant factors affecting it. Regarding loyalty, satisfaction, image, affective commitment, and calculate commitment are the significant factors to explain it. The overall model used fairly explain the satisfaction and loyalty outcomes

Fatores que afetam a satisfação e a fidelidade do cliente: um estudo com compradores de automóveis

This thesis presents a contribution to the study customer satisfaction models, analyzing the relationship between antecedent variables satisfaction and customer loyalty, through a survey with car s buyers in Natal. The theorical survey is focused in concepts of customer satisfaction and loyalty, and in the customer satisfaction index models. For the field survey, was applied a questionnaire, based on the Norwegian Customer Satisfaction Barometer (NCSB), considered by Johnson et al. (2001), with 106 customer of concessionary Fiat, the Pontanegra Automóveis. The main results obtained by the multiple regression analysis reveal that, considering the Fiat, the satisfaction is influencing by reliance degree in the firm seriousness and by complaining handling, the loyalty is influenced by possibility of again pay the same value if was again buy a car, the satisfaction degree with a car, affective commitment relationship firm customer of the own car and the complaining handling. Considering the concessionaire, the satisfaction is influenced by reliance degree in the firm seriousness, ability degree of the concessionaire in delivery service and by complaining handling, already the loyalty is influencing by possibility of again pay the same value if was again buy a car, affective commitment relations to be concessionaire s customer, by calculate commitment in relation the economic loss of bought this car of this firm and complaining handling

Gestão de satisfação e fidelidade do cliente: um estudo com turistas em hotéis

This Thesis deals with a study on customer satisfaction and loyalty focusing on a model of factors antecedents of customer satisfaction and loyalty. The model is based on a Satisfaction Index model adopted in Norway developed by Johnson et al.(2001) and the service quality drivers from the literature. It is surveyed a sample of tourist in Natal. It is used a survey questionnaire applied at the airport in the departure moment of the tourist. The final sample results on 198 cases. Is is used a multiple regression analysis as the method to verify the factor affecting satisfaction and loyalty. Two models arise from the analysis. The first model concerning satisfaction results with cleaness and hygiene of the bathroom, leisure facilities, employees promptness, and price as the significant factors affecting satisfaction. The model has a R2 of 0.6430 and the also check in service, cleaness of the apartment and the hotel in general, bedroom setting have colinearity with some factors entering the model. The loyalty model results with satisfaction, affective commitment as the main factors affecting loyalty, with a R2 0.5396, and also image has collinearity with satisfaction. A small part of the sample has complained and this factor was not considered in the models. The results are consistent with the literature in term of quality as the main driver of the satisfaction and that it is not the only one factor to explain loyalty