Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

A avaliação da atenção básica e o trabalho dos agentes comunitários de saúde: implantação do PMAQ-AB na região do Médio Paraíba Fluminense

Este estudo tem por objeto a implantação do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) na região do Médio Paraíba fluminense sob o olhar dos Agentes Comunitários de Saúde e dos gestores da Atenção Básica. A indagação norteadora desta pesquisa foi: em que medida o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) capta a importância do trabalho dos Agentes Comunitários de Saúde? Partindo do pressuposto que o desenvolvimento do PMAQ não se dá, no concreto, de forma linear nem livre de tensões, e que o trabalho do ACS, por seu caráter de mediação, é um campo privilegiado para análise sobre essas tensões. O objetivo geral do estudo é analisar a implantação do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) nos municípios da região do Médio Paraíba do Estado do Rio de Janeiro, tomando como eixo de análise o processo de trabalho dos agentes comunitários de saúde. O estudo apresenta uma abordagem quantitativa e qualitativa, através de questionários, entrevistas e grupos focais e o método de análise dos dados qualitativos foi de base interpretativa com apoio do referencial da Hermenêutica-Dialética. O campo da pesquisa foi a região do Médio Paraíba fluminense. Os resultados evidenciam que na opinião dos gestores, o PMAQ aparece como uma estratégia norteadora do processo de trabalho das equipes, que possibilita o resgate de alguns princípios da ESF, já os ACS apontam que o seu primeiro contato com o PMAQ foi fundamentado na pactuação do cumprimento de metas que resultariam no pagamento de um incentivo financeiro. Percebemos que não existe uma crítica quanto a implantação do PMAQ, nem por parte da gestão, muito menos por parte das equipes. Não encontramos nos relatos dos gestores nenhuma menção ao trabalho do ACS, sua participação e importância em todas as fases do PMAQ. Os gestores consideram que o PMAQ promoveu uma mudança positiva na forma de organização do trabalho dos ACS. Os ACS não perceberam mudanças em sua rotina a partir da implantação do PMAQ, exceto pela questão da sobrecarga de trabalho. Conclui-se que o PMAQ-AB não capta a potencialidade e o trabalho dos ACS. A participação do ACS nas fases do PMAQ é identificada somente no aspecto instrumental, ou seja, dele ser um produtor, um registrador de informações.Para os gestores o PMAQ surge como algo que abre um horizonte positivo, de maior envolvimento e retomada de alguns processos pelas EAB, mas não é assim, de fato, que a questão chega até os ACS e, por consequência, nem para as equipes.

Avaliação da qualidade de serviços de saúde mental um estudo de caso do CAPS Profeta Gentileza

Este estudo visa potencializar a discussão sobre metodologias avaliativas delineadas para os serviços de saúde mental. A questão que orienta a pesquisa é como avaliar um serviço de saúde do tipo Centro de Atenção Psicossocial (CAPS). Realizamos pesquisa avaliativa, em formato de estudo de caso, de um CAPS localizado na Zona Oeste do município do Rio de Janeiro. Apresentamos dados quantitativos e qualitativos sobre a assistência prestada no serviço, referentes a pacientes matriculados e encaminhados em um período de seis meses. O estudo contou com a observação participante do pesquisador, coleta de dados em prontuários e registros oficiais da unidade e discussão de casos clínicos em reunião com a equipe multiprofissional. Procedemos a considerações avaliativas sobre o serviço estudado, privilegiando os eixos de análise: acesso, acolhimento e acompanhamento.

Avaliação da assistência pré-natal, com ênfase nos processos de orientação às mulheres: o ponto de vista das puérperas

O período pré-natal é uma época de preparação física e psicológica para o parto e a maternidade e, como tal, é um momento de intenso aprendizado e oportunidade para os profissionais da equipe de saúde desenvolverem a educação como dimensão do processo de cuidar. O Ministério da Saúde preconiza que a atenção obstétrica e neonatal prestada pelos serviços de saúde deve ter como características essenciais o acolhimento, a qualidade e a humanização; o profissional deve ser um instrumento para que a gestante adquira autonomia no agir, aumentando a capacidade de enfrentar situações de estresse e crise, e decida sobre a vida e a saúde. Entre os procedimentos do pré-natal, importância especial precisa ser dada a um conjunto de orientações sobre questões ligadas aos cuidados durante a gestação e com o bebê, que vão desde as recomendações para o aleitamento materno até as relativas ao uso de medicamentos durante a gestação. Isso só se torna possível quando o profissional escuta as queixas e dúvidas apresentadas pelas mulheres. Esta pesquisa tem como objetivo analisar a percepção das mulheres sobre o atendimento recebido no pré-natal, parto e pós-parto, avaliar as práticas assistenciais voltadas ao acolhimento, humanização e integralidade, e conhecer as representações de acolhimento, humanização e integralidade da assistência articuladas pelos profissionais de saúde envolvidos no atendimento às mulheres. Por fim, são analisadas as representações profissionais sobre as necessidades e práticas no atendimento às demandas reais das mulheres. A análise comparou sobretudo as narrativas das mulheres com as diretrizes preconizadas para o pré-natal na perspectiva da construção da integralidade e da autonomia das mulheres. As narrativas das entrevistadas mostraram a ausência de sistematização na assistência pré-natal, com grande diversidade de posturas dos profissionais. Muitos temas que deveriam ser objeto de conversa durante o pré-natal não foram tratados nos atendimentos, e diversas mulheres utilizaram outras fontes de informação que não os serviços de saúde para sanar suas dúvidas. Na conclusão, destaca-se a dificuldade de praticar de modo eficaz as orientações preconizadas no pré-natal, e busca-se, a partir das pistas obtidas ao longo do trabalho, indicar possíveis fatores-chave para a superação dessa dificuldade.

Avaliação da atenção à saúde de portadores de HIV no centro de referência para o tratamento da Aids em Natal/RN por profissionais e usuários do serviço

Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Avaliação da assistência ao paciente e/ou diabético na Estratégia Saúde da Família

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Construção e evidências de validação de instrumentos de pesquisa para avaliação da assistência nos centros de atenção psicossocial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Investigação sobre qualidade de vida e qualidade de vida relacionada com a saúde

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Avaliação do programa saúde da família no Rio Grande do Norte

The Family Health Program implemented in Brazilian municipalities from 1994 represents today the most promising proposal to promote important changes in municipality`s health systems, to allow universal access to health care, comprehensiveness, equity and to promote social control, achievements provided by the health reform process and incorporated to the Unified Health System principles. However, many are the challenges imposed to the Family Health Program so that it can cause these advances. In this study, we aimed to answer the following research question: what are the results of the Family Health Program in relation to beneficiaries at small, medium and large municipalities? The hypothesis that guided this work was that the variation in levels of achievement/results (strict, impacts and effects) of the Family Health Program is related to the size of the municipalities. Therefore, our general aim was to evaluate the results of the Family Health Program in municipalities at Rio Grande do Norte, Brazil. And as specific objectives, to measure strict results, effects and impacts of the Program, from the criteria of efficiency and effectiveness on the beneficiated population, and to measure the Program`s impact on the organization of municipality`s health system. This is an impact assessment research, developed from multiple case studies with quanti-qualitative approach. The study included small municipalities (Acari and Taipu), midsize (Canguaretama and Santa Cruz) and large (Natal and Mossoró). The individuals chosen to the research were users/beneficiaries of the Program and health professionals. Data analysis was performed using descriptive statistics and content analysis compared from the Program`s logical /theoretical model. The results obtained in relation to the principles evaluated (universality, comprehensiveness and community participation) presented that municipalities show different results, although not directly related to the size, but related with characteristics of the Program`s implementation form in each municipality and the arrangements made for its operationalization. The positive effect that generated significant change in people`s lives has been linked to the increase of access and to the decrease of geographic barriers. However, to the municipal health system, regarding the changes desired by the Program, it was not observed a positive impact, but a negative impact related to the increase of barriers for the user to access other levels of the health system

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

Avaliação da estratégia saúde da família na capital potiguar

This research aimed to evaluate the Family Health Strategy (FHS) in Natal, Rio Grande do Norte, through its managers, professionals and users, having as its support the Theory of Belief and the Cognitive-Behavioral Theory. This is a multimethod research and is divided into three sub-studies. In the first study, nine managers answered to a semi-structured interview, to verify the knowledge and beliefs on SUS; the quantitative data were analyzed with descriptive statistics with the aid of SPSS software and the qualitative data were submitted to lexical analysis with support of ALCESTE software. In the second study, we have a descriptive correlational research in which the antecedent variables are related to working conditions in the family health units (FHUs) and to the professionals‟ profile; the corresponding variables refer to the evaluations of the FHS; a stratified probabilistic sample with 475 professionals, who answered to two scales, both consisting of three factors: Physical infrastructure, Material resources, and Treatment effectiveness, and data were analyzed using descriptive, bivariate and multivariate statistics, with the aid of SPSS. The third study is a descriptive correlational research in which the antecedent variables refer to the treatment in the FHUs and to the users‟ profile, and the corresponding variables refer to the evaluations of the FHS, with a stratified non-probabilistic sample with 390 users, who contributed to the construction of a new scale with a factor, effectiveness in treatment, analyzed through descriptive, bivariate and multivariate statistics, with the aid of SPSS. The results showed problems which start from management, under the shape of admission due to political indication and lack of knowledge on SUS and the FHS; they pass through the low tenure of professionals and insufficient professional; and they end up spreading all over the analyzed items: infrastructure of FHUs, material resources, professionals‟ training, accessibility and referral system. One concludes that, despite following an ideal model, the FHS is in need of changes with regard to the barriers to its operational reality

Uso do AHP na avaliação do desempenho do sistema de gestão da qualidade, meio ambiente e segurança e saúde ocupacional integrados

The paper analyses the application of the AHP method together with the attach A of ISO 9004:2000 in order to evaluate the performance of two industrial organizations, both possessing quality management systems with ISO 9001:2000 certifications, based on the specific requirements of quality, environment, occupational health and management systems. The evaluated organizations were a government-owned company from the science and technology sector that works in the nuclear area, and a private company that works in the automotive and railroad area. The open software Web-Hipre version 1.22 from Helsinki University of Technology, Finland, was used. The results demonstrated that the AHP method together with the attach A of ISO 9004:2000 is adequate to evaluate organizational performances. Both organizations presented similar performance levels.

Avaliação da assistência pré-natal no município de Botucatu-SP na perspectiva dos diferentes modelos de atenção básica

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Constituição cidadã e representações sociais: uma reflexão sobre modelos de assistência à saúde

Este artigo apresenta uma reflexão sobre o significado dos termos cidadania e saúde, abordando a Teoria das Representações Sociais como estratégia para implementação e avaliação dos modelos de assistência a saúde no Brasil. Na primeira parte, traçamos um breve histórico sobre a concepção de cidadania; na segunda, tratamos dos princípios de liberdade e igualdade pautados no pensamento de Kant; na terceira, evidenciamos a saúde como um direito do cidadão e um dever do estado; por fim, destacamos a Teoria das Representações Sociais como estratégia para avaliar e implementar os serviços de saúde prestados ao cidadão pelos modelos assistenciais de saúde em vigor no Brasil.