I vår tid växer nya generationer upp i ett samhälle med hög förändringstakt. Ur ett personsäkerhetsperspektiv innebär förändringsintensiteten en osäkerhet gällande vilka potentiella risker vi utsätts för. Risker kan identifieras och hanteras genom ett systematiskt säkerhetsarbete. Det kräver en god säkerhetskultur som bland annat innebär att samtliga individer inom en organisation vet hur det ska påtala risker för sin arbetsgivare och känner sig trygga att göra det (Reason, 1997; Power, 2007). Arbetsmiljölagen (1977:1166) föreskriver att risker ska identifieras och hanteras i ett systematiskt arbetsmiljöarbete. Samtidigt rapporteras att ca trettio procent av tusen grundskollärare upplever någon form av risk i samband med att föra fram kritik till eller om sin arbetsgivare (Helte, 2011). Hur påverkar den situationen förekomsten av internrapportering, förmåga att hantera risker och att dra lärdom av händelser? Är skolan en lärande organisation? Syftet med studien är att få en inblick i hur riskbilden kan se ut på en skola och, belysa hur fyra pedagoger upplever kulturen på sin arbetsplats, generellt och i förhållande till det systematiska arbetsmiljöarbetet enligt arbetsmiljölagens (1977:1166) intentioner. Studien genomfördes som en kvalitativ fallstudie. Studiens resultat visar att i samtliga fall var avsaknaden av en god säkerhetskultur med systematisk och strukturell approach anmärkningsvärd, även på de skolor som hade en trygg och öppen kultur. Den riskbild som framkom i intervjuerna omfattade risker i den psykiska och fysiska arbetsmiljön. Riskerna var tätt sammanlänkade med den pedagogiska verksamheten. Informanterna förmedlade behov av ökat systematiskt säkerhetsarbete och nämnde flera önskvärda effekter inom hela verksamheten som detta skulle kunna medföra. / In our time, new generations grow up into a society of rapid change. From a personal security point of view, the high rate of change implies an uncertainty regarding which potential dangers we will face. Risks can be identified, addressed and managed through Systematic Safety Work. It requires a good safety culture which among other things means that everyone knows how they are supposed to report risks to their employers and that they are comfortable doing so. (Reason; 1997; Power, 2007). The Work Environment Act (1977:1166) stipulates that risks are to be identified and managed in a Systematic Safety Work. At the same time it is reported that about thirty percent of one thousand teachers experience some kind of risk expressing criticism to or about their employers. (Helte, 2011). How does this affect internal reporting, ability to manage risks and to learn from incidents? Is school a Learning Organization? The purpose of this study is to gain insight into what kind of risks there are in school and to illustrate how four teachers experience the culture in their workplaces, generally and in relation to Systematic Safety Work according to the intentions of the Work Environment Act (1977:1166). The study was conducted as a qualitative case study. Our results demonstrate that in all cases there was a notable lack of good safety culture including systematic and structural approach. This also applied even to the schools with a confident and open culture. The risks which were expressed in the interviews concerned both mental and physical work environment. The risks were closely interconnected with the educational activities. Informants conveyed the need for increased Systematic Safety Work and mentioned several desirable effects in the whole school organization as a result.

Ce travail de didactique des mathématiques s'appuie sur le cadre de la Théorie des Situations Didactiques et s'intéresse à l'action conjointe des professeurs et des élèves dans un environnement numérique et à la dynamique que cette action conjointe engage. Il s'appuie aussi sur le cadre théorique de l'approche documentaire, qui complète et prolonge le cadre de l'approche instrumentale : les artefacts numériques présents dans cet environnement sont ainsi considérés comme des éléments du système documentaire des professeurs et des élèves. Considérant l'intégration de ces artefacts dans la classe ordinaire de mathématiques, nous mettons en évidence l'importance de moments particuliers, que nous nommons incidents didactiques, qui engagent des perturbations modifiant la dynamique de la classe. En développant cette notion d'incident didactique, nous construisons un cadre d'analyse permettant de mettre en évidence des phénomènes de genèse documentaire des enseignants et des élèves et d'en suivre les effets, à court ou à long terme, sur l'enseignement et l'apprentissage des mathématiques. Nous montrons que les incidents didactiques peuvent être, sous certaines conditions, des occasions de réorganisation locale et globale des connaissances pour le professeur dans le cadre de son enseignement ou pour l'élève dans son apprentissage des mathématiques

Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine: (i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia; (ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and (iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards. Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year. For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers. Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated. Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation. For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established. The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill. The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident. The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents. Discussion: The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents. Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved. The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.

The problem of Third Party Interference (TPI) on Oil and Gas Pipelines is on the rise across the world. TPI is not only common in developing countries but is now occasionally experienced in developed countries including Germany and the UK. The risks posed by these third-party activities on Oil and Gas pipelines are enormous and could be measured in terms of financial costs, environmental damages as well as health and safety implications. The quest for an end to these malicious activities has triggered a lot of studies into the root causes of pipeline TPI, other causes of pipeline failure, risks associated with pipeline failure and their mitigation measures. However, despite the significance of the effects of TPI, very little has been done to proffer an enduring solution through research. This research therefore aims at developing a framework for integrated oil and gas pipeline monitoring and incident mitigation system through integration of various wireless sensors for effective monitoring of oil and gas pipelines. Having identified the existing gaps in literature as lack of reliable, accurate and standard method for oil and gas pipeline risk assessment model, the study undertook a quantitative approach to develop an effective Quantitative Risk Assessment (QRA) model for pipelines. The QRA model developed benchmarks pipeline risk assessment and gives the parameters with which standard QRA could be measured. The research findings indicate that risk associated with Nigerian Pipeline system is in the intolerable region whereas TPI is an increasing menace across the globe. Further findings show that Support Vector Machine (SVM) gave the best performance with 91.2% accuracy while Neural Networks (NN) and Decision Tree (DT) gave 63% and 57% accuracies respectively in terms of pipeline failure mode prediction accuracies. It was recommended that operators should draw out Pipeline Integrity Management (PIM) programs and store pipeline data in a format that captures number of fatalities, property damages and costs as well as volume of oil or gas spilled to ensure that accurate data is obtainable for improved PIM. In conclusion, having achieved its aim and objectives evidenced by the framework, model developed, and the recommendations presented, the research has contributed in no small measure to providing a solution to pipeline incidences.

Este trabalho aborda a aplicação da Geomática no apoio às ações de rápida resposta às emergências ambientais passíveis de ocorrência, nas rodovias do País, por incidentes com produtos perigosos. A cadeia logística nacional de infraestrutura de transporte de carga está apoiada, principalmente, no modal rodoviário, que é responsável por cerca de 60% do volume total transportado. Seguindo essa tendência, a maioria dos produtos perigosos também é transportada através de estradas. Nessas operações, apesar de todas as medidas de segurança empregadas, tanto na embalagem quanto no manuseio, há sempre a possibilidade da ocorrência de incidentes com esse tipo de carga, no deslocamento entre o ponto de partida e o destino final. Diante dessas potenciais ameaças, ficam evidentes os riscos à integridade física e patrimonial das populações lindeiras, bem como ao meio ambiente, no tocante à qualidade das águas superficiais e subterrâneas, do solo e do ar. Este trabalho sugere, com base na integração dos recursos tecnológicos do Sensoriamento Remoto, do Sistema de Posicionamento Global-GPS e do Geoprocessamento, implantar um sistema de informações georreferenciadas que proporcione os elementos necessários às ações de rápida resposta a esses eventos. A estrutura proposta, denominada Bureau de Informações Territoriais, está moldada para proporcionar uma solução para os problemas relacionados com o posicionamento na superfície terrestre, e que engloba os conceitos da Geomática, através da aplicação das suas quatro etapas básicas: coleta de dados, análise de dados, distribuição da informação e uso da informação. Assim, atendendo ao princípio da mobilidade, o projeto visa, ainda, a disponibilizar na tela de um laptop as informações necessárias ao planejamento e à execução das ações, no menor tempo possível. Por outro lado, considerando que o Bureau também proporciona às organizações que participam das ações de combate aos incidentes rodoviários com produtos perigosos as informações necessárias, através de uma conexão à Internet, espera-se a maximização dos benefícios do planejamento das ações preventivas e corretivas de resposta aos sinistros, assim como a minimização dos efeitos desse tipo de evento sobre a população, as propriedades e o meio ambiente. / This work proposes the application of Geomatics in support to actions of fast response to environmental emergencies derived from incidents in transportation of dangerous goods on Brazilian roadways. The national cargo transportation network utilizes, mainly, the road modal, which responds for aproximately 60% of the total volume transported. Following this modal utilization, the majority of dangerous goods flows through the roads as well. Despite the use of all safety procedures in the packing and handling stages of dangerous goods transport operations, there is always the possibility of incidents, specially in trips from origins to final destinations. This possibility or, in other words, this potential threat, obviously gives rise to risks to the integrity of assets and health of communities located alongside the roads. In addition to that, environmental risks also arise in the form of contamination of the soil, the air and the surface and underground water. This work, by integrating technological resources, such as Remote Sensing, Global Positioning System (GPS), and Geoprocessing, suggests the implantation of a georreferenced information system, which provides the elements needed for actions of fast response to these events. The proposed system, termed the Territorial Information Bureau, has a structure built to solve problems related with the positioning of sites on the earth surface. It integrates the Geomatics concepts through the application of its four basic stages: data collection, data analysis, information distribution and information use. Thus, complying with the mobility principle, the system still aims at displaying on laptop screen the necessary information for the planning and the execution of actions of response to these events, at the shortest time possible. On the other hand, considering that the Bureau provides, through an Internet connection, the necessary information to those organizations involved in the actions of response to road incidents, it is expected a maximization of benefits of the planning of the preventive and corrective actions of response, as well as a minimization of the effects of such events on the population, assets and the environment.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-04-20T11:34:30Z No. of bitstreams: 1 arquivo total.pdf: 2536313 bytes, checksum: bf528ab534ff5a996c8f2eda9196a851 (MD5) / Made available in DSpace on 2016-04-20T11:34:30Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 2536313 bytes, checksum: bf528ab534ff5a996c8f2eda9196a851 (MD5) Previous issue date: 2015-02-24 / Over the past decades, alternative views to the traditional approach of occupational accidents have emerged, fact that expands the perimeter of analyzes and paves the way to questioning about the assumptions concerning concepts of security in the work environment. Therefore, this study aims to describe the relationship of risk factors and unsafe behavior in the constitution of incidents and accidents at work, during the period of 2012-2014 in the production sector of a food factory in the state of Paraíba. The obtained results, by means of mathematical modeling based on Multiple Linear Regression Models, showed that occupational accidents and incidents are explained by a coefficient of determination of 63,55%, by the risk factors and the unsafe behaviors caused by workers. However, when analyzing the correlation between unsafe behaviors due to the risk factors, it was obtained a coefficient of determination of 38% characterized as a low correlation among the observed variables; such fact is enhanced by the perception of workers, analyzed by Hypothesis Test for Proportion with α = 5% (significance level), which identified that only two risk factors – environment temperature and discomfort when using Personal Protective Equipment (PPE) – have a strong association with the unsafe behaviors of removing the arms protectors, gloves and face shield during operational activities. In spite of that, it was found that there is a strong association between these two risk factors, which allowed significant conclusions. / Nas últimas décadas, surgiram visões alternativas à abordagem tradicional de acidentes de trabalho, fato que amplia o perímetro das análises e abre caminho para questionamentos acerca dos pressupostos relativos às concepções de segurança nos ambientes de trabalho. Portanto, este trabalho tem, como objetivo, descrever a relação dos fatores de riscos e comportamentos inseguros na constituição dos incidentes e acidentes de trabalho no período de 2012 a 2014 no setor de produção de uma fábrica de alimentos localizada no estado da Paraíba. Os resultados obtidos, através de modelagem matemática baseada em Modelos de Regressão Linear Múltipla, mostraram que os acidentes e incidentes de trabalho são explicados através de um coeficiente de determinação de 63,55%, pelos fatores de risco e pelos comportamentos inseguros provocados pelos trabalhadores. Entretanto, ao analisar a correlação entre os comportamentos inseguros em função dos fatores de risco, obteve-se um coeficiente de determinação de 38%, caracterizada como uma baixa correlação entre as variáveis observadas; tal fato é reforçado pela percepção dos trabalhadores, analisada através de Teste de Hipótese para Proporção com α = 5% (nível de significância), a qual possibilitou identificar que apenas dois fatores de risco – temperatura do ambiente e desconforto na utilização dos Equipamentos de Proteção Individual (EPI) – têm uma forte associação com os comportamentos inseguros de retirar o mangote para proteção de braços, as luvas e o protetor facial durante as atividades operacionais, entretanto, constatou-se que há uma forte associação entres esses dois fatores de risco, o que permitiu conclusões significativas.

Este trabalho aborda a aplicação da Geomática no apoio às ações de rápida resposta às emergências ambientais passíveis de ocorrência, nas rodovias do País, por incidentes com produtos perigosos. A cadeia logística nacional de infraestrutura de transporte de carga está apoiada, principalmente, no modal rodoviário, que é responsável por cerca de 60% do volume total transportado. Seguindo essa tendência, a maioria dos produtos perigosos também é transportada através de estradas. Nessas operações, apesar de todas as medidas de segurança empregadas, tanto na embalagem quanto no manuseio, há sempre a possibilidade da ocorrência de incidentes com esse tipo de carga, no deslocamento entre o ponto de partida e o destino final. Diante dessas potenciais ameaças, ficam evidentes os riscos à integridade física e patrimonial das populações lindeiras, bem como ao meio ambiente, no tocante à qualidade das águas superficiais e subterrâneas, do solo e do ar. Este trabalho sugere, com base na integração dos recursos tecnológicos do Sensoriamento Remoto, do Sistema de Posicionamento Global-GPS e do Geoprocessamento, implantar um sistema de informações georreferenciadas que proporcione os elementos necessários às ações de rápida resposta a esses eventos. A estrutura proposta, denominada Bureau de Informações Territoriais, está moldada para proporcionar uma solução para os problemas relacionados com o posicionamento na superfície terrestre, e que engloba os conceitos da Geomática, através da aplicação das suas quatro etapas básicas: coleta de dados, análise de dados, distribuição da informação e uso da informação. Assim, atendendo ao princípio da mobilidade, o projeto visa, ainda, a disponibilizar na tela de um laptop as informações necessárias ao planejamento e à execução das ações, no menor tempo possível. Por outro lado, considerando que o Bureau também proporciona às organizações que participam das ações de combate aos incidentes rodoviários com produtos perigosos as informações necessárias, através de uma conexão à Internet, espera-se a maximização dos benefícios do planejamento das ações preventivas e corretivas de resposta aos sinistros, assim como a minimização dos efeitos desse tipo de evento sobre a população, as propriedades e o meio ambiente. / This work proposes the application of Geomatics in support to actions of fast response to environmental emergencies derived from incidents in transportation of dangerous goods on Brazilian roadways. The national cargo transportation network utilizes, mainly, the road modal, which responds for aproximately 60% of the total volume transported. Following this modal utilization, the majority of dangerous goods flows through the roads as well. Despite the use of all safety procedures in the packing and handling stages of dangerous goods transport operations, there is always the possibility of incidents, specially in trips from origins to final destinations. This possibility or, in other words, this potential threat, obviously gives rise to risks to the integrity of assets and health of communities located alongside the roads. In addition to that, environmental risks also arise in the form of contamination of the soil, the air and the surface and underground water. This work, by integrating technological resources, such as Remote Sensing, Global Positioning System (GPS), and Geoprocessing, suggests the implantation of a georreferenced information system, which provides the elements needed for actions of fast response to these events. The proposed system, termed the Territorial Information Bureau, has a structure built to solve problems related with the positioning of sites on the earth surface. It integrates the Geomatics concepts through the application of its four basic stages: data collection, data analysis, information distribution and information use. Thus, complying with the mobility principle, the system still aims at displaying on laptop screen the necessary information for the planning and the execution of actions of response to these events, at the shortest time possible. On the other hand, considering that the Bureau provides, through an Internet connection, the necessary information to those organizations involved in the actions of response to road incidents, it is expected a maximization of benefits of the planning of the preventive and corrective actions of response, as well as a minimization of the effects of such events on the population, assets and the environment.

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-10-27T18:01:23Z No. of bitstreams: 2 Dissertação - Jaciane Soares de Sá - 2013.pdf: 2086467 bytes, checksum: 981c508d390d7ce0ea5a9d89c434b7c2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-28T14:31:28Z (GMT) No. of bitstreams: 2 Dissertação - Jaciane Soares de Sá - 2013.pdf: 2086467 bytes, checksum: 981c508d390d7ce0ea5a9d89c434b7c2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-28T14:31:28Z (GMT). No. of bitstreams: 2 Dissertação - Jaciane Soares de Sá - 2013.pdf: 2086467 bytes, checksum: 981c508d390d7ce0ea5a9d89c434b7c2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-11-08 / The Catheter Peripherally Inserted Central is a device used in intravenous therapy in neonatal intensive care units and pediatric and in neonatal intermediate care units, which promotes venous access safe for a long time and with a low rate of infection, however, the use of this technology by being a complex process, may be subject to adverse events. The aim of the study was to analyze the use of central venous catheter peripherally inserted into a child public hospital from the perspective of nurses, identify and classify the events in the stages of the process of insertion, maintenance and removal of PICC and verify the procedures adopted in these events and the consequences for patients. Descriptive analysis was performed of the results, with minimum and maximum for continuous variables and absolute and relative frequencies for categorical variables. Qualitative data were grouped and categorized by approaching answers. Results The results showed a predominance of females with an average age between 24-58 years and 5 or more years of professional performance, function and institution. The working day was 30 hours per week and 53.8% were specialists with training course for handling PICC. 84.6% witnessed some kind of adverse event, 57.7% in the insertion, highlighting the difficulty of progression / closing valve / capillary fragility; 84.6% in keeping with an obstruction of the catheter 61.5% EA as mentioned, caused by the blood reflux, drug incompatibility, poor permeabilization and lack of washing (flushing) of the catheter; and 15.4% in recession, caused by rupture / breakage of the catheter. The adopted clinical management were the exchange of venous access, monitoring, traction of the catheter and pressure dressing in case of bleeding. The consequences for patients were prolonged length of stay in the service, need to complement therapy and new IV line installation. The results signaled the size of adverse event occurrences in the safe use of PICC, the safety measures and quality of patient care, requiring the training of nursing professionals, combined with a policy of promoting continuing education activities and formulation strategies to minimize flaws and building a professional and institutional culture of safety. / O Cateter Central de Inserção Periférica é um dispositivo utilizado em terapia intravenosa nas unidades de terapia intensiva neonatal e pediátrica e nas unidades de cuidados intermediários neonatais, que promove acesso venoso seguro por tempo prolongado e com baixo índice de infecção, todavia, a utilização dessa tecnologia, por ser um processo complexo, pode estar sujeito à ocorrência de eventos adversos. O objetivo do estudo foi analisar a utilização do cateter venoso central de inserção periférica em um hospital público infantil sob a ótica dos enfermeiros, identificar e classificar os eventos ocorridos nas fases do processo de inserção, manutenção e retirada do PICC e verificar as condutas adotadas na ocorrência desses eventos e as consequências para os pacientes. Foi realizada análise descritiva dos resultados, apresentando mínima e máxima para variáveis contínuas e frequência absoluta e relativa para as variáveis categóricas. Os dados qualitativos foram agrupados e categorizados por aproximação de respostas. Os resultados Os resultados evidenciaram a predominância do sexo feminino com idade média entre 24 a 58 anos e 5 ou mais anos de atuação profissional, na função e na instituição. A jornada de trabalho foi de 30 horas semanais e 53,8% eram especialistas com curso de capacitação para manuseio do PICC. 84,6% presenciaram algum tipo de evento adverso, 57,7% na inserção, destacando-se a dificuldade de progressão/fechamento da válvula/fragilidade capilar; 84,6% na manutenção sendo a obstrução do cateter com 61,5% o EA mais citado, ocasionado por refluxo sanguíneo, incompatibilidade de medicamentos, permeabilização inadequada e falta de lavagem (flushing) do cateter; e 15,4% na retirada, ocasionada por ruptura/quebra do cateter. As condutas clínicas adotadas foram a troca do acesso venoso, o monitoramento, o tracionamento do cateter e curativo compressivo em caso de sangramento. As consequências para os pacientes foram prolongamento do tempo de permanência no serviço, necessidade de terapêutica complementar e instalação de novo acesso venoso. Os resultados sinalizaram a dimensão de ocorrências de eventos adversos na utilização segura do PICC, nas medidas de segurança e na qualidade da assistência ao paciente, sendo necessária a capacitação dos profissionais de enfermagem, aliada a uma política de promoção de atividades de educação permanente e formulação de estratégias para minimizar as falhas existentes e a construção de uma cultura de segurança profissional e institucional.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-17T16:11:52Z No. of bitstreams: 1 Edzangela de Vasconcelos Santos.pdf: 2212555 bytes, checksum: 062fb866a8c14cd3a67c1143d081e054 (MD5) / Made available in DSpace on 2015-07-17T16:11:52Z (GMT). No. of bitstreams: 1 Edzangela de Vasconcelos Santos.pdf: 2212555 bytes, checksum: 062fb866a8c14cd3a67c1143d081e054 (MD5) Previous issue date: 2014-11-27 / In literature, incidents arising from healthcare assistance are well defined. Nevertheless, there are incidents related to administrative processes that are rarely studied, specifically in ICU. This study aims to analyze the influence of the management of administrative processes in the safety of ICU patients. We used descriptive exploratory empirical approach to perform this research. Data from medical records were obtained and collected daily. Additional information form medical and nursing visits were also noted in an appropriate form for reporting safety incidents and, compared with the records in the chart. Double-checking the records with the printed data collection was performed. In this study, 9,396 incidents were found in 202 admissions. Of these, 653 (6.94%) in 148 admissions were classified as administrative incidents. Thus, we conclude that the administrative incidents occupy a small but important portion of total incidents (6.94%), occurring in processes that directly affect the care provided, and may cause serious damage and even death. Almost all safety incidents related to administrative failures were preventable type, therefore fitting the development and implementation of measures to prevent such occurrences, and consequently contributing to the improvement of management and care for critical patients. / Na literatura estão bem definidos os incidentes decorrentes de ações assistenciais, porém, há uma parcela de incidentes não classificáveis, relacionados essencialmente a processos administrativos sobretudo em UTI. Nesse sentido, o presente estudo objetivou analisar a influência da gestão de processos administrativos na segurança de pacientes internados em quatro UTIs clínicas. A metodologia utilizada conta com uma abordagem empírica de caráter exploratório-descritivo e estratégia de pesquisa-ação. As informações relacionadas à caracterização da população e a potenciais eventos adversos foram registradas em formulários apropriados, criados pela autora. As visitas médicas e de enfermagem foram acompanhadas com caráter observacional, anotadas em impresso próprio para relatos de eventos adversos e comparadas com a revisão diária dos registros dos prontuários. Foi realizada dupla checagem dos prontuários com os impressos de coleta de dados. Neste estudo, foram encontrados 9.396 incidentes em 202 admissões, sendo 653 (6,94%), em 148 admissões, classificados como incidentes administrativos. Dessa forma, concluímos que os incidentes administrativos ocupam uma pequena, porém, importante parcela do total de incidentes e ocorrem em processos que interferem diretamente na assistência prestada, podendo gerar danos graves ou até a morte. Quase a totalidade dos incidentes de segurança relacionada às falhas administrativas foi do tipo evitável, cabendo então o desenvolvimento e implantação de medidas de prevenção dessas ocorrências e, consequentemente contribuindo para a melhoria da gestão e assistência ao paciente crítico.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-04-06T00:41:51Z No. of bitstreams: 1 Carla Roberta Moreira Da Silva.pdf: 865329 bytes, checksum: b5f3ee55a98d4dc38ce6593deb318134 (MD5) / Made available in DSpace on 2016-04-06T00:41:51Z (GMT). No. of bitstreams: 1 Carla Roberta Moreira Da Silva.pdf: 865329 bytes, checksum: b5f3ee55a98d4dc38ce6593deb318134 (MD5) Previous issue date: 2015-12-07 / Incidents regarding the safety of the patient happen for many reasons and are increased by the inefficiency of the mechanism to register notifications. They enlighten the knowledge, the dimension and the intensity of the problem that afflict hospitals when it comes to mistakes made during the assistance. The prevention of incidents is based on legal and ethic norms and is a challenge for the World Health Organization and the responsible organs. By increasing the notifications, those in charge for the nucleus of patient safety have more information and can set strategies to avoid adverse events. The objective of this work is to present a proposal of a knowledge management model developed to increase the volume of the registrations of notifications regarding incidents of patient safety in public hospitals. To subsidize the proposal of the model, this study was exploratory and the methodology of literature review was applied. In order to complete this research, notifications of patient safety developed by a multi-professional team in 2014 at a public clinic were retrospectively analyzed. This dissertation also presented a descriptive quantitative approach, which occurred through the application of a structured questionnaire on the members of the multi-professional team of the clinic. Data found on the documental research were confronted with the questionnaire results and everything seems to show that if professionals adopted the culture of notifying, as they theoretically showed, the volume of registrations in a one year period would have been more expressive. After analyzing the collected data, a proposal of a knowledge management model was elaborated, which can collaborate with the development of more effective preventive strategies. That is, everyone can benefit from it; the patient will have a safer attendance; the professional will work more systematically; society will reduce extraordinary costs with procedures performed because of unnecessary damages. It is important that the involved people receive constant feedbacks about the benefits of their efforts when it comes to adopting the practice of notifying. / Os incidentes de segurança do paciente ocorrem por vários fatores e são potencializados pela ineficiência do mecanismo de registro de notificações. São as notificações que trazem à tona o conhecimento, a dimensão e a intensidade do problema que aflige os hospitais no que se refere a erros durante a assistência. A prevenção de incidentes é pautada em preceitos legais e éticos e é um desafio para Organização Mundial da Saúde e para os órgãos competentes. Com o aumento das notificações, os responsáveis pelo núcleo de segurança do paciente têm mais informações e podem delinear estratégias para evitar eventos adversos. O objetivo desse trabalho é apresentar uma proposta de modelo de gestão do conhecimento desenvolvido para aumentar o volume do registro de notificações de incidentes de segurança do paciente em hospitais públicos. Para subsidiar a proposta do modelo, este estudo foi exploratório e o procedimento metodológico utilizado foi o levantamento bibliográfico. Para complementar esta averiguação, foram retrospectivamente analisadas as notificações de incidentes de segurança do paciente desenvolvidas pela equipe multiprofissional em 2014 em um ambulatório público de grande porte. Esta dissertação também apresentou uma abordagem quantitativa descritiva que ocorreu mediante a aplicação de um questionário estruturado fechado aos membros da equipe multiprofissional do ambulatório. Os dados encontrados na pesquisa documental foram confrontados com os resultados do questionário e tudo indica que se os profissionais fossem tão adeptos à cultura da notificação como se mostraram em teoria, o volume de registros no período de um ano seria mais expressivo. Após a análise dos dados coletados elaborou-se uma proposta de modelo de gestão do conhecimento que pode colaborar com o desenvolvimento de estratégias preventivas mais eficientes. Neste sentido, todos poderão se beneficiar, o paciente do hospital que terá um atendimento mais seguro, o profissional que executará o trabalho de forma sistemática e a sociedade com a redução de custos extraordinários por procedimentos causados por danos desnecessários. É importante que as pessoas envolvidas na assistência recebam feedbacks constantes acerca dos benefícios de seus esforços no que se refere à adesão à prática da notificação.