Esta tese tem por objeto descrever e analisar o processo de desenvolvimento da Política Nacional de Saúde Bucal (PNSB) no terceiro nível de atenção. Para entender esse desenvolvimento, foram realizados três macroprocessos de pesquisa. O primeiro grupo de pesquisas procurou mapear a distribuição espacial dos hospitais com disponibilidade de leitos/SUS nos país e saber, dentre estes, quantos contam com serviços de atenção à saúde bucal cadastrados no Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES). O segundo grupo de pesquisas se ocupou em levantar junto ao DATASUS, através das ferramentas de consulta TABNET e TABWIN, dados nacionais relativos ao movimento das Autorizações de Internação Hospitalar (AIH) voltadas para procedimento de código 041402041-3 cuja descrição é Tratamento Odontológico para Pacientes com Necessidades Especiais em todas as unidades hospitalares que apresentaram este tipo de produção no país no biênio 2011/12. Foram consideradas 15 categorias de análise. O terceiro grupo de pesquisas buscou levantar junto ao site do Ministério da Saúde dados das Comissões Intergestores Regionais (CIR) existentes no Brasil até dezembro de 2012 assim como os Planos Diretores de Regionalização (PDR) e os Planos Estaduais de Saúde (PES) dos 26 estados e do Distrito Federal. Os resultados da pesquisa foram cotejados com aqueles verificados no TABWIN acerca do local de internação e de residência dos usuários SUS que se submeteram ao procedimento pesquisado. A fim de permitir uma análise comparativa deste processo numa perspectiva internacional, também foram levantados dados acerca da assistência hospitalar pública em saúde bucal levada a termo nos três países da América do Norte e em 31 países da Europa. Os resultados das pesquisas revelaram o caráter focalizador da atual ação da PNSB, em contraste com a atenção à saúde bucal hospitalar realizada na grande maioria dos países estudados. Entre outros resultados, as pesquisas permitiram concluir que: somente 32% dos hospitais que apresentaram AIH para os fins pesquisados possuía serviço de atenção à saúde bucal cadastrado SCNES; 1% das AIH apresentadas está relacionado ao atendimento de pacientes internados por motivos médicos; e 44% dos estados brasileiros preveem em seus instrumentos de gestão a atenção à saúde bucal em nível hospitalar. Assim, são apresentadas algumas sugestões tanto para o aperfeiçoamento da normatização da PNSB no que diz respeito à gestão da Rede de Cuidados à Pessoa com Deficiência, como para a expansão e extensão dos cuidados assistenciais em saúde bucal a todos os pacientes internados ou em tratamento ambulatorial nos hospitais do SUS. / This thesis aims to describe and analyze the development process of the National Oral Health Policy (PNSB) in the third level of assistance. To understand it, three research processes were performed. The first sought to map the spatial distribution of Brazilian hospitals with available beds in the public sector and check how many were registered for oral health assistance in the National Health Services Registry System (SCNES). The second used statistics tabulation tools (TABNET and TABWIN) from the Ministry of Healths data department (DATASUS) to search for the registration of Hospital Admission Authorization (AIH) with procedure code 041402041-3 (Dental treatment for patients with special needs) in the country in the biennium 2011/12. Fifteen analysis categories were considered. The third examined the Ministry of Healths website for the existing Regional Management Commissions (CIR) in Brazil until December 2012 as well as for the Master Regionalization Plans (PDR) and the State Health Plans (PES) of the 26 Brazilian states and the Federal District. These results were compared to the ones produced by the TABWIN tool regarding hospital and residence venues of the users who have undergone the searched procedure in the Brazilian National Health System (the so-called SUS). In order to allow a comparative analysis of this process in an international perspective, three countries in North America and 31 European countries were surveyed on the oral health care procedures available in their public hospitals. The results revealed the current focalizing character of the PNSB in contrast to the hospital oral health care practiced in most studied countries. Among other results, the research showed that: Only 32% of the hospitals with AIH for the studied procedure have its oral care service registered in the SCNES; 1% of AIH is related to patients hospitalized for medical reasons; and 44% of the Brazilian states provide oral health care in hospitals in their management documents. Thus, some suggestions are presented for both PNSB normalization improvement, regarding the management of the health services network for the care of people with disabilities, and for the expansion and extension of oral health care for all inpatients or outpatients in SUS hospitals.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-10-17T18:54:20Z No. of bitstreams: 2 Dissertação - Luciano Eduardo Braga dos Santos - 2016.pdf: 4527753 bytes, checksum: 8db193f1cca4949ecdcfe2e93d9399f2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2016-10-18T17:16:29Z (GMT) No. of bitstreams: 2 Dissertação - Luciano Eduardo Braga dos Santos - 2016.pdf: 4527753 bytes, checksum: 8db193f1cca4949ecdcfe2e93d9399f2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-10-18T17:16:29Z (GMT). No. of bitstreams: 2 Dissertação - Luciano Eduardo Braga dos Santos - 2016.pdf: 4527753 bytes, checksum: 8db193f1cca4949ecdcfe2e93d9399f2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-06-17 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / This work prop oses numerical metho d of simulation and optimization of waiting time in queues in hospital emergency. The case study is carried out in private hospital in the city of Goiania, Goias/Brazil. It is used to mo del discrete event systems as computational simulator and two optimization heuristics: the Brute Force algorithm and Genetic Algorithm. The optimization results are compared with the directives found in Resolution CFM 2077/2014, in an attempt to adapt the system to this resolution. With the results, it is observed that the simulation metho d and optimization metho ds are efficient to minimize queues at hospital emergency system. / Este trabalho prop˜oe m´eto do num´erico de simula¸c˜ao e otimiza¸c˜ao do temp o de esp era nas filas da emergˆencia hospitalar. O estudo de caso ´e realizado em hospital da rede particular, do munic´ıpio de Goiˆania. Utiliza-se a mo delagem de sistemas a eventos discretos como simulador computacional e dois m´eto dos heur´ısticos de otimiza¸c˜ao: o Algoritmo de For¸ca Bruta e o Algoritmo Gen´etico. Os resultados da otimiza¸c˜ao s˜ao comparados com as diretivas encontradas na Resolu¸c˜ao CFM no 2077/2014, na tentativa de adequar o sistema a esta resolu¸c˜ao. De posse dos resultados obtidos, observa-se que o m´etodo de simula¸c˜ao e os m´etodos de otimiza¸c˜ao s˜ao eficientes para minimiza¸c˜ao de filas em sistema de emergˆencia hospitalar.

Doctorat en sciences sociales, politiques et économiques / info:eu-repo/semantics/nonPublished

The study sought to investigate the factors influencing the contents of antiretroviral therapy (ART) reports in the Amathole Health District of the Eastern Cape Province. A qualitative and quantitative study was conducted to assess the challenges that inhibit this phenomenon. Structurally, the population consists of Amahlati and Nkonkobe sub-districts. Operational managers, information officers, professional nurses, data capturers, and administration clerks were randomly selected from sixteen facilities. Data collection was done on semi-structured interviews, questionnaires; observations were done using the probability sampling method, and the findings were analysed according to the same technique. The study revealed that the District Health Information System (DHIS) is the universal data management and reporting system which all healthcare and ART facilities are using to manage ART. However, regardless of all these universal arrangements such as the use of the DHIS to aid in reporting, the contents of ART reports from various facilities have not been uniform due to various factors. There is a lack of a reliable network to link DHIS computers across facilities. The shift from paper-based to electronic data management has caused the difficulties in the collating and management of ART data since some facilities are manual paper- based while others are automated using the modern DHIS. Lack of daily capturing and validation is a major challenge across the ART facilities. Further, there are Non-Governmental Organisations(NGOs) such as AFRICARE and the IYDSA that have signed a memorandum of understanding (MOU) with the district to provide a budgetary support for staff training in data management of ART reports in the district. While the NGOs keep on assisting the ART facilities with data management, there is a lack of skills transfer. The district could not account on follow-up of ART patients from one facility to another. This is increasing the number of defaulting in ART patients, thus there is no accurate figures on retention of patients in ART Programme. The officials from ART sites tend to use their own transport to carry data from facilities to the district offices and this resulted in late submission of reports. The study thus recommends that, inter alia, data management and trainings should be done to improve data quality in reporting, a reliable computer network be installed, backed-up and maintained for data and report management in the all healthcare facilities. All the ART sites should adopt and use the automated data management system for universality and eliminating the faults of manual paper data management and reporting. This would ensure that the contents of ART reports are uniform and a true reflection of the situation on the ground towards universal access to ART and healthcare in the Amathole Health District, and South Africa at large.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-11-26T14:53:23Z No. of bitstreams: 1 Josevane Aparecida Barbosa Domingos.pdf: 936906 bytes, checksum: 1c24cff04754caf66233afb1657e9254 (MD5) / Made available in DSpace on 2018-11-26T14:53:23Z (GMT). No. of bitstreams: 1 Josevane Aparecida Barbosa Domingos.pdf: 936906 bytes, checksum: 1c24cff04754caf66233afb1657e9254 (MD5) Previous issue date: 2018-08-20 / The fragmentation of the network and the lack of communication of the health services lead users to a pilgrimage for health care, yet when the beneficiaries feel secure in a service, in many cases it is not able to meet all the demands that the health-disease process requires. Thinking about cancer patients, these are perhaps the ones most dependent on holistic care and an interconnected network. The objective of this study was to study the network restructuring of a supplementary health care provider, who has been implementing vertical structure in the oncological health service offered. The qualitative and quantitative approaches were adopted and the method was a single case study. In the qualitative approach, structured interviews were carried out, elaborated by a construct based on assumptions and in the theoretical reference with the managers directly involved in the vertical structure implementation. For the evaluation of the data and compilation of the results we used the content analysis, where grouping the questions by similarity categories were created. Since the health care provider has a wide network of providers in the city of São Paulo, who attend cancer patients, and requests for chemotherapy demand from these various providers and each provider practices a different value for similar care, not always contemplating all the needs of the patients, in the quantitative approach was carried out a survey of the chemotherapy requests from December 2017 to February 2018 for patients with breast and prostate cancer and compared the value of chemotherapy in network of providers and in own service. This comparison was analyzed with the help of microsoft® excel software for windows 2007. The results obtained demonstrate that the infusion of chemotherapy in service for treatment of breast and prostate cancer can be 17% and 7%, respectively, cheaper than the same service offered in an outsourced network, and that the implementation of the vertical structure in health provides a greater integration among the professionals involved, greater care responsibility and provides knowledge exchange which strengthens the service provided. / A fragmentação da rede e a falta de comunicação dos serviços de saúde levam usuários a uma peregrinação por atendimento de saúde, ainda assim, quando os beneficiários se sentem seguros em um serviço, por muitas vezes esse não é capaz de suprir todas as demandas que o processo saúde-doença exige. Pensando em pacientes oncológicos, esses sejam talvez, os que mais dependem de um cuidado holístico e de uma rede interligada. O objetivo deste trabalho foi estudar a reestruturação de rede de uma operadora de saúde suplementar, que vem implementando estrutura vertical no serviço oncológico de saúde oferecido. Foram adotadas as abordagens - qualitativa e quantitativa - e o método, um estudo de caso único. Na abordagem qualitativa foram realizadas entrevistas estruturadas, elaboradas por um construto baseado em pressupostos e no referencial teórico com os gestores diretamente envolvidos na implantação da estrutura vertical. Para a avaliação dos dados e compilação dos resultados foi utilizada a análise de conteúdo, onde agrupando as perguntas por semelhança foram criadas categorias. Uma vez que a operadora de saúde possui uma rede de prestadores ampla na cidade de São Paulo, que atendem pacientes oncológicos, e as solicitações de quimioterapia demandam desses diversos prestadores e cada prestador pratica um valor diferente para atendimento assemelhado, nem sempre contemplando todas as necessidades dos pacientes, na abordagem quantitativa foi realizado levantamento das solicitações de quimioterapia de dezembro de 2017 a fevereiro de 2018 para pacientes com câncer de mama e próstata e comparado o valor da quimioterapia em rede de prestadores e em serviço próprio. Esse comparativo foi analisado com o auxílio do software microsoft® Excel para Windows 2007. Os resultados obtidos demonstram que a infusão de quimioterápicos em serviço próprio para tratamento de câncer de mama e próstata pode ser 17% e 7% respectivamente mais barato que o mesmo serviço oferecido em rede terceirizada, e que a implantação da estrutura vertical em saúde proporciona uma maior integração entre os profissionais envolvidos, maior responsabilidade assistencial e propicia a troca de conhecimentos, o que fortalece o serviço prestado.

The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.

MCur / Department of Advanced Nursing Science / Nursing students’ absenteeism has become a very serious concern in every higher educational institution in the whole world especially those of nursing. This study was conducted to investigate factors leading to student nurses’ absenteeism in Limpopo College of Nursing during Psychiatric Nursing Science clinical placement. A quantitative approach using descriptive design was used. Purposive sampling method was used to get a sample of two hundred and six (206) of students who have absented themselves before. Data was collected through a self-report scale in the form of questionnaires of structured questions, entered and analysed using SPSS version 24. Ethical considerations were adhered to throughout. The correlation between clinical factors and absenteeism was determined. The main reported factors for absenteeism were: student nurses being treated as a workforce in the clinical areas; shortage of staff in the clinical areas; study for tests and examinations; inadequate supervision of student nurses by professional nurses; and being inconsiderate of student nurses request for days off in the clinical area. This study recommends that the college should make a provision of one week of study for student nurses between the period of clinical placement and tests or final examinations as most of the respondents indicated that they absent themselves due to study for tests and examinations. The Department of Health should find a way of not overworking students due to shortage of staff in the wards but consider them for experiential learning. A research study should be conducted to develop a model to reduce student nurses absenteeism. / NRF

The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)

Bakgrund: Att ge andlig omvårdnad ligger i sjuksköterskans ansvar. Trots alltmer forskning som visar att en tillfredställande andlig omvårdnad har positiv inverkan på hälsa, har detta dock ofta försummats inom vården. Begreppet andlighet kan ha olika betydelser och behöver därför uppfattas i sin bredd. Syfte: Beskriva vuxna patienters (18+) upplevelse av andlig omvårdnad inom somatisk slutenvård. Metod: En integrativ översikt bestående av nio kvalitativa originalartiklar från USA, Singapore, Kanada, Nederländerna, Iran och Australien. Data samlades genom CINAHL, Medline och manuell sökning. Analys gjordes efter inspiration av Friberg och Whittemore och Knafl analysmodeller. Resultat: Andlig omvårdnad kunde av patienterna upplevas positiv, negativ eller obefintlig beroende på olika faktorer. Patienterna i studien upplevde andlig omvårdnad genom att få möjlighet till uttryck av sin andlighet, genom att få möjlighet till relationer, genom att få ha sin värdighet i behåll och genom sjuksköterskans närvaro. Andlig omvårdnad ska utföras utifrån en personcentrerad vård eftersom uttryck av andlighet kan variera mellan individer. Slutsats: För att kunna prata om andlig omvårdnad behöver både personalen och patienter ha förståelse för vad andlighet kan innebära. Sjuksköterskan behöver få kunskap och verktyg för att lätt kunna införa andlig omvårdnad i sitt arbete och känna sig trygg med att utföra en holistisk vård dvs att se hela människan. Detta skulle resulterar i mer tillfreställda patienter.

Pražské nemocnice v letech 1948-1968 Ing. Mgr. Kateřina Murtingerová Summary: This work presents a development of Prague hospitals during 1948 and 1968. The first part of my thesis describes theoretical and historical background of health care provision in the first half of the 20st century and it is focused on development of Czech healthcare system. This part of thesis also includes reform plans and concepts proposed during the first republic and the Second World War, with special attention to Albert and Nedvěd's plans playing a key role in setting of healthcare provision after the year 1948. The second part of this thesis is based on legislative and institutional analysis after the Second World War that was developing hand in hand with social, political, and economic changes in Czechoslovakia. Important part of this capture is also an assessment of the results of health care provision during 1948-1968 from the perspective of the whole country, including structure and availability of hospital care, demographic trends and population health trends, expenditure of health care provision and preventive measures etc. Thesis also includes historical overview of academic environment. The issue of Prague hospitals and hospital care is framed in the context of institutional and legal framework of health care system...