Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2017-08-02T12:02:02Z No. of bitstreams: 1 Liciê Helena Ribeiro Nardi_.pdf: 1188279 bytes, checksum: 137f5fe70a0a2e1ffb8bc408416ed655 (MD5) / Made available in DSpace on 2017-08-02T12:02:03Z (GMT). No. of bitstreams: 1 Liciê Helena Ribeiro Nardi_.pdf: 1188279 bytes, checksum: 137f5fe70a0a2e1ffb8bc408416ed655 (MD5) Previous issue date: 2017-04-25 / Nenhuma / Esta pesquisa abordou o tema da Política de Ações Afirmativas, nos processos de in/exclusão dos alunos com renda inferior, a partir da análise das práticas institucionais mobilizadas pela equipe multidisciplinar da Divisão de Seleção e Acompanhamento Pedagógico, Psicológico e Social (DSS), que pertence a Pró-Reitoria de Assuntos Estudantis (PRAE), da Universidade Federal do Rio Grande do Sul (UFRGS). Por meio desta pesquisa foi possível: a) discutir os processos de in/exclusão, especialmente no que diz respeito à renda inferior e à inclusão como um imperativo de Estado; b) relatar brevemente como ocorreu o processo de democratização do Ensino Superior no Brasil, buscando identificar pontos relevantes do processo de implantação das ações afirmativas; c) construir um breve histórico do processo de implantação das Ações Afirmativas na UFRGS e algumas mudanças que ocorreram no decorrer deste percurso; d) compreender as práticas desenvolvidas pela DSS a partir do conjunto de políticas que a mobiliza, nos processos de in/exclusão dos estudantes com renda inferior; e) buscar alternativas para o seu melhor funcionamento através do levantamento de questões e f) propor reflexões que digam respeito às práticas postas em funcionamento por esta equipe no contexto institucional. Foram utilizados como procedimentos metodológicos entrevistas semiestruturadas com os servidores da DSS e ex-gestores da PRAE. As categorias de análise foram construídas a partir das recorrências dos excertos analisados. Nas análises, foi possível evidenciar a necessidade de uma gestão mais qualificada e engajada para buscar atender a esses novos compromissos assumidos pela Universidade, fortalecendo o importante trabalho realizado pela equipe multidisciplinar da DSS. Assim, esta dissertação traz pistas que podem nortear a (re) construção do setor a partir dos seguintes pressupostos: 1) retomada do histórico do setor no contexto institucional, reconstituída na dissertação; 2) reorganização da gestão do setor a partir: a) da visão da DSS como um espaço de estudo e de elaboração de propostas de trabalho conjuntas: b) da elaboração de um cronograma de trabalho que mescle momentos de estudo e de planejamento do trabalho da equipe; c) da discussão e da organização do trabalho de acompanhamento dos alunos (ingresso, permanência e sucesso acadêmico), tendo em vista as atribuições de cada uma das áreas dos profissionais que atuam no setor; d) da necessidade de avançar na discussão com outros setores da UFRGS – no caso das ações de acompanhamento, o diálogo com as COMGRAD’s e a elaboração de ações conjuntas será essencial; e) da avaliação do tipo de acompanhamento que será realizado; e) da criação de mecanismos que possibilitem a avaliação processual do trabalho desenvolvido, bem como a sistematização e o registro permanente dos dados coletados. / This research addressed the topic of Affirmative Action Policy in the processes of in / exclusion of lower income students, based on the analysis of the institutional practices mobilized by the Multidisciplinary Team of the Pedagogical, Psychological and Social Selection and Monitoring Division (DSS), which Belongs to Pro-Rectory of Student Affairs (PRAE), Federal University of Rio Grande do Sul (UFRGS).Through this research it was possible to: a) discuss the processes of in / exclusion, especially with regard to lower income and inclusion as a state imperative; B) to report briefly how the process of democratization of Higher Education in Brazil occurred, seeking to identify relevant points of the process of implementation of affirmative actions; C) construct a brief history of the implementation process of Affirmative Actions in UFRGS and some changes that occurred during this course; D) understand the practices developed by the DSS from the set of policies that mobilize it, in the processes of in / exclusion of students with lower incomes; E) seek alternatives for its better functioning through the survey of issues and f) propose reflections regarding the practices put in place by this team in the institutional context. Semi-structured interviews were used as methodological procedures with the DSS servers and former PRAE managers. The categories of analysis were constructed from the recurrences of the excerpts analyzed. In the analyzes, it was possible to highlight the need for a more qualified and engaged management to seek to meet these new commitments assumed by the University, strengthening the important work carried out by the DSS multidisciplinary team. This dissertation presents clues that can guide the (re) construction of the sector from the following assumptions: 1) resumption of the history of the sector in the institutional context, reconstituted in the dissertation; 2) reorganization of the management of the sector from: a) the vision of the DSS as a space for study and preparation of joint work proposals; b) the preparation of a work schedule that combines moments of study and planning of the work of the team; C) discussion and organization of student follow-up work (admission, permanence and academic success), considering the responsibilities of each of the areas of professionals working in the sector; D) the need to advance the discussion with other sectors of UFRGS - in the case of follow-up actions, dialogue with COMGRAD's and the elaboration of joint actions will be essential; E) the evaluation of the type of follow-up to be carried out; F) the creation of mechanisms that allow the process evaluation of the work developed, as well as the systematization and permanent recording of the data collected.

A pneumonia associada à ventilação mecânica é uma infecção nosocomial que ocorre em pacientes sob assistência ventilatória mecânica. Apesar dos inúmeros avanços no entendimento desse quadro, sua incidência continua elevada, resultando em altas taxas de mortalidade. Do ponto de vista clínico, a prevenção ainda é a melhor estratégia para reduzir os custos desse quadro, sendo que o emprego de protocolos elaborados juntamente com a equipe tem grande efeito para a prevenção da pneumonia associada à ventilação mecânica. O objetivo do estudo foi elaborar um protocolo de prevenção de pneumonia associada à ventilação mecânica em um hospital privado do sul de Minas Gerais. Trata-se de um estudo de abordagem qualitativa que utilizou como referencial teórico a pesquisa convergente assistencial. Para a coleta de dados foram realizados quatro encontros (uma entrevista individual e três encontros grupais). Para a análise dos dados foi utilizado o referencial de Morse e Field. Os cuidados citados nas entrevistas individuais pelos profissionais das equipes médica, enfermagem e fisioterapia, totalizando 17 profissionais participantes foram organizados de acordo com o nível de evidência sugerido no Guideline da American Thoracic Society. Nos dois encontros grupais seguintes os cuidados foram discutidos de acordo sua relevância na prevenção da pneumonia associada à ventilação mecânica. Com base nos cuidados elencados foi elaborado o protocolo, o qual foi apresentado aos profissionais no quarto encontro. Assim, observa-se que o referencial da pesquisa convergente assistencial possibilitou a elaboração de um protocolo para prevenção de pneumonia associada à ventilação mecânica, com o envolvimento dos profissionais atuantes na UTI, demonstrando a motivação de cada um para agregar conhecimento de sua especialidade no protocolo, além disso, houve interação entre todos os membros das categorias profissionais atuantes no setor. / The pneumonia associated to mechanical ventilation is a nosocomial infection that occurs in patients under mechanical ventilatroy support. In spite of the numerous advances in the understanding of this framework, its incidence remains high, resulting in high mortality rates. From the clinical point of view, prevention is still the best strategy to reduce the cost of this frame, being that the use of protocols designed along with the team has great effect for the prevention of pneumonia associated to mechanical ventilation. The aim of the study was to elaborate a protocol for the prevention of pneumonia associated to mechanical ventilation in a private hospital in the south of Minas Gerais. This qualitative study used the convergent care research as theoretical framework. For data collection, were held four meetings (one individual interview and three group meetings). Data were analyzed based on the Morse and Field theoretical reference. The mentioned care in the individual professionals of the medical, nursing and physiotherapy teams, totalizing 17 professionals were organized according to the level of evidence suggested in the Guideline of the American Thoracic Society. In the following two meetings with the groups, the care were discussed according to their relevance in the prevention of pneumonia associated to mechanical ventilation. Based on the indicated care, the protocol was drawn up and presented to professionals at the fourth meeting. The convergent care research framework made possible the elaboration of a protocol for the prevention of pneumonia associated to mechanical ventilation, with the involvement of professionals that work in the intensive care unit, demonstrating the motivation of each one to add knowledge of their area of expertise in the protocol; in addition, there was interaction between all the members of the professional categories involved in the sector.

Introdução: a cirurgia bariátrica destaca-se como o método mais eficaz no tratamento da obesidade em longo prazo, acarretando remissão significativa das enfermidades associadas ao excesso de peso. Ocorre que os resultados da cirurgia nem sempre são duradouros. Estima-se que 20% a 30% das pessoas que são submetidas ao procedimento bariátrico irão apresentar reganho de peso passados os dois primeiros anos. Objetivo: compreender a experiência de reganho de peso para as pessoas que foram submetidas à cirurgia bariátrica. Método: pesquisa qualitativa de abordagem fenomenológica, realizada em um hospital público de São Paulo. A Amostra foi composta de 17 participantes que apresentaram reganho de peso após a cirurgia bariátrica. Para obtenção dos dados, utilizou-se a entrevista aberta com as seguintes questões norteadoras: Como é para você se perceber ganhando peso novamente? O que você acredita que esteja contribuindo para o seu ganho de peso? Como você lida com o reganho de peso? Como você se vê daqui a alguns anos em relação ao seu peso corporal? A organização e a análise dos depoimentos foram realizadas seguindo os passos preconizados por estudiosos da fenomenologia social de Alfred Schütz. Resultados: o típico da ação vivida pela pessoa que apresenta recidiva de peso após a cirurgia bariátrica mostrou-se como aquela que: atribui o reganho de peso à instabilidade emocional, que a leva a dificuldades no controle do comportamento alimentar; afirma que o estresse, a ansiedade e a solidão contribuem para o reganho de peso; associa a recidiva de peso a alterações anatômicas relacionadas à cirurgia; expressa sentimentos como derrota, culpa e tristeza; refere consequências físicas, psíquicas e sociais advindas da recuperação de peso, medo de engordar demais e ficar sem saída; relata consumo excessivo de álcool; tem como expectativa controlar o peso com vistas a impactar positivamente sua qualidade de vida, para tanto, necessita suporte multidisciplinar para as questões físicas e emocionais envolvidas no reganho de peso; almeja se submeter a uma nova cirurgia bariátrica e a cirurgia plástica para melhorar a autoestima. Conclusões: os achados ilustram o quanto o fenômeno reganho de peso é complexo em seus aspectos biopsicoemocionais e necessita uma escuta individualizada e qualificada, acolhendo as questões subjetivas vividas por aqueles que foram submetidos à cirurgia bariátrica e estão passando pela situação de recuperação de peso. Acredita-se que a discussão proporcionada por esta investigação reforce a necessidade de as equipes de saúde investirem nos encontros com o paciente bariátrico, pautados na relação intersubjetiva que respeite e considere o outro, compartilhando decisões e contribuindo para que os pacientes se tornem ativos na produção de sua saúde e corresponsáveis pelo êxito no alcance e manutenção do peso desejado. / Introduction: bariatric surgery stands out as the most effective method in the long-term treatment of obesity, leading to significant remission of diseases associated with overweight. However, the results of the surgery are not always long lasting. It is estimated that 20% to 30% of the people who undergo the bariatric surgery will regain weight after the first two years. Aim: to understand the experience of weight regain to people who were subjected to bariatric surgery. Method: qualitative research with a phenomenological approach, conducted in a public hospital of Sao Paulo. The sample was composed of 17 participants who presented weight regain after bariatric surgery. To collect the data, an open interview was used with the following guiding questions: How is it to you, to notice yourself gaining weight again? What do you believe is contributing to your weight gain? How do you deal with the weight regain? How do you see yourself in a few years, in relation to your body weight? The organization and analysis of the interviews were conducted following the steps recommended by scholars of the social phenomenology of Alfred Schütz. Results: the typical action experienced by people with weight regain after bariatric surgery showed up as one that: assigns the weight regain to an emotional instability that leads them to difficulties in the control of eating behaviour; states that stress, anxiety and loneliness contributes to weight regain; associates the recurrence of overweight to anatomical changes related to the surgery; expresses feelings of defeat, guilt and sadness; points out physical and mental consequences arising from the weight regain; fears gaining too much weight and losing control; report excessive alcohol consumption; has the expectation of controlling the weight gain in order to positively impact the quality of life, thus, requires multidisciplinary support for issues regarding weight regain; intend to undergo another bariatric surgery and a plastic surgery to improve self-esteem. Conclusions: the findings illustrate how the phenomenon of weight regain is complex in its bio-psycho-emotional aspects and requires an individualized and qualified attention, welcoming of the subjective issues experienced by those who were submitted to a bariatric surgery and are going through a situation of weight regain. It is believed that the discussion on this research reinforces the need of the healthcare teams to invest on a follow-up of bariatric patients, based on an intersubjective relationship that respects and considers the other, sharing decisions and contributing to the patients becoming active in the production of their health and partners in the success of reaching and maintaining their desired weight.

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SAMMANFATTNING Trakeotomi är ett operativt ingrepp och innebär att man gör ett strupsnitt på halsens framsida för att skapa fri luftväg. Denna öppning, trakeostoma, som skapats på halsen hålls öppen av en trakealkanyl. Trakealkanylen sitter i luftstrupen och skapar patientens artificiella andningsväg. Trakeostomi är ett ingrepp som ökar i Sverige och görs när sjukdomar eller skador i luftvägarna eller i centrala nervsystemet försämrar eller hindrar patienten från att andas genom näsan och munnen. Ingreppet genomförs också på patienter som behöver långvarig respiratorbehandling. Komplikationer av olika allvarlighetsgrad förekommer hos trakeostomerade patienter. Vård av trakeostomerade patienter är komplext och kräver ibland fördjupad förståelse och specialistkunskap av varje enskilt aspekt och därför kan samverkan i team mellan olika professioner behövas för professionellt omhändertagande. Syftet med denna studie var att beskriva vilken effekt multidisciplinärt trakeostomiteam har på vården av trakeostomerade patienter. Studien är en litteraturöversikt och sökning av de 15 inkluderade artiklarna genomfördes i PubMed och CINAHL. Majoriteten av de inkluderade artiklarna är baserade på observationsstudier där data insamlades retrospektivt. Litteraturöversikten resulterade i följande beskrivna effekter av multidisciplinärt trakeostomiteam på vården av trakeostomerade patienter, minskade komplikationer av olika allvarlighetsgrad. De minskade vårdtiden, den totala längden på sjukhusvistelse, vistelsetid efter utskrivning från intensivvårdsavdelningen och den totala tiden på intensivvårdsavdelningen. Teamet bidrog även till snabbare handläggning och beslut om dekanylering, förbättrade kommunikationsmöjligheter för patienten men även bättre kommunikation inom teamet. Utöver detta utarbetade och implementerade teamet kliniska riktlinjer och ansvarade för utbildning av personal, patienter och anhöriga. Några få studier visade även på kostnadseffektivitet. Resultatet av denna litteraturöversikt visade att multidisciplinärt trakeostomiteam har positiva effekter i vården av trakeostomerade patienter framförallt i form av minskade komplikationer och reducerad vårdtid. Teamet bidrar även till effektivare dekanyleringsprocess och snabbare initiering av talventil. Men dessa effekter måste tolkas med stor försiktighet pga. de inkluderade studiernas metodologiska svaghet och för att resultaten inte rakt av går att generalisera och överföra till svenska förhållanden och sjukvård.

No description available.

Blast injury is a very serious lesion caused by the shock wave resulting from an explosion. Further secondary injuries can arise from burying under debris, pieces of shards from the explosive cover, at burning, poisonous gases created by chemical reactions during detonation. The injuries often happen to be fatal and the percentage of people who survive it depends on the fact how far from the epicentre they were situated. If the individual is very close, there is almost no chance to survive, if, however, the individual is situated further from the epicentre, a few tens of meters, the chance is higher. It is so called mass disaster, which includes more injured people at an explosion. Therefore it is necessary for nurses and the hospital staff to know what the procedures are at this incident and how to take medical and nursing care of higher number of such patients suffering from blast injury. The care itself is extremely demanding, since the injured are often in critical condition. The aim of this diploma thesis, the topic of which is multidisciplinary cooperation and the role of a nurse when taking care of the patients suffering from blast injury, was to find out the information based on the latest Czech and foreign literature and create a compact overview of the knowledge of this issue, for it is necessary to have this knowledge to carry out nursing care of such patients. The second aim of this diploma thesis was to map the role of a nurse in details when taking care of a patient suffering from blast injury. This aim was stated for the reason of the demanding character and complexity of nursing care at urgent reception and anaesthesiology and resuscitation unit because the nurses at these units are placed demands on high qualification and requirements. This diploma thesis was purely elaborated as theoretical thesis based on Czech and foreign sources. The given pieces of information were obtained from a great deal of professional and scientific publications, monographs, professional journals and internet sources for each chapter. The first part of the thesis was dedicated to the description of the given issue, pre-hospital care and classifying algorithms that are used at mass health losses in such way so that the injured people have a higher chance to survive. The crisis management at hospitals, the reception of the injured, the care at the urgent unit and finally the follow-up care at the anaesthesiology and resuscitation unit are worked out in the following part. Thereafter the theoretical part focuses on nursing care at the critical care department where the nursing care of a patient suffering from blast injury is described as well as the duties of a nurse. The needed competences of a nurse working at the urgent unit, anaesthesiology and resuscitation unit are also defined in this chapter. According to the valid Czech legislation, only specially trained nurses for intensive care should take care of the patients with blast injury because the extent of their competence for intensive care is many times higher than general nurses have. The last chapter deals with team and multidisciplinary cooperation among the doctors and hospital staff as well as the cooperation concerning the pre-hospital care of the emergency services at emergency incident, for their active and quality communication are the keys for good and well done work with the least consequences.

This thesis focuses on the explanation of the concept of social activation services for families with children and touches on the concept of family rehabilitation with which social activation services are associated. It also discusses frequent and less frequent questions and problems, which are deal with by this service and it explains how these problems arise. Using specialized literature and the experience of family support center staff, it characterizes specific work of social activation services, such as the program of the preparation for the return to family and to home, family rehabilitation inside the frame of preliminary measures, social work with families, who have the described problems and basic characteristics of multidisciplinary teams. The goal of this thesis is to critically reflect work of social activation services on the basis of some ethical principles and ethical codes of social workers, with the help of the Center of family support in Aš. Thanks to this reflection it is trying suggest possible ways of solving every day work of social activation services.

Merged nursing inpatient ward is in the last few years becoming a trend of smaller, but also medium-sized hospitals. Due to the restructuring of beds of acute inpatient care in the Czech Republic, separate inpatient wards are merged to one joint ward, in the context of surgical as well as internal medicine. Merged inpatient ward is a combination of various disciplines (specialisms) of inpatient care under one senior consultant, or there is a common nursing ward, where senior consultants of individual disciplines are retained, while nursing care is merged. The main reason for the establishment of a merged inpatient ward is the optimization of beds and the related effective use of bed capacity in connection with an effort to preserve access to health care. The aim of the thesis Merged Nursing Inpatient Ward from the Perspective of Nurses and Management was to evaluate the contribution of a merged nursing inpatient ward, to identify the reasons for the project and the complications that accompanied the project. This research should analyze the problems in nursing care in connection with the origination of the project, to assess the demands of nursing on the ward and map errors in the field of nursing care in the context of the realization of the project. The thesis should evaluate interdisciplinary collaboration and map the occurrence of conflicts in a multidisciplinary team. During the survey it was found that the main reasons for the project were the financial savings associated with the restructuring of acute care beds in the Czech Republic. The establishment of a merged nursing inpatient ward helped the hospital to keep some expertise and it unified nursing care of the separate wards. In connection with the establishment of a joint nursing care, some complications and disadvantages that accompanied the project initially were analyzed. The survey showed how sensitively employees responded to the major change in the organization and how the cooperation between superiors and subordinates functioned. The study analyzed in what form the selection of employees for a common bed fund was realized and whether managers themselves could choose subordinates for their departments. One part of the research was the evaluation of the quality of nursing care on the merged inpatient ward, which showed that the establishment of the project did not have a negative impact on the quality of nursing care. In contrast, nursing care was united and there was also unified organization of nursing on the ward. The research evaluated the feedback from the subordinates to the top managers which was implemented through meetings and sessions. The survey refers to the greater workload on nurses in the working process on the merged ward. The origin of the project had an impact on the creation of new multidisciplinary teams and interdisciplinary collaboration. The project of a joint nursing inpatient ward was realized that the hospital can continue to provide quality health services to all patients. Research has shown that although the project had certain disadvantages and complications, it was certainly beneficial for the organization. The conclusions of the thesis may be presented in seminars, conferences and may be offered to professional journals for publication. The results of the research can help organizations that are going to realize the project of merged nursing inpatient ward.

Abstract This diploma thesis aims to describe coordinated health rehabilitation of people after severe brain injury provided by multidisciplinary team within home environment. It comprises both theoretical and practical part. The theoretical part presents the history and development of coordinated rehabilitation services and the function of multidisciplinary team. Furthermore, it characterizes a brain injury in more details. The practical part was carried out by means of qualitative research strategy semi structured interview. The first part of the research was aimed at the interviews with clients after brain injury and cerebrovascular accident. The interviews started after three months from entering the project and were realized by social workers. Its main propose was to evaluate the care of multidisciplinary team. Clients were questioned about work, time, communication and co-operation of individual experts involved in the process of recovering. The second part of the research used a method called focus group, where 12 members of the team were involved. The goal of the research was to describe how the multidisciplinary team works from both the point of view of a patient after the brain injury and the members of the multidisciplinary team within the project GAJU. The GAJU project is entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 138/2016/S)". The selection of patients was based on the communicative skills criteria e.g. skills to participate in the directed conversation based on the FIM and WHODAS and the follow-up questions concerning social issues, physiotherapeutic and ergo therapeutic methods and techniques. To achieve the aim of the diploma thesis two research questions were defined: "How is the function of multidisciplinary team perceived by clients involved in GAJU project?" and "How is the function perceived by the members of multidisciplinary team involved in GAJU project who put the coordinated rehabilitation into practice?" It was found out that after the discharge from a hospital being with family members was the most important. Besides, multidisciplinary team who regularly commuted to clients helped them. The members of the team were physiotherapists, ergo therapists, social workers and doctors. In view of the fact that physiotherapist attended the client the most frequently, the function of this expert is perceived as crucial during recovery. No less important is ergo therapist who is useful concerning motor activity and presenting various tools and aids leading to improvement. Social worker is apprehended rather as a psychological or informative support. Positively valued is attending clients at home, interconnection of the team members and the progress of the client from all points of view. On the other hand the lack of working experience of some team members is pointed out. Additionally, some clients were not satisfied that the data were collected by means of questionnaires.