Made available in DSpace on 2014-12-17T14:46:45Z (GMT). No. of bitstreams: 1 RafaelaCM_DISSERT.pdf: 1886244 bytes, checksum: a5c5c4c82ecca244631ff9cd5ba36f2a (MD5) Previous issue date: 2010-11-08 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / It is a descriptive-exploratory research, with a quantitative approach, aiming to characterize typical occupational accident suffered by the professionals from nursery group, in the Intensive Care Units and Emergency in a hospital in Natal-RN, trying to identify the factors that contribute to those accidents; to identify some information taken by those professionals related to the accident risks; to know the procedures taken after each accident. This sample is composed by 176 professionals that are 44 nurses and 132 nursing technicians/auxiliaries, collected from March to April 2010. The results related to the personal characterization of the nursery group showed that 31 (18.61%) are between the 36-40 years of age; 148 (84.09%) females and 96 (55.68%) had finished High School. Related to the professional characterization, 53 (30.11%) are nurses, and 123 (69.88%) nursing technicians and auxiliaries; 44 (25.00%) are working as nurses, and 132 (75.00%) as nursing technicians and auxiliaries; 45 (25.56%) are working in the nursery area between 15 to 20 years and 11 months; 53 (30.11%) are in this institution between 10 to 14 years and 11 months; 79 (44.88%) work in the ICU; 55 (31.25%) are working in this area from 1 to 4 years and 11 months; 110 (62.50%) like to work in this area; 161 (91.47%) work 30 to 40 hours per week; 90 (51,13%) have another employment. Related to knowledge about typical occupational accident, 167 (94.88%) said they know about it; 96 (54.54%) know the accident rules; 103 (58.52%) think it is important to talk about this subject in the nursery courses; 92 (52.27%) said this subject is important to be discussed in the work and 372 (87.73%) think education is necessary to reduce accident. Related to the data about accidents, 104 (59.09%) have suffered typical occupational accident, among them 69 (39.20%) have suffered it once; 47 (36.19%) did not register any accident; 60 (57.69%) were caring some patient during the accident; 47 (45.19%) of them occurred in the ICU; 50 (48.07%) professionals were working during the night period; 69 (66.34%) have suffered perforation; 86 (82.69%) had upper limbs affected; 64 (61.53%) were affected by needle; about the reason of the accident, 89 (60.54%) said it occurred due to carelessness. Related to the accident evolution, 88 (85.57%) did not need to remain off work after accident; 13 (81.25%) remained off work during 15 days; 87 (83.65%) had no sequelae and for 101 (97.11%) it was not necessary rehabilitation. We conclude that typical occupational accident can occur with young workers who admit a knowledge about the subject, however they do almost nothing to prevent it. We believe this research has contributed to the characterization of this kind of accident suffered by the nursery group of a public hospital in Natal, and it can stimulate the creation and reformulation of personal protection against typical occupational accident suffered by nursery professionals / Estudo do tipo descritivo-explorat?rio com abordagem quantitativa, com o objetivo de caracterizar os Acidentes de Trabalho, sofridos pelos profissionais da equipe de enfermagem, nas Unidades de Terapia Intensiva e de Urg?ncia em Hospital de refer?ncia-Natal/RN, identificar os fatores que contribuem para os acidentes de trabalho; identificar as informa??es dos profissionais da equipe de enfermagem com rela??o aos riscos para os acidentes; conhecer os procedimentos adotados ap?s cada acidente. A popula??o constou de 176 profissionais, sendo 44 enfermeiros e 132 t?cnicos/auxiliares de enfermagem, com dados coletados de mar?o a abril de 2010. Os resultados mostram no que se refere ? caracteriza??o pessoal da equipe de enfermagem que 31 (18,61%) encontram-se na faixa de 36 a 40 anos de idades sendo 148 (84,09%) sexo feminino e 96 (55,68%) conclu?ram o ensino m?dio. Quanto ? caracteriza??o profissional, 53 (30,11%) eram enfermeiros, e 123 (69,88%) t?cnicos e auxiliares de enfermagem; 44 (25,00%) t?m ocupa??o profissional de enfermeiro, e 132 (75,00%) de t?cnico/auxiliar de enfermagem; 45 (25,56%) com tempo de servi?o na enfermagem entre 15 a 20 anos e 11 meses; 53 (30,11%) com tempo de servi?o na institui??o de 10 a 14 anos e 11 meses; 79 (44,88%) atuam nas UTIs; 55 (31,25%) com tempo de servi?o no setor de trabalho de 1 a 4 anos e 11meses; 110 (62,50%) trabalham no setor porque gostam; 161 (91,47%) com jornada semanal de 30 a 40 horas; 90 (51,13%) possuem outro emprego. Quanto ao conhecimento sobre Acidentes de Trabalho, 167 (94,88%) informaram saber sobre este tema; 96 (54,54%) conhecem as normas sobre os acidentes; 103 (58,52%) consideram a abordagem do tema muito importante nos cursos de enfermagem; 92 (52,27%) consideram a abordagem do tema muito importante no local de trabalho e 372 (87,73%) sugerem a educa??o para diminuir a ocorr?ncia dos acidentes. Quanto aos dados sobre o acidente ocorrido, 104 (59,09%) sofreram acidente sendo que 69 (39,20%) com 1 acidente; 47 (36,19%) n?o notificaram nenhum acidente; 60 (57,69%) realizavam cuidado com o paciente no momento do acidente; 47 (45,19%) ocorreram nas UTIs; 50 (48,07%) trabalhavam no noturno; 69 (66,34%) sofreram perfura??o; 86 (82,69%) a les?o foi nos membros superiores; 64 (61,53%) por agulha; com rela??o a causa do acidente, 89 (60,54%) afirmaram que ocorreu descuido. Quanto ? evolu??o do acidente, 88 (85,57%) n?o precisaram de afastamento do trabalho ap?s o acidente; 13 (81,25%) se ausentaram at? 15 dias; 87 (83,65%) n?o tiveram sequelas e 101 (97,11%) n?o necessitaram de reabilita??o. Conclu?mos que os acidentes de trabalho acometem jovens trabalhadores que afirmam conhecer sobre este assunto, mas pouco fazem para preven?-lo. Contudo, acreditamos que este estudo contribuiu para a caracteriza??o da demanda desses acidentes da equipe de enfermagem de um hospital p?blico de Natal, bem como poder? apoiar ? formula??o e implementa??o de medidas de prote??o, promo??o e preven??o dos acidentes de trabalho nos profissionais de enfermagem

Made available in DSpace on 2014-12-17T14:46:46Z (GMT). No. of bitstreams: 1 IsabelleKFC_DISSERT.pdf: 1938690 bytes, checksum: 22cd4a4b6a66ab1a100e508363b67a58 (MD5) Previous issue date: 2011-03-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients? quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients? QOL. The study?s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universit?rio Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury / A ?lcera Venosa (UV) ? uma les?o dos membros inferiores resultante do inadequado retorno de sangue venoso nos p?s ou pernas. Embora n?o fatais, tais feridas cr?nicas comprometem seriamente a qualidade de vida (QV) dos doentes trazendo mudan?as por vezes dr?sticas no ?mbito familiar, social, econ?mico e psicol?gico. Nesse sentido, s?o diversos os aspectos que podem estar associados ? QV da pessoa com UV. O estudo teve o objetivo de analisar a associa??o dos aspectos sociodemogr?ficos e de sa?de, de assist?ncia ? sa?de e cl?nicos da les?o na QV dos portadores de UV. Estudo anal?tico, com delineamento transversal e abordagem quantitativa. O projeto obteve parecer favor?vel do Comit? de ?tica do HUOL (n.279/09). A coleta de dados realizou-se no ambulat?rio de angiologia do Hospital Universit?rio Onofre Lopes (HUOL), num per?odo de tr?s meses em 2010. A amostra foi de 60 pessoas com UV atendidos por angiologistas no ambulat?rio de Cl?nica Cir?rgica do HUOL. Os resultados foram processados no programa SPSS 15.0 por estat?stica descritiva e inferencial. Identificamos usu?rios com UV predominantemente do sexo feminino, idade m?dia de 61,4 anos, baixo n?vel de escolaridade e de renda familiar, com profiss?es que exigiam longos per?odos em p? ou sentados, aposentados, desempregados ou afastados do trabalho devido ? doen?a e com doen?as cr?nicas associadas, em uso de produtos inadequados, curativos realizados por profissional ou cuidador sem treinamento, aus?ncia de terapia compressiva e orienta??es adequadas, sem realizar eleva??o de membros inferiores e exerc?cios regulares, com tempo de les?o maior ou igual a seis meses, falta de exames laboratoriais espec?ficos, sem registro no prontu?rio, com les?es recidivantes, ?rea de m?dia a grande, leito da les?o com fibrina e/ou necrose, exsudato com quantidade de m?dia a grande, sem odor e sinais de infec??o, perda tecidual entre grau I e II, sem coleta de swab ou biopsia e com presen?a de dor. Em geral, a QV dos pesquisados foi considerada baixa, com pontua??o m?xima de 69 pontos. Sendo os dom?nios que mais influenciaram nos escores totais da QV a capacidade funcional (0,021), aspecto emocional (0,000) e aspecto social (0,080). Dos 60 pesquisados, 53,3% tiveram pontua??o entre 40 a 69 pontos no SF-36, e apresentaram os escores melhores nas vari?veis sociodemogr?ficas e de sa?de (ρ=0,049). Quanto ?s caracter?sticas da assist?ncia e da les?o, os pacientes que tiveram pontua??o entre 40 a 69 pontos no SF-36 apresentaram escores melhores em tais caracter?sticas. Ao associar as vari?veis sociodemogr?ficas, de sa?de, caracter?sticas da assist?ncia e da les?o, verificamos que houve uma diferen?a significante (ρ=0,032) ao relacion?-las com o escore total da QV. Analisando separadamente os dom?nios do SF-36 com os escores obtidos na QV, verificamos que os dom?nios que apresentaram signific?ncia estat?stica foram a capacidade funcional (ρ= 0,035), aspecto f?sico (ρ= 0,019), aspecto emocional (ρ= 0,000) e sa?de mental (ρ= 0,050). Dentre as caracter?sticas sociodemogr?ficas estudadas, o sexo e estado civil contribu?ram mais para a redu??o da QV; e entre as vari?veis da assist?ncia e da les?o destacam-se as vari?veis: orienta??es, refer?ncia e ?rea da UV. Ao analisarmos o conjunto dessas cinco vari?veis de acordo com o escore geral obtido na QV, verificamos correla??o significativa (ρ= 0,002), sendo 6,23 vezes maior a chance de os pacientes apresentarem melhor QV na presen?a desses cinco fatores positivos. Ao realizarmos o Teste de Mann Whitney U entre o conjunto das cinco vari?veis sociodemogr?ficas, de sa?de, cl?nica e assistencial, verificamos que tal conjunto tamb?m demonstrou ser significativo (ρ=0,006). Portanto, os pacientes que apresentam essas cinco vari?veis positivas tendem a ter melhor QV. Diante dos resultados obtidos, rejeitamos a hip?tese nula (H0) e aceitamos a hip?tese alternativa (H1) proposta no estudo, pois evidenciamos que a QV dos portadores de UV est? associada aos aspectos sociodemogr?ficos e de sa?de, de assist?ncia ? sa?de e dos aspectos cl?nicos da les?o

Made available in DSpace on 2014-12-17T14:46:46Z (GMT). No. of bitstreams: 1 CeciliaNV_DISSERT.pdf: 1725675 bytes, checksum: 9144b1d9ed640918280827b346f71a08 (MD5) Previous issue date: 2011-03-14 / One of the Ministry of Health s attempts at contributing to making collective health more appealing to health students is the Experience and In-Service Training within the Reality of the Unified Health Service Project (VER-SUS). Hence, the object of this investigation is to survey learners views on the teaching of nursing based in the experiences they have lived through in the VER-SUS. Its purpose is to analyze the views and lived-through experiences of nursing students on how the VER-SUS contributed to their professional education. This is a study of the descriptiveexploratory type with a qualitative approach. Eighteen undergraduate students from the nursing program at the Federal University of Rio Grande do Norte (UFRN), former VER-SUS participants, took part in this study, from 2006 to 2009. Information was collected using focus group techniques guided by a set of questions and semistructured interview with open and closed questions. The information collected was analyzed using content analysis technique, of the thematic analysis type. The UFRN Research Ethics Committee approved of the survey pursuant to Report Opinion number 223/2010 and CAAE number 0105.0.051.000-10. Lived-through experiences and in-service training gathered from the VER-SUS have contributed meaningfully to health education, as they helped understand the role of the university and of a health and nursing education within the hegemonic model of education. According to the views and lived-through experiences of nursing students who took part in the SUS project it was extremely relevant to use active methodologies in the teaching-learning process and have the facilitators act as liaisons for the SUS. It follows from this study that the VER-SUS does contribute to a health-nursing education and brings the students close to the reality of the community / Uma das tentativas do minist?rio da sa?de de contribuir para tornar a sa?de coletiva mais atraente para o estudante da ?rea de sa?de/enfermagem se trata do projeto de Viv?ncias e Est?gios na Realidade do SUS (VER-SUS). Portanto, estudar a vis?o de discentes sobre o ensino de enfermagem a partir de suas viv?ncias no VER-SUS constitui o objeto desta investiga??o. Seu objetivo ? analisar as vis?es e viv?ncias de estudantes de enfermagem sobre a contribui??o do VER-SUS na sua forma??o profissional. Trata-se de um estudo do tipo descritivo/explorat?rio, com abordagem qualitativa. Participaram 18 estudantes da gradua??o em enfermagem da Universidade Federal do Rio Grande do Norte (UFRN), egressos do VER-SUS, no per?odo de 2006/2009. Para a coleta de informa??es, foram utilizadas as t?cnicas de grupo focal orientado por um roteiro de quest?es, e entrevista semiestruturada, com quest?es abertas e fechadas. As informa??es coletadas foram analisadas atrav?s da t?cnica de an?lise de conte?do, na modalidade de an?lise tem?tica. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da UFRN pelo parecer n?. 223/2010 e CAAE n?. 0105.0.051.000-10. A viv?ncia e o est?gio do VER-SUS contribu?ram de forma significativa para a forma??o em sa?de, pois ajudaram a perceber o papel da universidade e da forma??o em sa?de/enfermagem em meio ao modelo hegem?nico de forma??o. Nas vis?es e viv?ncias dos estudantes de enfermagem participantes do projeto sobre o SUS foi de suma import?ncia a utiliza??o de metodologias ativas para o processo ensino/aprendizagem e os facilitadores atuaram como condutores da aproxima??o com o SUS. O estudo concluiu que o VER-SUS contribuiu para a forma??o em sa?de/enfermagem, aproximando os estudantes da realidade da comunidade

Made available in DSpace on 2014-12-17T14:46:47Z (GMT). No. of bitstreams: 1 MariaNFF_DISSERT.pdf: 2703676 bytes, checksum: 0a6535bf05102a424a0070968ed1d915 (MD5) Previous issue date: 2011-05-16 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The desire to research on this subject arisen from the experience as nursing in the indigenous health, where I observed that many professionals from all regions of Brazil chose to work within this zone. It was notorious the nurse s difficult to settle in only one place for a long length of time. Probably due to health care in indigenous zones happens from a cultural confront. This confront materialize because both sides are imbued with their own culture: in one hand the nurse professional with its scientific knownledgment on the other the indigenous with their rituals and peculiars habits. In this context nurses should delineate and negotiate the reality through symbolic representations of life, and then make questions on the new reality. In this way, this study set out with the aim of apprehends the nurse s social representations of transcultural care in indigenous health. This knownledgment is important to avoid possible conflicts, shocks, difficulties and health care incongruence within this context. The data collect was carried out on a range of non structured interview guided by a pre-elaborated questionnaire with four questions and a hand drawing related to nurse s health care in the indigenous health. This research had a sample of 17 nurses from the Indigenous Sanitary District of Manaus in the Amazon State. To interpret data we used the Discourse of the Collective Subject, which findings were presented in three chapters: characterization of participants, discussion on themes prevalent in discourse; social representation of nursing care through infographics. The analysis revealed that the care in the indigenous health is challenging because the native people imbued in its world are perceived and processed according to the nurse s cultural lens, leading to materialize of some strangeness and adaptation difficulties, especially in the first contacts. The Social Representation on nursing practice, in many cases, is projected and contrived on the basis of scattered believes and on perception derived from common sense. The findings shows that representions are essential to mitigating the initial strangeness and help nurses to better situate themselves in the new universe. The nurse s practice in the indigenous health care should merge into each other. From the Social Representations is possible to perceive that assimilation, also comprehension on indigenous health system and its traditional knowledge are important to developing strategies to improve access and quality of care for indigenous peoples. After analysis the nurse s discourses and drawings, it is possible to represent the nurse s practice in the indigenous health as anthropophagism, since nurses should literally consuming its patients culture, digesting it and seize it as means to provide culturally congruent care. We highlight the urgent need for preparation and training of professionals to work more effectively with indigenous peoples / A realiza??o deste estudo surgiu a partir da experi?ncia como enfermeira na sa?de ind?gena, ao observar que muitos profissionais oriundos das mais diversas regi?es do Brasil optavam por esta ?rea de atua??o. Era not?ria a dificuldade que o enfermeiro tinha em fixar-se por muito tempo em um ?nico local de servi?o. Provavelmente porque o cuidado de sa?de na ?rea ind?gena acontece a partir de um confronto de culturas diversas, pois traz o profissional, de um lado, com todo o seu conhecimento acad?mico e cultura pr?pria e, do outro lado, o ?ndio com seus ritos, usos e costumes peculiares. Neste contexto, o enfermeiro deve definir e negociar a realidade atrav?s de representa??es simb?licas da vida, para, em seguida, questionar a nova realidade. Assim, este estudo busca apreender as representa??es sociais sobre o cuidado transcultural na sa?de ind?gena para os profissionais enfermeiros. Conhecimento, este, importante para evitar poss?veis conflitos, choques, dificuldades e incongru?ncia do cuidado nesse contexto. A coleta de dados foi realizada atrav?s de entrevista n?o-estruturada guiada por um roteiro contendo quatro quest?es norteadoras e elabora??o de um desenho que fosse relacionado ao cuidado do enfermeiro na sa?de ind?gena. A pesquisa contou com a participa??o volunt?ria de 17 enfermeiros do Distrito Sanit?rio Ind?gena de Manaus, no Estado do Amazonas. Para o tratamento dos dados foi utilizada a T?cnica de An?lise do Discurso do Sujeito Coletivo, sendo os resultados apresentados em tr?s momentos, a saber: caracteriza??o dos participantes do estudo, discuss?o das categorias predominantes nos discursos e representa??o social do cuidado de enfermagem atrav?s de infogr?ficos. A an?lise revelou que o cuidado na sa?de ind?gena ? desafiador porque o ind?gena e seu mundo s?o percebidos e processados de acordo com a lente cultural dos enfermeiros, levando ao surgimento de alguns estranhamentos e dificuldades de adapta??o, principalmente nos primeiros contatos. A RS da pr?tica de enfermagem na sa?de ind?gena, em muitos casos, ? projetada e idealizada com base nas cren?as disseminadas e nas percep??es originadas do senso comum. Percebe-se, pois, que o trabalho de representar ? essencial em atenuar as estranhezas iniciais e ajudar o enfermeiro a situar-se melhor no novo universo. A pr?tica de enfermagem na sa?de ind?gena deve ser a fus?o das culturas do ind?gena e do enfermeiro. A partir da Representa??o Social reconhece-se que a assimila??o, a compreens?o do sistema de sa?de ind?gena e o uso dos conhecimentos dessas pr?ticas s?o elementos essenciais para o desenvolvimento de estrat?gias que podem melhorar o acesso e a qualidade do cuidado aos povos ind?genas. Ap?s a an?lise dos discursos e desenhos realizados pelos enfermeiros, pode-se representar a pr?tica de enfermagem na sa?de ind?gena atrav?s do antropofagismo, no qual o enfermeiro deve literalmente devorar a cultura dos seus pacientes, digeri-la e apoderar-se dela para prestar um cuidado culturalmente congruente. No entanto, ressalta-se a necessidade urgente do preparo e treinamento desses profissionais para uma atua??o mais eficaz com os povos ind?genas

Made available in DSpace on 2014-12-17T14:46:48Z (GMT). No. of bitstreams: 1 KarolinaMMR_DISSERT.pdf: 3518895 bytes, checksum: 32684247921e6da96aba6c25a78b69c8 (MD5) Previous issue date: 2011-12-08 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / It is a descriptive, exploratory study, quantitative comparative approach, whose general objective was to analyze the violence at school in a comparative way in the context of two schools in Natal / RN. The specifics were to identify the types of manifestations of violence in the contexts of public and private schools, to identify the position of the leadership, teachers and school staff during and after the occurrence of manifestations of violence in the school environment, to identify measures to prevent violence within of schools. The results show that 68 of the 121 participants (56.20%) were female and 53 (43.80%) were male, 38 (31.40%) were between 40 and 49, 85 (70.2%) lived in the south of Natal (RN), 46 (38.02%) specialization, 68 (56.20%) were Catholic, 63 (52.07%) married, 41 (33.88%) received between 03 and 05 and 68 minimum wages (56.20%) were teachers, 51 (42.15%) 02 employees (01,65%) and directors, 46 (38.02%) providers had between 05 and 14 years and 11 months experience in teaching 70 (57.85%) less than five years in the job, 68 (56.20%) worked between 20 hours and 40 hours per week, 81 (16.30%) worked in the 9th grade of elementary school II. As for the sizing of violence, 111 (91.74%) respondents witnessed episodes of this event who work in the institution, 100 (82.64%) witnessed verbal violence, 87 (71.90%) called for parents when some event happenedviolent that it caused injury to students, 66 (54.55%) believed that family violence is the main reason for young people practiced bullying, 44 (38.98%) reported daily episodes of bullying, 64 (52.89% ) the event happens in the courtyard. Of the 37 victims of violence at school, 22 (59.45%) suffered verbal abuse, 18 (48.65%) experienced violence once a week, 36 (97.30%) were attacked by students, 104 (85.95 %) are able to differentiate the bad acts of bullying behavior, 28 (23.14%) separated the involved coordination and communicated verbally, 23 (19.00%) stated that the coordination of schools talked with parents about the aggressive behavior of the student. Regarding the actions taken to minimize bullying, 69 (57.02%) participated in any professional education process, 47 (38.84%) was the educational process at another institution, 49 (71.01%) took courses lasting 12 to 24 hours, 59 (48.76%) stated that interaction with parents and family was the most stimulated by the school to try to minimize and prevent the event and 116 (95.87%) participated in meetings at the institutions surveyed , 58 (50.00%) responded that the meetings took place every two months and 121 (100.00%) reported having no refresher course on school violence in the schools surveyed. We conclude that violence in schools has been expressed in any social class and that professionals are poorly prepared to deal with the situation. So we hope that education professionals through the reading of our study may realize that school violence takes place in any institution affecting the lives of all who make up the educational universe. It is extremely important that these professionals always seek to empower through knowledge so that they can develop strategies to prevent and minimize the bullying to change the reality of the workplace / Trata-se de um estudo descritivo, explorat?rio, comparativo com abordagem quantitativa, cujo objetivo geral foi analisar a viol?ncia na escola de forma comparativa no contexto de duas institui??es de ensino em Natal/RN. Os espec?ficos foram identificar os tipos de manifesta??es da viol?ncia nos contextos da escola p?blica e particular; identificar a postura da dire??o, professores e funcion?rios da escola durante e ap?s a ocorr?ncia de manifesta??es de viol?ncia no ambiente escolar; identificar medidas de preven??o da viol?ncia no ?mbito das escolas. Os resultados mostram que dos 121 participantes 68 (56,20%) eram do sexo feminino e 53 (43,80%) masculino, 38 (31,40%) tinham entre 40 e 49 anos, 85 (70,2%) residiam na Zona Sul da cidade de Natal (RN), 46 (38,02%) especializa??o, 68 (56,20%) eram cat?licos, 63 (52,07%) casados; 41 (33,88%) recebiam entre 03 e 05 sal?rios m?nimos e 68 (56,20%) eram professores; 51 (42,15%) funcion?rios e 02 (01,65%) diretores; 46 (38,02%) profissionais possu?am entre 05 e 14 anos e 11 meses de experi?ncia no ensino 70 (57,85%) menos de cinco anos de servi?o na institui??o; 68 (56,20%) trabalhavam entre 20 horas e 40 horas por semana, 81 (16,30%) atuavam no 9? ano do ensino fundamental II. Quanto ao dimensionamento da viol?ncia, 111 (91,74%) entrevistados presenciaram epis?dios deste evento na institui??o que trabalham; 100 (82,64%) presenciaram a viol?ncia verbal; 87 (71,90%) ligaram para os pais quando acontecia algum evento violento que causava les?o aos alunos, 66 (54,55%) acreditaram que a viol?ncia familiar ? o principal motivo para os jovens praticaram o bullying, 44 (38,98%) observaram os epis?dios de bullying diariamente; 64 (52,89%) o evento acontecer no p?tio. Das 37 vitimas de viol?ncia na escola, 22 (59,45%) sofreram agress?o verbal; 18 (48,65%) sofreram viol?ncia uma vez por semana, 36 (97,30%) foram agredidos por alunos, 104 (85,95%) conseguem diferenciar os atos mal comportamento do bullying; 28 (23,14%) separaram os envolvidos e comunicaram verbalmente a coordena??o; 23 (19,00%) afirmaram que as coordena??es das escolas conversaram com os pais a respeito da conduta agressiva do aluno. No tocante as a??es realizadas para minimizar o bullying, 69 (57,02%) profissionais participaram de algum processo educativo, 47 (38,84%) o processo educativo foi em outra institui??o, 49 (71,01%) fizeram cursos com dura??o de 12 a 24 horas; 59 (48,76%) afirmam que a intera??o com os pais e familiares foi a a??o mais estimulada pela escola para tentar minimizar e prevenir o evento; 116 (95,87%) participaram de reuni?es nas institui??es pesquisadas; 58 (50,00%) responderam que as reuni?es aconteciam bimestralmente e 121 (100,00%) afirmaram n?o ter nenhum curso de atualiza??o sobre viol?ncia na escola nas escolas pesquisadas. Conclu?mos que a viol?ncia na escola vem se expressando em qualquer classe social e que os profissionais est?o pouco preparados para lidarem com a situa??o. Assim esperamos que os profissionais da educa??o, atrav?s da leitura do nosso estudo, possam perceber que a viol?ncia na escola acontece em qualquer institui??o prejudicando a vida de todos que comp?em o universo educacional. ? de extrema relev?ncia que estes profissionais procurem se capacitar sempre para que atrav?s do conhecimento possam criar estrat?gias de preven??o e minimiza??o do bullying que mudem a realidade do seu ambiente de trabalho

Made available in DSpace on 2014-12-17T14:46:50Z (GMT). No. of bitstreams: 1 KalyaneKDO_DISSERT.pdf: 3830897 bytes, checksum: e5e6fb62aa3066294d259dd5695ffd67 (MD5) Previous issue date: 2011-12-05 / The research aimed to analyze the feasibility of forming a network of municipal services to prevent and treat child victims of violence from the Basic Health Units in the Family Mossor? / RN. The research is a qualitative approach and was developed in the form of action research. The population was composed of representatives of institutions of the child and primary care professionals. Data were collected through questionnaires, workshops and semi-structured interview. The results were analyzed from data collected through the questionnaire designed to assess the material, lectures, dialogues and assessments with the team and presented in accordance with the findings of the research. The study was approved by the Ethics in Research UFRN with protocol No. 158/2010, CAAE: 0176.0.051.000-10. Situational diagnosis in the participants answered a questionnaire to characterize and then launched the guiding question of the focus group FHS While professional what your perception towards violence against children? It was felt the fear and ignorance on the part of the unit staff on how to prevent and to refer cases of violence against children and adolescents in the area of coverage of the unit and also realized that the professionals felt victims of occupational violence before the violence has reached proportions that the area of the unit. Mind the need to change strategies to work to combat violence, we plan to conduct focus group workshop to complete the questionnaire, training for protection against occupational violence, and meeting with other bodies responsible visor protecting children and adolescents to draw the flowchart of the victims in safety net. The next moment training to fill the notification form professionals were interested in learning and use this tool to combat violence. At the third meeting in Unity, meeting with representatives of the Child Protection Council, the professional unit showed interest in interacting with the agency to expose and combat violence against children and adolescents. Due to difficulties in the physical structure of the unit was not possible to continue the research and planned every moment, and then completed the data collection with interviews with the participating professionals, to assess the meetings. Therefore, it is considered that action research has also achieved its goals because the team was involved in the collective construction of a proposed change in the practices of referral and prevention of violence against children and adolescents. This involvement was favored using the principles Freirian during the course of the study. However, it is assumed that the network was not fully implemented because it is known that it is in a continual process of improvement and must continue evolving with the unit team. / A pesquisa teve como objetivo analisar a constru??o coletiva de uma rede de servi?os municipais para preven??o e tratamento ?s crian?as v?timas de viol?ncia a partir das Unidades B?sicas de Sa?de da Fam?lia em Mossor?/RN. A pesquisa ? de abordagem qualitativa e foi desenvolvida na forma de pesquisa-a??o. A popula??o foi constitu?da por representantes de institui??es de direitos da crian?a e profissionais da aten??o b?sica. Os dados foram coletados atrav?s de question?rios, semin?rios e entrevista semi-estruturada. Os resultados foram analisados a partir dos dados coletados atrav?s do question?rio de avalia??o do material elaborado, palestras dialogadas e nas avalia??es com a equipe e apresentados de acordo com os achados da pesquisa. A pesquisa foi aprovada pelo Comit? de ?tica em Pesquisa da UFRN com protocolo de n? 158/2010, CAAE: 0176.0.051.000-10. No diagn?stico situacional os participantes responderam um question?rio para caracteriza??o e em seguida foi lan?ada a quest?o norteadora do grupo focal Enquanto profissional da ESF qual a sua percep??o frente ? viol?ncia contra a crian?a? Percebeu-se o medo e o desconhecimento por parte dos profissionais da unidade de como prevenir e encaminhar os casos de viol?ncia contra a crian?a e o adolescente existentes na ?rea de cobertura da unidade e, ainda percebeu-se que os profissionais se sentiam v?timas da viol?ncia ocupacional, diante das propor??es que a viol?ncia alcan?ou na ?rea da unidade. Vista a necessidade de mudan?a das estrat?gias para trabalhar o combate a viol?ncia, planejamos no grupo focal realizar oficina para preenchimento da ficha de notifica??o, capacita??o para prote??o contra a viol?ncia ocupacional; e reuni?o com outros ?rg?os respons?veis pala prote??o da crian?a e do adolescente para tra?ar o fluxograma das v?timas na rede de prote??o. No momento seguinte de capacita??o para preenchimento da ficha de notifica??o os profissionais mostraramse interessados em aprender e utilizar esse instrumento de combate a viol?ncia. No terceiro encontro na Unidade, a reuni?o com representantes do conselho tutelar, os profissionais da unidade demonstraram o interesse em se articular com o ?rg?o para denunciar e combater a viol?ncia contra a crian?a e o adolescente. Devido ?s dificuldades na estrutura f?sica da unidade n?o foi poss?vel dar continuidade a pesquisa e a todos os momentos planejados, sendo ent?o finalizada a coleta de dados com a realiza??o de entrevistas com os profissionais participantes, a fim de avaliar os encontros realizados. Diante disso, considera-se que a pesquisa-a??o tamb?m teve seus objetivos alcan?ados, pois houve envolvimento da equipe na constru??o coletiva de uma proposta de mudan?a nas pr?ticas de preven??o e encaminhamento da viol?ncia contra a crian?a e o adolescente. Esse envolvimento foi favorecido pelo uso dos princ?pios freirianos durante o desenrolar do estudo. No entanto, admite-se que a rede n?o foi implantada integralmente, pois sabe-se que ela se constitui em um processo cont?nuo de aperfei?oamento e deve continuar em evolu??o junto ? equipe da unidade.

Made available in DSpace on 2014-12-17T14:46:51Z (GMT). No. of bitstreams: 1 MariaCCG_DISSERT.pdf: 2302501 bytes, checksum: 97cbbe5d4b5a91a6182b0e5e8c2d02fc (MD5) Previous issue date: 2011-12-08 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group. / A tuberculose (TB) ? um dos principais agravos ? sa?de a ser enfrentado em ?mbito global. No Brasil, a responsabilidade pelas a??es de diagn?stico e controle dessa doen?a foi transferida aos munic?pios, no ?mbito da Aten??o Prim?ria ? Sa?de (APS), visando melhorias nos indicadores epidemiol?gicos, impondo reorienta??o da pr?tica das equipes de sa?de da fam?lia e requerendo metodologias que analisem em que medida os componentes da APS est?o sendo alcan?ados. Destarte, este estudo tem o objetivo de analisar o desempenho dos servi?os de APS do Munic?pio de Natal/RN para o diagn?stico e controle da TB, sob a perspectiva dos profissionais de sa?de (m?dicos e enfermeiros). O estudo ? descritivo, de corte transversal e quantitativo. A coleta de dados foi realizada de mar?o a julho de 2011, e envolveu 121 profissionais de sa?de, que atuam em 52 unidades de sa?de (USF, UBS e Unidades Mistas). O instrumento de coleta ? estruturado, baseado no Primary Care Assessment Tool (PCAT), validado e adaptado para avaliar a aten??o ? TB no Brasil, e inclui quest?es referentes aos componentes Estrutura e Processo dos servi?os de sa?de. Para an?lise quantitativa, constru?ram-se indicadores, cujos padr?es de respostas s?o seguidos de acordo com a escala de Likert, entre 1 e 5, que significou o grau de rela??o de prefer?ncia (ou concord?ncia) das afirma??es. Os valores entre 1 e 3 foram considerados insatisfat?rios para o indicador; entre 3 e menores que 4, regulares; e, entre 4 e 5, satisfat?rios. No tocante aos insumos e equipamentos, as unidades apresentaram condi??es satisfat?rias, para formul?rio (=4,26), consulta m?dica (  =4,02) e cesta b?sica (  =4,24); condi??o regular para pote (  =3,56); e condi??es insatisfat?rias para vale-transporte (  =1,50), e realiza??o da baciloscopia (  =2,42) e raioX (  =1,07). Em rela??o ?s a??es, observou-se desenvolvimento satisfat?rio para aquelas centradas no indiv?duo doente. As a??es voltadas para o ?mbito coletivo, como a busca de sintom?ticos respirat?rios (SR), controle de comunicantes e orienta??es para comunidade, variaram de regular a insatisfat?rias (  =3,16 -  =1,34). Quanto ? capacita??o, 94,2% receberam treinamentos para identificar SR. No que se refere ao tempo para o diagn?stico, a mediana do tempo decorrido entre a identifica??o do SR e o in?cio do tratamento foi de 22 dias. Em rela??o ?s dificuldades enfrentadas pelos profissionais para o diagn?stico da TB, 56,2% referiram que estas est?o relacionadas somente aos servi?os de sa?de, com destaque para defici?ncia na retaguarda laboratorial e na refer?ncia para os servi?os especializados, o d?ficit de recursos humanos e materiais e a baixa realiza??o de busca ativa. Os profissionais percebem o desempenho das a??es de diagn?stico e controle da TB permeados por limita??es e entraves de car?ter organizacional e operacional de diversas dimens?es, emergindo a necessidade de articula??o efetiva dos diversos setores e atores-chave da aten??o ? TB, para ado??o de novas estrat?gias intersetoriais que visem ? amplia??o da capacidade de resposta da APS, promovendo o melhor desempenho na presta??o dos servi?os ao usu?rio, fam?lia e comunidade, e assegurando a??es efetivas e resolutivas ?s necessidades deste grupo populacional.

Made available in DSpace on 2014-12-17T14:46:51Z (GMT). No. of bitstreams: 1 IllaDC_DISSERT.pdf: 2351170 bytes, checksum: 8112ddeed5d91d971d4e747e0bb37218 (MD5) Previous issue date: 2011-12-09 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health. / A tuberculose (TB) ? uma doen?a de grande repercuss?o no contexto mundial atual. No Brasil, o controle da doen?a foi direcionado para a Aten??o Prim?ria ? Sa?de, em virtude da determina??o do Minist?rio da Sa?de de descentralizar as a??es de sa?de para a Aten??o B?sica. Dessa forma, desde ent?o as a??es de diagn?stico, controle e tratamento da doen?a devem acontecer nesse contexto, por?m, ainda existem muitos entraves que podem dificultar a realiza??o dessas determina??es. Este estudo tem o objetivo analisar o desenvolvimento das a??es de controle de TB desenvolvidas nos servi?os de Aten??o Prim?ria ? Sa?de, a partir da vis?o do doente. O estudo ? descritivo, de corte transversal e quantitativo. A popula??o ? constitu?da por 517 doentes de tuberculose em tratamento nas Unidades de Aten??o Prim?ria ? Sa?de no Munic?pio de Natal/RN; a amostra ? formada por 93 doentes de TB. O instrumento de coleta ? estruturado, baseado no The Primary Care Assessment Tool (PCAT), validado no Brasil e adaptado para avaliar a aten??o ? TB no Brasil, com modifica??es. Tal instrumento foi dividido em blocos: o primeiro correspondeu ?s informa??es sociodemogr?ficas do doente de TB e o segundo ?s a??es de controle, diagn?stico e tratamento de TB nos servi?os de sa?de (SS), e inclui quest?es relacionadas ?s dimens?es da aten??o prim?ria: acesso, v?nculo, elenco de servi?os, coordena??o da aten??o, orienta??o ? comunidade e enfoque na fam?lia. Para an?lise quantitativa, constru?ram-se indicadores para cada item do instrumento. Os padr?es de respostas s?o seguidos de acordo com a escala de Likert, ? qual se atribuiu um valor entre 1 e 5, que significaram o grau de rela??o de prefer?ncia (ou concord?ncia) das afirma??es. Os valores entre 1 e 3 foram considerados insatisfat?rios para o indicador; entre 3 e menores que 4, regulares; e, entre 4 e 5, satisfat?rios. Os resultados indicam que 62,37% dos doentes eram homens, 27,96% com faixa et?ria de 41 a 50 anos, sendo 34,41% desempregados, de baixa escolaridade e baixa renda familiar. Verificou-se que os servi?os hospitalares de refer?ncia s?o a porta de entrada para o doente (59,14%), e tamb?m os locais de diagn?stico da doen?a (72,04%). Sobre o acesso, as condi??es encontradas foram satisfat?rias quanto: ao n?mero de vezes em que precisavam busc?-lo at? o atendimento ao problema de sa?de, ? marca??o e ? facilidade para conseguir consulta no SS, ? realiza??o do atendimento sem preju?zos ao comparecimento do indiv?duo ao trabalho, e ?s facilidades referentes ? proximidade entre a resid?ncia e os servi?os; foram consideradas insatisfat?rias as condi??es relacionadas ao deslocamento at? o SS, e sobre hor?rio e dias de funcionamento dos servi?os. No que se refere ao elenco de servi?os, foram satisfat?rias ou regulares as a??es relacionadas ? solicita??o de exames at? a sua viabiliza??o no primeiro SS, ? disponibiliza??o de pote para realiza??o de baciloscopia e de medicamentos para o tratamento, al?m da realiza??o de consultas de controle e recebimento de informa??es sobre a doen?a e o tratamento realizado; considerou-se insatisfat?rias a realiza??o de atendimento domiciliar ao doente de TB por parte do SS que atua como porta de entrada, a realiza??o do Tratamento Diretamente Observado (TDO), de visitas domiciliares durante o tratamento, de oferta de aux?lio-transporte ao doente e de exist?ncia de grupos para doentes de TB. Em rela??o ? coordena??o da aten??o, resultou em regular a a??o de encaminhamento do doente a outros SS para obten??o de exames; e como insatisfat?rio o encaminhamento para obten??o de medicamentos. J? as rela??es de v?nculo entre doente e equipe de sa?de foram consideradas em sua maioria satisfat?rias ou regulares. Quanto ao enfoque familiar e comunit?rio, foi satisfat?rio apenas o indicador referente aos questionamentos dos profissionais ao doente sobre a exist?ncia de sintom?ticos respirat?rios na fam?lia. Considera-se que h? necessidade de maior compromisso dos agentes governamentais para com os incentivos obrigat?rios ao controle da TB, assim como da disponibiliza??o dos insumos necess?rios e capacita??o dos recursos humanos que atuam na APS, na cont?nua busca de fortalecimento da aten??o prim?ria, como lugar do mais amplo acolhimento ?s necessidades de contato do usu?rio com as a??es e os profissionais de sa?de. Recomenda-se a ado??o de mecanismos de gest?o poss?veis de ampliar a capacidade resolutiva da APS, promovendo a presta??o dos servi?os ao usu?rio e assegurando a aten??o ? sa?de da popula??o.

Made available in DSpace on 2014-12-17T14:46:52Z (GMT). No. of bitstreams: 1 JoseELL_DISSERT.pdf: 1209800 bytes, checksum: 6ccdf27e7399044ee694fed91b7f4663 (MD5) Previous issue date: 2011-03-30 / The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others. / O Processo de Enfermagem (PE) ? considerado como a din?mica das a??es sistematizadas e inter-relacionadas visando ? assist?ncia do ser humano. No entanto, percebemos a falta de uso do PE nos servi?os e observamos que a dificuldade de implanta??o dele est? relacionada ? pr?pria valoriza??o pelos enfermeiros e quest?es institucionais que envolvem recursos humanos e materiais. Acreditamos que o gerente, como representante de toda a assist?ncia prestada pela enfermagem da institui??o, ? um personagem importante para efetiva??o de pol?ticas de interesse da enfermagem, como a implanta??o do PE no servi?o. No entanto, a literatura ? escassa quanto ao PE na perspectiva do gerente de enfermagem. O objetivo geral deste estudo ? analisar a viabilidade do Processo de Enfermagem no contexto hospitalar a partir das atitudes dos gerentes de enfermagem das institui??es acerca desse instrumento. Realizamos uma pesquisa descritivo-explorat?ria, de abordagem quantitativa, com uma popula??o de 45 gerentes de enfermagem de hospitais atuando na rede p?blica estadual de Natal-RN e nas unidades hospitalares da UFRN. Foram utilizados dois instrumentos para a coleta de dados, um question?rio sobre o PE, desenvolvido para prop?sitos deste estudo e a escala para medi??o de atitudes, Posi??es sobre o Processo de Enfermagem. A popula??o ? predominante feminina (91,0%) e relativamente experiente na pr?tica da enfermagem (M?dia = 17,6 anos). No entanto, possuem pouca experi?ncia na ?rea gerencial (M?dia = 8,6 anos). Expressam ter pouco conhecimento dos termos relacionados ao PE e pouca experi?ncia com ele. Possuem uma atitude favor?vel ao PE (M?dia Geral = 110,9); s?o favor?veis a seu desenvolvimento no servi?o (88,9%) e sugeririam a sua implanta??o (86,7%); 48,9% indicaram pouca possibilidade de implanta??o no servi?o e 37,8% muita possibilidade. O teste de Spearman entre a Atitude sobre o PE e a Possibilidade de implanta??o no servi?o mostrou uma associa??o negativa fraca, tanto na atitude geral (-0,316), quanto nos 20 itens do instrumento, com coeficientes variando entre -0,014 a -0,464. A an?lise fatorial da escala realizada neste estudo identificou tr?s fatores subjacentes ?s atitudes dos gerentes neste estudo: relev?ncia , operacionaliza??o e colabora??o , com Coeficiente Alfa Cronbach de 0,955; 0,844 e 0,807, respectivamente e de 0,956 para todos os itens em conjunto, demonstrando que a escala geral e as fatoriais possuem coer?ncia interna para uso nessa popula??o. Presumimos que h? uma tend?ncia, embora leve, dos profissionais com atitude favor?vel ter percep??o negativa sobre a possibilidade de implanta??o do PE no servi?o. A posi??o favor?vel ao PE parece n?o ser suficiente para a viabilidade de implanta??o dessa metodologia no servi?o hospitalar, sendo esse resultado desconfort?vel para a enfermagem. Essa situa??o sugere que as dificuldades de implanta??o do PE est?o vinculadas ? outras quest?es, como as organizacionais. A implanta??o do PE em uma institui??o onde n?o ? conhecido, nem praticado, constitui a introdu??o de uma inova??o tecnol?gica e de trabalho que envolve m?ltiplos requisitos, entre eles a ades?o das pessoas ? inova??o proposta. Isso demanda n?o s? tempo, mas um processo com estrat?gias espec?ficas para a difus?o do conhecimento acerca do m?todo, bem como os ajustes institucionais e de recursos humanos necess?rios. Nesse processo o envolvimento de todos os profissionais da institui??o ? necess?rio. Essa situa??o retoma as discuss?es de autonomia profissional, limites e perspectivas da a??o e influ?ncia do enfermeiro no contexto hospitalar, (re) defini??o de papeis, delimita??o (ou consenso) do objeto de estudo ou do(s) processo(s) de trabalho, entre outras.

Made available in DSpace on 2014-12-17T14:46:53Z (GMT). No. of bitstreams: 1 JaquelineMBS_DISSERT.pdf: 1765859 bytes, checksum: 6d288bdaf8d4615845eb0265dedead22 (MD5) Previous issue date: 2011-12-13 / The counseling on HIV/Aids consists in a prevention strategy that contributes to increase the diagnosis of HIV and start earlier the treatment. The counseling has as pillars the emotional and educational support, risks evaluation that aim at the adoption of safe practices and the individual s responsibility for his own health. To accomplish these results, it is necessary that health workers understand counseling as a unique educational moment that stimulates the user s critical-reflection when it comes to his role as an active subject in this process. This study aimed to analyze the counseling on HIV/Aids conducted by the professionals of the Testing and Counseling Center (CTA), based on the educational perspective of Paulo Freire . This is a descriptive qualitative study with a critical reflexive design based on the principles of Action-Science. All the professionals acting as counselors in the Joao Pessoa, PB CTA, eight in total, took part in the study. Data were collected during the month of March, 2011, through non participative observation and semi-structured interviews with a critical-reflexive focus, analyzed according to the tenets of the critical-reflexive methodology, and discussed taking into consideration the Paulo Freire s pedagogy and pertinent literature. It was observed that most of the professionals expressed the work philosophy of CTA as the diagnosis and prevention of the disease, associated with the utilization and demonstration of condoms. However, upon observation of their counseling sessions, these ideas were not converted in actions. Educational themes were not covered and the condom wasn t offered at any time. The counseling actions focused on the provision of information and filling out the paper forms which are necessary for attendance. The sessions were conducted with brief dialogues and little opportunity for the users to expose or complement their thoughts and needs. The professionals mentioned as facilitating conditions for counseling, the team interaction and physical structure. The difficulties focused on the users low cognition, the large demand for attendance, aspects related to the service organization, and the counselors absences and delays. After reflecting about the actions observed in the counseling, the majority of professionals admitted the need to modify their practice in the incorporation of educational principles for the achievement of a broader prevention, and seemed to be willing to work in this perspective. In conclusion, although the counselors show ideas consistent with the purposes of CTA, these ideas are limited when it comes to the understanding of the meaning of prevention in HIV/Aids. Taking into consideration that they express a certain comprehension and act differently during the counseling, they demonstrate a lack of bond between the theories in use and the proposed ones, in accordance with the contribution of the action-science theory. The counseling, as an educative practice, doesn t materialize in the counseling itself and the orientation for reflection is not given during the attendance. These findings suggest the need to include the process of reflection in the execution of the actions of counseling, so that these practices are guided by reflexive practice, aiming at transforming the way of thinking and acting into a more educational perspective toward a more democratic and holistic assistance. / O aconselhamento em HIV/Aids consiste numa estrat?gia de preven??o pela qual ? poss?vel aumentar o diagn?stico do HIV e iniciar o mais precoce o tratamento. Os pilares que sustentam a estrat?gia s?o o apoio emocional e educativo, e a avalia??o de riscos, que visam ? ado??o de pr?ticas seguras e responsabilidade do sujeito como agente da sua sa?de. Para o alcance dos resultados, torna-se necess?rio que os profissionais de sa?de compreendam o aconselhamento como um momento educativo ?mpar, por estimular a reflex?o cr?tica do usu?rio no tocante ao seu papel como sujeito ativo nesse processo. Este estudo teve como objetivo analisar o aconselhamento em HIV/Aids realizado pelos profissionais do Centro de Testagem e Aconselhamento (CTA), na perspectiva educacional de Paulo Freire. Realizou-se um estudo descritivo com abordagem qualitativa e delineamento de investiga??o cr?tico-reflexiva, com base nos princ?pios da Ci?ncia-A??o. Participaram desta pesquisa todos os profissionais, totalizando oito, que atuam no aconselhamento no CTA de Jo?o Pessoa/PB. Os dados foram coletados no m?s de mar?o de 2011, por meio da observa??o n?o participativa e entrevista semiestruturada, com enfoque cr?tico-reflexivo, e analisados segundo os aportes da metodologia cr?tico-reflexiva e discutidos ? luz da pedagogia de Paulo Freire e autores pertinentes. Observou-se que a maioria dos profissionais compreende a filosofia de trabalho do CTA como sendo o diagn?stico e a preven??o associada ? utiliza??o e demonstra??o do preservativo. Contudo, ao observar as suas a??es durante os aconselhamentos, essas ideias se concretizam parcialmente. Temas educativos n?o foram abordados e o preservativo n?o foi oferecido em nenhum dos atendimentos. As a??es centraram-se no acolhimento de informa??es e no preenchimento dos formul?rios necess?rios ao atendimento, com di?logo breve e com pouca abertura para o usu?rio expor, ou completar, os seus pensamentos e necessidades. Os profissionais citaram as condi??es facilitadoras para o aconselhamento, a intera??o da equipe e estrutura f?sica. Focalizaram as dificuldades do baixo grau de cogni??o dos usu?rios, a demanda de atendimentos e outros aspectos da organiza??o de servi?o, e o descompromisso dos aconselhadores quanto ?s faltas e atrasos. Ao refletir sobre as a??es observadas nos aconselhamentos, a maioria dos profissionais reconheceu que precisa modificar algumas a??es do atendimento para incorpora??o dos princ?pios educativos na realiza??o de uma preven??o mais ampla, e se mostraram dispostos a trabalhar nessa perspectiva. Conclui-se que, embora os profissionais expressem ideias condizentes com os prop?sitos do CTA, estas s?o limitadas como apropria??o do significado de preven??o em HIV/Aids. Na medida em que expressam uma compreens?o e agem de forma diferente na realiza??o das a??es durante o aconselhamento, demonstram a desarticula??o entre as teorias em uso e as teorias propostas, conforme os aportes da teoria da ci?ncia-a??o. O aconselhamento como pr?tica educativa se concretiza parcialmente nos atendimentos e a orienta??o para uma reflex?o ? pouco oportunizada no atendimento. Esses achados sugerem a necessidade de inserir o processo de reflex?o na realiza??o das a??es de aconselhamento, de forma que estas sejam pautadas na pr?tica reflexiva, objetivando a transforma??o do seu modo de pensar e agir para uma perspectiva educacional com vistas a uma assist?ncia mais democr?tica e integral.