Base Teórica: Nas duas últimas décadas houve um crescimento no número de estudos que abordam o tema espiritualidade em cuidados paliativos, ressaltando o impacto desta dimensão na qualidade de vida dos pacientes/famílias. A atenção às necessidades espirituais tem sido reconhecida como um importante aspecto de avaliação da qualidade assistencial nas instituições de saúde. Os estudos indicam que uma das principais barreiras para uma abordagem que inclua espiritualidade no cuidado tem sido a falta de preparo/educação dos profissionais de saúde. Objetivos: Desenvolver e avaliar a eficácia do uso de um módulo de educação sobre espiritualidade na atenção a pacientes/famílias em cuidados paliativos para os profissionais de saúde do Hospital de Clínicas de Porto Alegre (HCPA). Para alcançar este objetivo foi necessário na primeira etapa da pesquisa realizar o processo de adaptação/validação transcultural e avaliação das propriedades psicométricas da Spiritual Care Competence (SCCS) para o português falado no Brasil. Método: Na primeira etapa foi realizado um estudo de validação que seguiu os passos de Beaton: tradução para o português, retradução para o inglês, correção e adaptação semântica pelo comitê de especialistas, avaliação da clareza da versão pré-final e medidas psicométricas da versão final em português. Na segunda etapa foi realizado um estudo quase-experimental, do tipo pré-teste e pós-teste, a partir de uma abordagem quantitativa, com profissionais de saúde do HCPA. A coleta de dados foi realizada por meio de um questionário semiestruturado e da SCCS-versão brasileira. Resultados: Participaram da etapa de validação da SCCS 181 profissionais de saúde. Quanto à consistência interna, o alfa de Cronbach apresentou valor total de 0,92 e a média de correlação interitem foi de 0,29. O teste-reteste demonstrou que não houve diferença estatisticamente significante nas seis subescalas e o coeficiente de concordância intraclasse variou de 0,69 a 0,84, demonstrando a estabilidade da escala. Na etapa de uso do módulo de educação participaram 52 profissionais de saúde que atuam em cuidados paliativos no HCPA. Foram observadas diferenças significativas entre as medidas pré e pós-intervenção nas seguintes dimensões da SCCS - versão brasileira: avaliação e implementação do cuidado espiritual, profissionalização e melhoria da qualidade do cuidado espiritual, apoio e aconselhamento individualizado ao paciente (p<0,001) e encaminhamento (p=0,003). Conclusão: Estes dados indicam a qualidade das propriedades psicométricas da SCCS – versão brasileira para uso com profissionais de saúde. Quanto ao desenvolvimento e uso do módulo de educação permanente, os dados fornecem evidências preliminares, demonstrando os efeitos positivos do uso desta intervenção educativa no desenvolvimento das competências dos profissionais de saúde para uma abordagem integral, centrada no paciente/família e que contemple a atenção as suas necessidades espirituais e a sua participação no processo de tomada de decisão dos cuidados paliativos. Com base nos resultados deste estudo, sugere-se a necessidade da inclusão dos temas espiritualidade e cuidado espiritual nas bases curriculares e nos processos de educação permanente de instituições de ensino, assistência e pesquisa em saúde. / Theoretical Basis: Over the last two decades there has been an increase in the number of studies that address spirituality in palliative care, highlighting the impact of this dimension on patient/family quality of life. Attention to spiritual needs is recognized as an important aspect of evaluating the quality of care in health institutions. Studies indicate that one of the main obstacles to an approach which includes spirituality in palliative care has been the lack of preparation/education for healthcare professionals in relation to this issue. Objectives: Develop and evaluate the effectiveness of an education module on spirituality and spiritual care for patients/families under palliative care by healthcare professionals in Hospital de Clínicas de Porto Alegre. To achieve this objective it was necessary in the first stage of the research to carry out the cross-cultural adaptation/validation process and psychometric properties evaluation of the Spiritual Care Competence Scale for the Portuguese spoken in Brazil. Methods: During the first stage a validation study was conducted following the steps of Beaton: translation into Portuguese, back-translation into English, expert committee review for semantic equivalence, assessment of the clarity of the pre-final version, and evaluation of the psychometric properties of the final version in Portuguese. For the second stage, a quasi-experimental study, the pre-test and post-test type, from a quantitative approach, was carried out with health professionals of the HCPA. Data collection was conducted through the use of a semi-structured questionnaire and the SCCS - Brazilian version. Results: 181 health professionals participated in the validation stage of SCCS. Regarding the internal consistency, Cronbach's alpha showed a total value of 0.92 and the average inter-item correlation was 0.29. Test results demonstrated no statistically significant differences in the six subscales. The intraclass correlation coefficient ranged from 0.69 to 0.84, demonstrating the stability of the scale. Fifty-two healthcare professionals, who work in palliative care at HCPA, attended the education module. Significant differences were observed between pre and post-intervention in the following dimensions of SCCS - Brazilian version: assessment and implementation of spiritual care, professionalization and improving of spiritual care quality, personal support and patients counselling (p<0.001) and referral (p = 0.003). Conclusion: These data indicate the quality of the psychometric properties of SCCS - Brazilian version for use with health professionals. Through the development and use of the continuing education module, the results of this study provide preliminary evidence demonstrating the positive effects of using this educational intervention in developing the skills of healthcare professionals for a comprehensive approach centered on the patient/family including attention to their spiritual needs and their participation in the palliative care decision-making process. Based on the results of this study, we can suggest the necessity the inclusion of the theme of spirituality and spiritual care in curricular bases and in the continuing health education processes.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo traz uma reflexão sobre os desafios de educação permanente dos Agentes comunitários de Saúde inseridos no projeto Telessaúde/Rio de Janeiro. Temos como objetivo geral discutir o processo de educação permanente desses colaboradores inseridos no Projeto Telessaúde, Núcleo Rio de Janeiro, ressaltando os usos reais e potenciais das ferramentas da educação à distância, na perspectiva da educação crítica. Os objetivos específicos são: descrever o perfil demográfico de utilização de ferramentas de educação permanente a distância de Agente comunitário de saúde (ACS) do Estado do Rio de Janeiro inseridos no Telessaúde RJ, segundo as regiões administrativas do Rio de Janeiro; descrever e analisar a participação dos ACS no Telessaúde RJ durante o ano de 2009 nas atividades de teleconferências; discutir, com base na participação dos ACS no Telessaúde RJ, o papel da mediação da internet e das ferramentas do Telessaúde RJ no seu trabalho, na perspectiva pedagógica crítica. A metodologia utilizada é quali-quantitativa, no intuito de descrever, quantificar e classificar os dados em relação aos ACS que estão inseridos no Telessaúde. A coleta de dados se deu a partir de um relatório das oficinas presenciais e da análise de 100 formulários preenchidos pelos ACS nos workshops realizados nas regiões administrativas do Rio de Janeiro e no registro de teleconferências. Resultados: o relatório das oficinas nos mostrou que os ACS vêem no Telessaúde não só um espaço para troca de experiências, mas também para a educação permanente em serviço. Foi evidenciando na análise dos formulários, que a faixa etária na amostra de 100 dos ACS é de 23 a 38 anos com 59 ACS. Além disso, observou-se que os ACS utilizam a internet diariamente, com predominância do vinculo empregatício por CLT, acessam SIAB e DATASUS com frequência, realizam trabalho multidisciplinar com médicos e enfermeiros, propõem temas para capacitações pelo Telessaúde, em relação à assistência às teleconferências de 555 ACS no ano de 2009. Concluímos que a inserção do ACS no Telessaúde, com vistas à educação permanente, é uma real possibilidade e o estudo nos mostrou que eles vêem esta proposta do Ministério da Saúde como inovadora e viável. / This study reflects on the challenges of continuing education for the staff of Community Health Telehealth, being part of the project in Rio de Janeiro. We have as a general objective: to discuss the process of continuing education for ACS inserted in Telehealth Project, Rio de Janeiro, emphasizing the uses, actual and potential tools of distance education from the perspective of critical education. Specific Objectives: to describe the demographic profile of usage of tools for lifelong learning at a distance of ACS of Rio de Janeiro RJ inserted in Telehealth, according to the administrative regions of Rio de Janeiro; to describe the participation of the ACS for the RJ Telehealth, in year 2009 as well as the activities of teleconferencing, to discuss, based on participation in the ACS Telehealth RJ, the mediating role of the Internet and RJ Telehealth tools in their work, the critical pedagogical perspective. The methodology is quali-quantitative, in order to describe, quantify and classify data in relation to the ACS that are inserted in Telehealth. Data collection took place from a report of the workshops, and the analysis of 100 completed forms by the ACS in workshops held in the administrative regions of Rio de Janeiro, and the record teleconferences. Results: related to the report of the workshops It showed us that they see the ACS Telehealth not only as a space for exchanging experiences, but as a space for continuing education in service. It was evident in the analysis of the forms in relation to age in the sample of 100 of these ACS were ranging from 23 to 38 years with 59 CHA, the ACS uses the Internet daily, with majority of employment contract by CLT, with access SIAB And DATASUS often perform multidisciplinary working proposes topics for training for Telehealth, and assists with the ACS conference of 555 in 2009. We conclude that the insertion of ACS in Telehealth, aiming at continuing education is a real possibility, and the study showed us that they see this proposal from the Ministry of Health as an innovative and viable.

A presente pesquisa é um estudo qualitativo sobre a relação médico-paciente em pediatria, especificamente da relação do pediatra com a criança portadora de anomalia congênita e sua família. O estudo decorre da experiência em escolas especiais, na condição de médico pediatra. O pressuposto básico desta pesquisa é que existe uma dificuldade do médico em se relacionar com estes pacientes e sua família, devido a sua formação médica “deficiente". Os objetivos da pesquisa foram: 1) identificar sentimentos e atitudes do pediatra no seu relacionamento com crianças com anomalias congênitas e seus familiares e 2) identificar as dificuldades de relacionamento do pediatra com estas famílias. A metodologia utilizada é uma “variante da pesquisa qualitativa", que trabalha o conceito de representações sociais, segundo as correntes de pensamento mais importantes na área da saúde, aliada ao método psicodramático na coleta e análise dos dados. Foram entrevistados 10 (dez) pediatras, utilizando-se um roteiro de entrevista do tipo não-estruturada. As entrevistas foram gravadas em fita cassete e a análise dos dados evidenciou a “deficiência" da formação médica no ensino da relação médico-paciente. Além disso, emitimos a tese de que esta dificuldade está ligada com a imagem de onipotência, tanto do médico como de outros profissionais de saúde, fruto de sua formação universitária. Quanto à prática médica pôde-se identificar uma atividade intensa em número de horas por dia de trabalho, que prejudica a formação continuada formal e informal, a reflexão sobre esta prática e a atenção dispensada a cada paciente, caracterizando o que chamamos de “ativismo". Também pudemos perceber diferenças na relação médico paciente quanto à classe social do paciente. Foram identificados sentimentos de choque emocional, depressão e impotência nos médicos frente à deficiência, com destaque para a ansiedade no momento de falar com os pais sobre a deficiência de seus filhos. Quanto ao momento especifico de dar a notícia aos pais sobre o nascimento de um bebê com anomalia congênita, foram identificadas práticas consideradas inadequadas pela maioria dos estudiosos do assunto. Com a intenção de "proteger a mãe", quase todos os entrevistados revelaram a prática de contar a notícia primeiro ao pai, sem a presença da mãe, sedando-a logo após o parto. Outra prática identificada foi a de criar expectativa sobre a saúde do bebê para "preparar" a mãe e os familiares para receberem a notícia. Finalmente, é sugerido que a formação médica passe a discutir o relacionamento com famílias de crianças com deficiência e a criação de equipes multiprofissionais em maternidades e Unidades de Terapia Intensiva, com a função de transmitir informações aos pais e familiares, nos casos de anomalia congênita, estados graves de saúde com possibilidade de seqüelas ou morte de bebês. / The present investigation is a qualitative study of the doctor-patient relationship in pediatrics, specifically of the relationship between pediatrician and children with congenital anomalies and their families. The study is based on the author’s experience in special schools as a pediatrician. The basic assumption of this study is that the physician has difficulty in relating to these patients and their families due to his “disabled" medical training. The objectives of the study were: 1) to identify the feelings and attitudes of the pediatrician in his relationship with children with congenital anomalies and their relatives, and 2) to identify the difficulties experienced by the pediatrician in relating to this families. The methodology used was a “variant of qualitative research" which explores the concept of social representations according to the most important currents of thought in the health area, allied to the psychodrama method for data collection and analysis. Ten pediatricians were interviewed using a nonstructured questionnaire. The interviews were recorded on tape and data analysis demonstrated the “disablement" of medical training in terms of teaching about the doctor-patient relationship. In addition, the author proposes the thesis that this difficulty is linked to the image of omnipotence both of the doctor and of other health professionals, created by their university education. With respect to medical practice, intense activity was identified in terms of number of work hours per day, which impairs continuing formal and informal education, the reflection about this practice and the attention given to each patient, characterizing what we call “activism". It was also possible to perceive differences in the doctor-patient relationship in terms of the social class of the patient. Feelings of emotional shock, depression and impotence were detected in physicians facing these disablements, with emphasis on the anxiety they feel when they must talk to the parents about the disablement of their children. As to the specific time when the news should be broken to parents about the birth of a baby with a congenital anomaly, the practices identified are considered inadequate by most of those who study this subject. With the intention of “protecting the mother", almost all the doctors interviewed revealed the practice of first disclosing the news to the father without the presence of the mother, whom they submit to sedation soon after delivery. Another practice identified was to create expectations about the health of the baby in order to “prepare" the mother and the other relatives to receive the news. Finally, the author suggests that medical education should start to involve the discussion of the relationship with the families of disabled children and the creation of multiprofessional teams in maternities and in Intensive Care Units in order to transmit information to the parents and relatives in cases of congenital anomalies or of serious health conditions involving the possibility of sequels or of infant death.

Primary care physician (PCP) shortages have been a barrier to accessing care for millions of Americans, particularly those living in areas facing the worst shortages - primary care health professional shortage areas (HPSAs). Increased use of nurse practitioners (NPs) has been proposed as a solution to the shortages as NPs can effectively substitute for PCPs. However, this proposal has been hampered by regulatory restrictions on NP scope-of-practice (SOP) that exist in many states. While some states permit NPs to practice and prescribe medications independent of physicians (NP independence), others require extensive physician supervision that limit NPs ability to provide care and substitute for PCPs. Despite the limitations that restrictive regulations pose to improving access to primary care, research evidence of their effect on access in primary care HPSAs is limited. This dissertation fills this gap in the literature. Using individual-level data from the Medical Expenditure Panel Surveys (1996-2015) and a difference-in-differences approach, I exploit variation in NP independence across states and over time to evaluate the impact of NP independence on access to primary care in HPSAs Further, I examined for heterogeneity in the effect of NP independence between HPSAs and non-HPSAs as well as effect heterogeneity in HPSAs based on individual (age, insurance status, and insurance type) and health system characteristics (availability of primary care facilities and NP Medicaid reimbursement rate) I find that NP independence led to a 5% increase in the number of individuals with a primary care provider and a 2% increase in the use of non-physicians (relative to physicians) as the primary care provider in HPSAs. However, non-HPSAs experienced no significant changes in access to care. Further, I find evidence of heterogeneity in the effect of NP independence in HPSAs for all three individual characteristics but find no significant effect heterogeneity for any of the health system characteristics. Non-elderly individuals experienced greater improvements in access following NP independence compared to their elderly counterparts, and while both insured and uninsured individuals experienced improvements in access to care, uninsured individuals benefitted more from NP independence. Further, I find evidence of greater improvements in access to care among Medicaid beneficiaries relative to their privately insured and Medicare counterparts. These findings imply that removing regulatory restrictions on NP SOP could be an effective policy strategy for mitigating the effects of PCP shortages and improving access to care in HPSAs. Further, they demonstrate that NP independence could be a viable tool for addressing access to care issues in two traditionally underserved populations – the uninsured and Medicaid beneficiaries. Beyond addressing access issues, NP independence could also mitigate rising health care costs. The finding of increased use of lower-cost non-physicians rather than their more costly physician counterparts after NP independence indicates that this policy change could also bring about cost savings for society.

Early stages of the co-occurring, mental health and substance use disorder (MH-SUD) recovery process present various social and physical challenges to the recovering person, including habitual cigarette smoking. Presenting smoking cessation to a person with a co-occurring disorder could also depend on behavioral health professional’s perceptions of implementing supplemental services in early recovery. Behavioral health professionals also face the challenge of assessing people’s motivation to quit smoking. Data was collected through an online survey that shaped this quantitative, cross-sectional study focused on understanding perceptions of smoking cessation in early MH-SUD recovery. The study’s data highlighted that the participants (N = 61) perceive smoking cessation as an appropriate intervention while also reporting high levels of self-confidence when assessing motivation to quit to smoking. Identifying as a smoker and former smoker, highest level of education and gender did not have a significant impact on perceptions of smoking cessation in early MH-SUD recovery. The study created an overview on how behavioral health professionals understand and support smoking cessation that contributes additional knowledge to social work’s existing research on habitual cigarette smoking and co-occurring disorders.

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient’ (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-05 00:18:04.617

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

O presente estudo busca analisar a percepção das profissionais de saúde sobre a assistência à mulher em situação de violência sexual em um hospital de emergência do município do Rio de Janeiro. Considerando que as mulheres que vivem em situação de violência são mais expostas a problemas de saúde diversos, o desempenho da equipe de saúde que atua no setor de emergência pode exercer um papel primordial na assistência e prevenção da violência sexual. O grupo social da investigação referiu-se à equipe multiprofissional, composta por médicas, assistentes sociais, psicólogas e equipe de enfermagem. Considerou-se a pesquisa qualitativa como a mais apropriada para a análise do objeto em questão. A técnica adotada para a produção de dados foi a entrevista individual semi-estruturada. Buscou-se analisar a percepção das profissionais de saúde sobre violência sexual no contexto da emergência, estabelecer relações entre os discursos sobre a atuação profissional na assistência à violência sexual e as respostas oferecidas para o enfrentamento da problemática. O estudo indicou que, no caso de muitas profissionais de saúde, o conhecimento acerca da violência sexual parte dos casos atendidos no cotidiano da emergência. Nesse sentido, a herança cultural solidifica percepções, sentimentos e ações sexistas, reducionistas e preconceituosas contra as mulheres, reproduzindo um padrão hegemônico de relações assimétricas. Por outro lado, as entrevistadas indicaram a importância das capacitações para maior reflexão sobre a violência sexual contra a mulher. A adoção da categoria gênero pela equipe multiprofissional poderia, portanto, resultar em uma compreensão mais crítica da violência sexual contra a mulher, proporcionando respostas mais adequadas com a realidade desta população. / This study analyzes the perception of health professionals on the assistance to women under sexual violence in an emergency hospital in the city of Rio de Janeiro. Considering women who live under violence are more exposed to several health problems, the performance of the health team who work in hospitals emergency room can be of fundamental importance in the care and prevention of sexual violence. The staff selected was multiprofessional and included physicians, social workers, psychologists and nurses. A qualitative research was chosen as the most appropriate for the analysis, which used a semi-structured individual interview for the data collection. The study aimed to analyze the health professionals perception of sexual violence in the context of the emergency room, to establish the relation between the discourses on the professional performance in the care for sexual violence and the responses offered to face the problem. It indicated that, as for many health professionals, the knowledge about sexual violence is acquired from the cases in the daily routine of the emergency room. This way, the cultural heritage hardens the perception, feelings and sexist, shortened and prejudiced actions against women, reproducing hegemonic patterns of asymmetric relations. On the other hand, interviews demonstrated the importance of qualification for a better reflection of sexual violence against women. Adopting the concept of gender, the multiprofessional team could have, therefore, a more critic understanding of the sexual violence against women, with more adequate responses to the reality of that population.

Made available in DSpace on 2014-12-17T14:47:08Z (GMT). No. of bitstreams: 1 SimonePL.pdf: 367978 bytes, checksum: 92f8358b98111bbab5566cdabe217d43 (MD5) Previous issue date: 2006-05-19 / Empathy is a basic facilitating element of the therapeutic helping relationship and the humanization process in health care. The objectives of this study were to identify the empathy level of health professionals working in the obstetrical sector of a university hospital recognized for its humanistic care and the perceptions of the women under their care regarding the empathic behavior shown by these professionals during hospitalization. We conducted a quanti/qualitative study with 47 health professionals that worked in the obstetrical sector (13 obstetricians, 12 nurses, 22 nurse technicians) and an intentional sample of 101 women that received cared from these professionals during the study period. We collected data by means of the Jefferson Empathy Scale for Health Professioals (JEPS-HR) and the Patient?s Perception of Health Professional Empathy (PPHPE), and two additional open questions designed to obtain the subjective opinion about the empathic behavior during the care. We utilized thematic analysis for the data obtained through the open questions and descriptive and inferential statistics for the quantitative data. We identified five thematic categories that represent the aspects valued by the professionals in their relationship with the women under their care: emotional involvement, communication, warm environment, integral vision and technical/scientific knowledge. The mean score on the JEPS-HR reported for the health professionals was 120,40, being that the maximum possible was 140.The Cronbach Alpha for the JEPS-HR was 0,83, indicating an acceptable level of reliability for this population. We consider therefore, that these professionals presented an acceptable empathy level when compared to other populations observed with the JEPS-HR. The results also indicated that women had statistically significant (p &#8804; 0,05) higher scores than men and that professionals with higher working hours tended to have lower scores in the empathy scale (r = -0,288; p &#8804; 0,05). The analysis of the subjective responses of the women indicated that they were satisfied with the humanistic care provided by the professionals but they also point out the existence of some power relationships. There were no significant differences in the empathy level of the medical or nursing team perceived by the women who registered means of 41,90 and 41,20 respectively on the PPHPE. In view of these results and considering the relevance of the element of empathy for care based on humanistic values, we reiterate the importance of further in-service training for the health team of the hospital in focus, on the topics of empathy and global aspects of humanized care for the implementation of its mission / Os relacionamentos voltados a ajudar o outro s?o conceituados como terap?uticos, sendo a empatia, elemento fundamental e facilitador desse relacionamento e conseq?ente processo de humaniza??o da assist?ncia em sa?de. O presente estudo tem como objetivos, identificar o n?vel de empatia dos profissionais do setor obst?trico de um hospital universit?rio reconhecido pela assist?ncia human?stica prestada ?s parturientes e a percep??o das mulheres receptoras do cuidado acerca da empatia demonstrada no atendimento. Realizamos uma pesquisa de abordagem quanti/qualitativa, na qual participaram do estudo, os 47 profissionais que atuam no setor obst?trico (13 m?dicos, 12 enfermeiros, 22 t?cnicos de enfermagem) e uma amostra intencional de 101 mulheres atendidas por esses profissionais durante o per?odo do estudo. Dados foram coletados atrav?s das escalas Jefferson de Empatia dos Profissionais de Sa?de (EJEPS) e Percep??o do Paciente sobre a Empatia dos Profissionais de Sa?de (PPEPS) e duas quest?es abertas inicias, objetivando verificar as opini?es subjetivas sobre a empatia prestada durante o atendimento. Utilizamos an?lise estat?stica descritiva e inferencial para os dados quantitativos e an?lise tem?tica das respostas ?s quest?es abertas. Foram identificadas cinco categorias que representam os aspectos que os profissionais valorizam no relacionamento com as mulheres: envolvimento emocional, comunica??o, ambiente acolhedor, vis?o integral e o conhecimento t?cnico-cient?fico. Na an?lise quantitativa, o escore de empatia encontrado nos profissionais foi, em m?dia, de 120,40 , sendo o m?ximo poss?vel 140. Neste estudo, o EJEPS apresentou um coeficiente alfa de Cronbach de 0,83 demonstrando um n?vel aceit?vel de confiabilidade com essa popula??o. Consideramos, portanto, que esses profissionais apresentam um bom n?vel de empatia quando comparados com outras popula??es observadas com o EJEPS. Os resultados tamb?m demonstram que a empatia adquiriu maior n?vel entre as mulheres (p &#8804; 0,05) e que os profissionais com maior jornada de trabalho tendiam possuir menores n?veis de empatia (r = -0,288; p &#8804; 0,05). A an?lise das respostas subjetivas das mulheres indicam que elas est?o satisfeitas com o cuidado human?stico, mas identificam a exist?ncia de express?es de poder nos profissionais. Na percep??o das mulheres, n?o houve diferen?a na empatia demonstrada pela equipe m?dica e a de enfermagem conforme os escores m?dios no PPEPS (41,90 e 41,20 respectivamente).Diante desses resultados e considerando a relev?ncia da empatia para operacionaliza??o de uma assist?ncia voltada para os valores human?sticos, refor?amos a import?ncia da capacita??o dos profissionais que atuam no hospital em foco, abordando a empatia e aspectos globais da humaniza??o para melhor implementa??o de sua miss?o

Doctor Legum - LLD / The persistence of preventable Maternal Morbidity and Mortality (hereafter MMM), in the developing world, despite ground breaking technological and scientific advances, is unacceptable. There is no cause of death and disability for men between ages 15 and 44 that comes close to the large scale of maternal mortality and morbidity. Thus, the prevalence of high MMM ratios indicates the side-lining of women's rights. Surprisingly, the causal factors of preventable MMM and interventions needed to reverse the pervasively high numbers are now well known. Yet, hundreds of women continue to die daily and to suffer lifelong illnesses while giving birth. In Uganda, despite various regulatory, policy and programmatic strategies, the most recent survey revealed that the maternal mortality ratios were at a staggering 438 per 100,000 live births.