Made available in DSpace on 2014-12-17T15:16:14Z (GMT). No. of bitstreams: 1 CristinaMAH_DISSERT.pdf: 984384 bytes, checksum: dfe0fc420bd6e5c96fec7d33e3020b1d (MD5) Previous issue date: 2011-03-04 / Introduction: The Frailty Syndrome is characterized by the decrease of energy reserve and the reduced resistance to stressors. Studies indicate that the neuroendocrine markers can be related to the appearance of this syndrome. The main endocrine answer to stress is the increase of cortisol levels. Objective: To analyze the correlation between the frailty syndrome the salivary cortisol in elderly residing in nursing homes. Method: A traversal study was accomplished, in Jo?o Pessoa city, PB, with a sample composed by 69 institutionalized elderly. The collected data refer to the frailty phenotype (weight loss, exhaustion, slowness, weakness, and lower level of physical activity) and to salivary cortisol parameters (first measure - 6-7h; second measure - 11-12h; third measure - 16-17h). In the statistical analysis the Pearson s correlation test was used, Chi square Test and Anova and Simple Linear Regression analyses. Results: The sample was composed by 37.7% of men and 62.3% of women, with age average of 77.52 (?7.82). There was a percentile of 45.8% frail elderly. The frail elderly obtained higher cortisol values in the third measure (p=0.04) and the frailty load was significantly associated to the first measure (r=0.25, p=0.04). The simple linear regression analysis presented a determination rate (R2=0.05) between frailty load and first cortisol measure. Conclusion: The largest cortisol values in the morning and before sleeping among the frail elderly supply indications that can have a relationship of cortisol increase levels and the frailty presence in elderly from nursing homes. / Introdu??o: A S?ndrome da fragilidade ? caracterizada pela diminui??o da reserva de energia e pela resist?ncia reduzida aos estressores. Estudos indicam que os marcadores neuroend?crinos podem estar relacionados ao surgimento desta s?ndrome. A principal resposta end?crina ao estresse ? o aumento dos n?veis de cortisol. Objetivo: Analisar a correla??o entre a s?ndrome da fragilidade e o cortisol salivar em idosos residentes em institui??es de longa perman?ncia. M?todo: Foi realizado um estudo transversal, na cidade de Jo?o Pessoa-PB, com uma amostra composta de 69 idosos institucionalizados. Os dados coletados referem-se ao fen?tipo de fragilidade (perda de peso, fadiga, lentid?o fraqueza, e baixo n?vel de atividade f?sica) e aos par?metros do cortisol salivar (primeira medida 6-7h; segunda medida 11-12h; terceira medida- 16-17h). Na an?lise estat?stica utilizou-se o teste de correla??o de Pearson, Teste Qui quadrado e Anova. Posteriormente a an?lise de Regress?o Linear simples. Resultados: A amostra foi composta de 37,7% de homens e 62,3% de mulheres, com m?dia de idade de 77,52 (?7,82). Houve um percentual de 45,8% de idosos fr?geis. Os idosos fr?geis obtiveram maiores valores de cortisol na terceira medida (p=0,04) e a carga de fragilidade esteve associada significativamente ? primeira medida (r=0,25, p=0,04). A an?lise de regress?o linear simples apresentou uma taxa de determina??o (R2=0,05), entre carga de fragilidade e primeira medida de cortisol. Conclus?o: Os maiores valores de cortisol pela manh? e antes de dormir entre os idosos fr?geis fornecem ind?cios de que possa haver uma correla??o positiva entre os n?veis de cortisol e a fragilidade em idosos de institui??es de longa perman?ncia.

No / AIMS: The aims of this study were to determine the recording of drug sensitivities of elderly care home residents, to describe the nature of sensitivities and to identify and describe discrepancies in the documentation of drug sensitivity status in general practices, pharmacies and care homes. METHODS: A random sample of residents within a purposive sample of care homes (nursing and residential) was selected. A clinical pharmacist inspected the GP medical record, the medicines administration record, and the care home record for each resident to identify drug sensitivities and discrepancies between records and to describe the nature of the recorded sensitivities. RESULTS: The records of 121 residents in 31 care homes were studied. Thirty-one (26%) residents had at least one documented drug sensitivity in one of the sources inspected, with 48 sensitivities in total recorded. There was no description of the nature of the sensitivities recorded in 39/48 (81%) cases. The number of sensitivities recorded on the medicines administration record, care home record and the GP record were 3 (6%), 29 (60%) and 35 (73%), respectively. Only two sensitivities were simultaneously recorded on all three records. CONCLUSIONS: It was of concern that over 90% of drug sensitivities were not recorded on the medicines administration record which is the final checking document when administering medication. The reason for this was that the dispensing pharmacy was responsible for generating the medicines administration record; however, drug sensitivity status is seldom shared between the GP and the dispensing pharmacy. Printing sensitivities on prescriptions would help to resolve this.

No / INTRODUCTION: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. METHODS: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. RESULTS: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff's high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. CONCLUSIONS: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

Background & Objective: Acute gastroenteritis (AG) outbreak in elderly homes is common in Hong Kong, especially during the winter. Although mainly a self-limiting condition, the associated short-term as well as long-term medical and social costs can be extensive. This case-control study aims to investigate the hygienic risk factors related to infectious AG in elderly homes at both institutional and individual levels. Predictor variables under investigation include hand wash practice, infection control practice, routine institutional hygienic practice, food handling practice, and environmental factors such as the home setting, ventilation measures and isolation room setting. / Conclusions: This study found that 'sometimes or never wash hands after toilet' was a significant personal hygienic risk factor for AG transmission. This indicated that toilet may be the most susceptible place and hands are the most susceptible vehicle for AG transmission in Hong Kong elderly homes. A higher percentage of the NOHs had a more frequent routine cleaning practice than the OHs, demonstrating that routine cleaning practice may be an economical and an effective way to prevent AG infection. / Methods: All the elderly homes in the New Territories East were invited to take part in the study. A total of 34 homes and 2,995 residents were recruited in the study sample. The data collection period was from Dec 2007 to May 2009. Cases were notified within one week after a reported AG case, either by a report from the elderly home in question, the weekly check up with the New Territories East Community Geriatric Assessment Teams (NTE CGATs), regular contact with the elderly homes by the research assistant and case referrals from the Accident and Emergency Department from the Prince of Wales Hospital (PWH). One hundred and forty cases and 280 matched controls were recruited. For every AG case reported, two sex and age (within 5 years) and elderly home matched controls were selected. Structured questionnaires were conducted in face-to-face interviews in the elderly homes by trained interviewers. Information about the ventilation and the environmental hygiene of the elderly homes was collected by observation from the research team at the beginning of the study. Descriptive analysis was performed for the characteristics of cases and controls. Multivariate and multilevel logistic regression models were applied and odds ratios (ORs) were calculated for the potential hygienic risk factors. / Results: Multiple conditional logistic regression analysis revealed 'sometimes or never wash hands after toilet' OR:3.09 (95%CI: 1.28 -- 7.42) [ref gp: wash hands every time after toilet] was the major significant risk factor for AG in elderly homes, indicating the possible route of person-to-person transmission. Other significant risk factors included: Self-nutrition evaluation as 'not enough' (OR: 2.07; 95%CI: 1.05 -- 4.06), 'Being hospitalized in past month before the interview' (OR: 2.86; 95%CI: 1.16 -- 7.05), 'Simplified Barthel Index scored <15" (OR: 2.63; 1.06 -- 6.53), and 'Alzheimer's' (OR: 2.75; 95% 1.18 -- 6.40). The institutional hygiene factors were investigated based on the descriptive analysis between the outbreak homes (OHs) and the non-outbreak homes (NOHs). The results indicated that the health worker (HW) to resident ratio was much lower in OHs than NOHs (50% OHs: 1:30-55 vs > 80% NOHs:1:10-29), and a higher percentage of the NOHs had a more frequent routine cleaning practice than the OHs. / Fung, Pui Kwan. / Adviser: Ho Suzanne Sutying. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 182-206). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Dissertação(mestrado)- Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2011. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-01-02T16:52:31Z No. of bitstreams: 1 daianegauterio.pdf: 3507564 bytes, checksum: 6f393ecaff709e470512ea9006cc8595 (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-01-04T00:44:46Z (GMT) No. of bitstreams: 1 daianegauterio.pdf: 3507564 bytes, checksum: 6f393ecaff709e470512ea9006cc8595 (MD5) / Made available in DSpace on 2013-01-04T00:44:46Z (GMT). No. of bitstreams: 1 daianegauterio.pdf: 3507564 bytes, checksum: 6f393ecaff709e470512ea9006cc8595 (MD5) Previous issue date: 2011 / O objetivo geral do estudo foi propor diagnósticos de enfermagem direcionados a idosos institucionalizados, a partir de características definidoras, referentes às possíveis reações adversas e interações dos medicamentos utilizados. Os objetivos específicos foram: identificar perfil dos idosos institucionalizados, tendo como foco a utilização de medicamentos e possíveis reações adversas e interações, relacionando-os a títulos de diagnósticos de enfermagem da North American Nursing Diagnoses Association; indicar diagnósticos de enfermagem que representem contribuição para o cuidado de enfermagem em uma instituição de longa permanência para idosos; confirmar, junto com enfermeiros, assistenciais/docentes, experts, os diagnósticos de enfermagem, a fim de que façam parte da proposta de cuidados de enfermagem para idosos institucionalizados. Trata-se de estudo exploratório, descritivo, com abordagem quantitativa, efetuado em duas etapas. Na primeira, foram utilizados dados de um banco originado da pesquisa “Perfil de idosos residentes numa Instituição de Longa Permanência para Idosos (ILPIs): proposta de ação de enfermagem/saúde”, quando foram selecionados 39 idosos que faziam uso de medicação. Nessa etapa, foi realizada a identificação do perfil dos institucionalizados, tendo como foco a utilização de medicamentos. A partir de características definidoras manifestadas pelos idosos, foram estabelecidos os títulos de diagnósticos de enfermagem, considerando-se o processo de raciocínio diagnóstico de Risner e a Classificação da North American Nursing Diagnoses Association. Na segunda etapa da pesquisa, foi alcançada a confirmação dos diagnósticos de enfermagem estabelecidos, por enfermeiros experts, através da técnica Delphi de validação de conteúdo. Os achados referentes ao perfil dos idosos evidenciaram maior número de mulheres; idade entre 80-89 anos; a maioria sabe ler e constitui-se de viúvas. As doenças do aparelho circulatório são as mais frequentes. Os idosos usam em média 3,7 medicamentos e 30,8% deles utilizam polifarmácia. Os medicamentos mais usados foram para as intercorrências do sistema cardiovascular. Verificou-se a presença de medicamentos considerados impróprios para idosos. Foram identificados 11 diagnósticos de enfermagem, enviados para a confirmação por experts; desses, sete atingiram 70% ou mais de concordância. São eles: Risco de quedas, Eliminação urinária prejudicada, Constipação, Memória prejudicada, Intolerância à atividade, Perambulação e Fadiga. Os diagnósticos obtidos, integraram junto com as prescrições de enfermagem, uma proposta de cuidados de enfermagem ao idoso institucionalizado que faz uso de medicamentos. Os idosos institucionalizados e utilizam medicamentos podem apresentar maior fragilidade; por isso, a identificação de diagnósticos permite um melhor direcionamento do cuidado de enfermagem, por possibilitar reconhecimento prévio das necessidades manifestadas por eles e fornecer subsídios para estabelecimento de intervenções de enfermagem fundamentadas e adequadas aos mesmos. / Proposing nursing diagnosis for institutionalized elderly is the general purpose of the present study, based on defining features, referring to possible adverse reactions and interaction of the medicines used. The specific purposes were: identifying the profile of the institutionalized elderly patients, focusing on the use of medicines and possible adverse reactions and interactions, relating them to nursing diagnosis titles from the North American Nursing Diagnoses Association; indicating nursing diagnosis which represent a contribution to nursing care at an institution of long-term stay for elderly patients; confirming, with nurses, assistants/professors, experts, the nursing diagnosis, in order to have these as part of a nursing care proposal for institutionalized elderly patients. It is an exploratory, descriptive study, with a quantitative approach, developed in two phases. In the first one, data was used from a research named “The profile of resident institutionalized elderly at a long-term stay institution for elderly: a proposal of nursing/health action”, when 39 patients using medication were selected. In this phase, the identification of the patients’ profile was performed focusing on the use of medicines. From the defining features manifested by the elderly ones, the nursing diagnosis titles were defined, considering the Risner’s diagnosis reasoning process and the Classification from the North American Nursing Diagnoses Association. In the second part of the research, a confirmation of nursing diagnosis definition by expert nurses was reached, through the use of the Delphi technique for content validation. The findings referring to the elderly profiles highlighted a higher number of women; aging between 80-89; most know how to read and are widows or widowers. The circulatory system diseases are the most frequent ones. The patients use, in average, 3,7 medicines and 30,8% of them make use of polypharmacy. The most frequent medicines used were for complications of the cardiovascular system. The presence of inappropriate medicines for elderly patients was noticed. Eleven nursing diagnosis were identified, sent to be confirmed by experts; and, from these, seven had a 70% or more agreement. They are the following: Risk of falls, impaired urinary elimination, Constipation, memory failure, intolerance to activity, Perambulation and Fatigue. The diagnosis obtained, integrated with the nursing prescriptions, a proposal of nursing care to institutionalized elderly patients making use of medications. The elderly patients who are at institutions and make use of medicines may present higher weakness; therefore the identification of diagnosis enables a better guidance towards nursing care, as it brings previous acknowledgment to the needs manifested by them and supplies subsidies to define adequate and based nursing goals to serve these patients. / O objetivo general de este estudio fue proponer diagnósticos de enfermería específicos a la población institucionalizada, desde la definición de las características relacionadas con las posibles reacciones adversas y las interacciones de los fármacos utilizados. Los objetivos específicos fueron: identificar el perfil de los ancianos del estudio , centrándose en el uso de drogas y sus posibles reacciones adversas e interacciones, en relación a los diagnósticos de enfermería de la North American Nursing Diagnosis Association; indican diagnósticos de enfermería que representan la contribución a la atención de enfermería en un Hogar para Ancianos; confirmar, junto con las enfermeras, asistenciales/ profesoras, experts los diagnósticos de enfermería, de modo que hacen parte de los cuidados de enfermería propuestos para los ancianos institucionalizados. Este es un enfoque exploratorio, descriptivo y con um enfoque cuantitativo. La investigación se llevó a cabo en dos etapas. Al principio, se utilizaron los datos de una base de datos de origen en la investigación: "Perfil de los ancianos residentes en un Hogar para Ancianos: propuesta de acción de enfermería/salud”. Fueron selecionados 39 ancianos que estaban utilizando medicación. Este paso se realizó para identificar el perfil de los ancianos institucionalizados, centrándose en el uso de drogas. De las características que definen expresadas por los ancianos se establecieron los títulos de los diagnósticos de enfermería, teniendo en cuenta el proceso de razonamiento de diagnóstico de Risner y la clasificación de la North American Nursing Diagnosis Association. En la segunda etapa de la investigación se obtuvo la confirmación de los diagnósticos establecidos en la etapa anterior por enfermeras experts, utilizando la técnica Delphi para validar el contenido. Los resultados sobre el perfil de los ancianos mostraron mayor número de mujeres, la edad de 80 a 89 años, peuden leer y son viudas. Enfermedades del sistema circulatorio son las más frecuentes. El uso medio de medicamentos fue 3,7 por ancianos y el uso de polifarmacia fue 30,8%. Los fármacos más utilizados fueron las complicaciones del sistema cardiovascular. Se encontro el uso de medicamentos considerados inapropriados parar los ancianos. Se identificaron 11 diagnósticos de enfermería que se enviaron para su confirmación por experts, entre los cuales siete presentaron 70% o más de acuerdo. Estos son: Riesgo de caídas, Eliminación urinaria alterada, Estreñimiento, Problemas de memoria, Intolerancia a la actividad, Paseo y la Fatiga. Estos diagnósticos integrados com las prescripciones de enfermaría son una propuesta de una atención de enfermería para los ancianos institucionalizados em uso de medicamentos. Los ancianos residentes em instituciones y que usan drogas pueden ser más frágiles, por lo tanto, identificar los diagnósticos permite uma mejos dirección de los cuidados de enfermería, al permitir el reconocimiento prévio de las necesidades expresadas por ellos y conceder subvenciones para el establecimento de las intervenciones de enfermería motivado y adecuado para ellos.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-11T14:28:34Z No. of bitstreams: 1 Wagner Oliveira Batista.pdf: 2084389 bytes, checksum: c3c6a59fded37c2b95a63c642f1cdd3f (MD5) / Made available in DSpace on 2015-12-11T14:28:34Z (GMT). No. of bitstreams: 1 Wagner Oliveira Batista.pdf: 2084389 bytes, checksum: c3c6a59fded37c2b95a63c642f1cdd3f (MD5) Previous issue date: 2013 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O envelhecimento populacional é influenciado por diversos fatores como a diminuição das taxas de fecundidade; o aumento da expectativa de vida e; mudança nos padrões das doenças. Fatores estes que contribuem para a alteração nos cenários demográficos e epidemiológicos em todo o mundo. O declínio fisiológico-funcional inerente ao processo do envelhecimento traz um novo desafio para a saúde pública, que deve ter como finalidade a preservação da qualidade de vida. Neste contexto, é imperativo que o conhecimento sobre as necessidades da população idosa esteja adequado às suas demandas. Neste cenário, observa-se um aumento no número de Instituições de Longa Permanência para Idosos (ILPIs), nas quais se verifica maior deterioração das capacidades cognitivas, físicas e funcionais nos idosos que residem nelas, quando comparados àqueles que vivem em comunidades. Com esta probabilidade, verifica-se maior incidência da ocorrência de eventos incapacitantes como as quedas. Dessa forma, este trabalho teve como objetivo descrever e analisar as associações do tempo de institucionalização com o risco de quedas, por meio da avaliação do equilíbrio de idosos residentes nas ILPIs do município de Três Rios/RJ. Trata-se de uma pesquisa descritiva-analítica-correlacional, de delineamento transversal das associações do tempo de institucionalização em ILPI sobre o equilíbrio e o risco de quedas. A amostra foi constituída pelos idosos residentes nas duas ILPIs de Três Rios/RJ, selecionados de forma não probabilística, atendendo aos critérios de elegibilidade. Os idosos foram submetidos aos testes funcionais do equilíbrio postural e estabilometria; aplicados testes de associação e comparativos intrasubgrupos e intergrupos. O tratamento estatístico foi feito por meio do software BIOESTAT 5.2. Foram realizadas as análises de distribuição por meio do teste Shapiro-Wilk com o fim de designar testes paramétricos e não paramétricos para cada ocasião. Adotou-se como nível de significância α ≤ 0,05. Os resultados revelaram que os testes funcionais do equilíbrio postural não se associaram com o tempo de institucionalização, como também não se diferenciaram nos comparativos intrasubgrupos e intergrupos. Na avaliação estabilométrica, observou-se uma redução da área e da velocidade do centro de pressão, conforme o aumento do tempo de residência nas ILPIs, mostrando uma correlação “inversa” em alguns parâmetros. As descobertas expostas sugerem que o atual padrão de institucionalização asilar do idoso é extremamente nocivo ao controle do equilíbrio, por restrição das habilidades motoras ou cognitivas. Recomenda-se que estas descobertas subsidiem outras pesquisas com designs variados para determinar com mais acurácia os mecanismos e desfechos deste atual modelo de institucionalização para idosos. / Population aging is influenced by several factors such as a decline in fertility rates, increased life expectancy, changing patterns of disease. These factors contribute to the change in demographic and epidemiological scenarios worldwide. The physiological and functional decline inherent to the aging process brings a new challenge to public health, we should aim to preserve the quality of life. In this context, it is necessary that the knowledge about the needs of this older population is suited to your demands. Within this expectation is noticeable increase in the number of Homes for the aged. With the institutionalization of the elderly, accompanied by a more pronounced decline of physical, cognitive and functional compared to the elderly living in the community. With this probability, there is an increased incidence of occurrence of events such as falls disabling. Thus, this study aimed to describe and analyze the associations of the time of institutionalization with the risk of falls through the assessment of the balance of elderly residents in Homes for the aged in Tres Rios/RJ. This is a descriptive analytical-correlational cross-sectional associations of time to institutionalization in Homes for the aged about balance and risk of falls. The sample consisted of elderly people living in the two Homes for the aged from Três Rios / RJ, selected a non-probabilistic, meeting the eligibility criteria. Once selected, the elderly were subjected to functional tests of balance and postural stabilometry, association tests and comparative intrasubgrupos and groups. Statistical analysis was done by the software BioStat 5.2. Analyzes were performed distribution by using the Shapiro-Wilk test in order to designate parametric and nonparametric tests for every occasion. It was adopted as the significance α ≤ 0.05. In the results it is revealed that functional tests of postural balance were not associated with length of institutionalization, but also did not differ in intrasubgrupos and intergroup comparisons. In the evaluation stabilometric there was a reduction in the area and the speed of Center of Pressure with increasing residence time in Homes for the aged showing a correlation between "inverse" in some parameters. The findings exposed sujerem that the current pattern of asylum institutionalization of the elderly is extremely harmful to the balance control, by restriction of motor or cognitive skills and recommends that through these discoveries can be made with other research designs varied to determine more accurately the mechanisms and outcomes of this current model of institutionalization for the elderly.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-17T20:13:58Z No. of bitstreams: 1 Maria Auxiliadora Rodrigues.pdf: 3212897 bytes, checksum: 7762bf9774f2406714482d022b04e4d7 (MD5) / Made available in DSpace on 2016-05-17T20:13:58Z (GMT). No. of bitstreams: 1 Maria Auxiliadora Rodrigues.pdf: 3212897 bytes, checksum: 7762bf9774f2406714482d022b04e4d7 (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / Introdução: A busca pelo entendimento do quantitativo expressivo de solicitações de fiscalizações nas Instituições de Longa Permanência (ILPIs), em atendimento ao Ministério Público do Estado do Rio de Janeiro, à Promotoria de Justiça de Proteção ao Idoso e da Pessoa Portadora de Deficiência, definiu o interesse pela pesquisa. ILPIs não fazem parte do planejamento anual de fiscalização eletivas do COREN RJ, por serem empresas cadastradas no Conselho Nacional de Assistência Social (CNAS) e, não no Cadastro Nacional de Estabelecimentos de Saúde (CNES). Objetivo Geral: Avaliar os resultados da Fiscalização Ético-Profissional de Enfermagem nas Instituições de Longa Permanência para idosos (ILPIs) autuadas com Processo Administrativo (PADs). Método: Estudo retrospectivo, de análise documental, abordagem quantitativa. Para coleta de dados utilizou-se um instrumento estruturado nos quatro pilares da fiscalização: combater a ilegalidade do Exercício Profissional, orientar e estimular a Implantação da Sistematização da Assistência de Enfermagem, combater e notificar o Dimensionamento inadequado de Pessoal de enfermagem e esclarecer sobre a importância do Exercício Profissional pautado nas Legislações afins ao cuidado do idoso. A amostra foi composta por 51 processos administrativos. O período de coleta de dados foi de Agosto de 2014 a Fevereiro de 2015. Análise estatística descritiva e inferencial foi feita mediante uso dos programas SPSS (Statistical Packagefor the Social Science), versão 23.0, e do aplicativo Microsoft Excel 2007. Resultados: Das 51 instituições avaliadas, 45,1% delas eram instituições do Município de São Gonçalo e 19,6% eram do Rio de Janeiro. 80,4% das instituições eram privadas, (15,7%) filantrópicas e apenas (2%) era pública e (2%) de natureza mista, Privada e Filantrópica. O principal motivo das fiscalizações era o cumprimento de ordens do Ministério Público (56,9%); solicitações de Certidões de Responsabilidades Técnicas (CRT) (19,6%) e Denúncias (17,6%). Os p-valores mostram que não existem diferenças significativas entre as médias na maioria das avaliações realizadas, logo o perfil das instituições no que diz respeito ao número de pacientes atendidos e número de profissionais de cuidado não se alterou significativamente entre as duas avaliações. Os resultados com discreta melhora foram Profissionais de enfermagem com registro no Conselho (0,006); classificação de cuidados por dependência (0,008); apresentou escala de profissionais (0,006); não possuir outros profissionais na escala de enfermagem, principalmente, cuidadores (0,001); prontuário único (0,039); Normas e Rotinas de enfermagem (0,000); apresentou Protocolos Operacionais Padrões (0,000); e processo de enfermagem (0,001). Produto da Dissertação: Roteiro de Fiscalização nas Instituições de Longa Permanência para idosos. Conclusão: Ao fortalecer as fiscalizações em parceria com o Ministério Público e a Anvisa, poder-se-á viabilizar o atendimento das irregularidades e, principalmente, a inclusão das ILPIs na esfera sócio sanitária, tendo em vista a previsão de crescimento desses estabelecimentos em razão do aumento da longevidade, e ainda, por constituir a enfermagem sua maior classe trabalhadora. / Introduction: The search for understanding the expressive quantitative of surveillance requirements in Homes for the Aged, following the Public Ministry of Rio de Janeiro State and the Department of Justice for the Aged and Disabled Protection, established the interest to conduct this research. Homes for the Aged are not part of the yearly elective surveillance planning of COREN RJ, because they are companies registered in the Brazilian Council of Social Support (Conselho Nacional de Assistência Social – CNAS) instead of the Brazilian Registration of Health Institutions (Cadastro Nacional de Estabelecimentos de Saúde – CNES). General objective:To assess results of the Ethical-Professional Nursing Surveillance in Homes for the Aged issued with Administrative Processes. Method: This is a retrospective study with documental analysis and quantitative approach. An instrument for data collection was divided into the four edges of surveillance: to combat illegality of the Professional Activity; to guide and stimulate the Implantation of Nursing Care Systematization; to combat and notify the inappropriate nursing personnel downsizing and to clarify about the importance of the Professional Activity established in the similar laws regarding care of the aged. The sample included 51 administrative processes. Data collection period was from August 2014 to February 2015. The descriptive and inferential analysis was conducted using the programs SPSS (Statistical Package for the Social Sciences), version 23.0, and the Microsoft Excel 2007 software. Results: Of the 51 assessed institutions, 45.1% of them were from São Gonçalo and 19.6% were from Rio de Janeiro. 80.4% were private, (15.7%) were philanthropic, only 2% were public and 2% had mixed nature (private and philanthropic). The main reason for surveillance was compliance with the standards of the Public Ministry (56.9%); with the requirements of Technical Responsibility Certificates (19.6%) and accusations (17.6%). P-values show no significant differences between the averages in most of the conducted evaluations, therefore the profile of institutions regarding the number of cared patients and of care professionals did not show any significant change between the two evaluations. The results showing a discrete improvement were: nursing professionals with registration in the Council (0.006); care classification by dependence (0.008); presented professional turnover (0.006); do not have other professionals in the nursing turnover, especially caregivers (0.001); single record (0.039); standards and routines of nursing (0.000); presented standardized operational protocols (0.000); and nursing process (0.001). Dissertation product: script of surveillance in homes for the aged. Conclusion: By strengthening surveillance together with the Public Ministry and Anvisa, it will be possible to enable the compliance with irregularities and, mainly, the inclusion of such institutions in the socio-sanitary sphere, taking into consideration the growth prediction of these institutions due to the increase of longevity and also because nursing is its biggest working class.

CONCLUSION: A multi-faceted hand hygiene intervention with pocket-sized containers of alcohol-based hand rub was effective in increasing hand rubbing compliance and reducing incidence of total infections requiring hospitalization in elderly LTCFs. Its effect on outbreaks still needs further investigations. The questionnaire developed in this study may be a simple and effective method to assess the attitude and compliance change of the HCWs after implementing a hand hygiene programme. / DESIGN: Clustered randomized controlled trial / INTERVENTIONS: After a 3-month run-in period, we randomized three LTCFs to the treatment and three to the control group. The treatment group received pocket-sized containers of alcohol-based hand rub, education and reminding materials. The control group received basic life support education and workshops. They were followed up for another seven months. We measured the hand hygiene compliance of the HCWs by direct observation and recorded the incidence of infections of the residents from their hospital discharge summaries. / OBJECTIVE: To investigate the effectiveness of a multi-faceted hand hygiene programme with pocket-sized containers of alcohol-based hand rub for infection control in elderly long-term care facilities (LTCFs) / OUTCOMES & DATA ANALYSIS: Primary outcomes were direct observed compliances of hand washing and antiseptic hand rubbing of the HCWs, incidence of infections requiring hospitalization and death rate due to infection of the residents, and outbreaks of the LTCFs. Secondary outcomes were change in hand hygiene attitude and self-reported compliance. / PARTICIPANTS: All health care workers (HCWs) of the LTCFs recruited by snowball sampling. Their job categories were nurses, nursing assistants and physiotherapists. / RESULTS: In the treatment group, the compliance of alcohol-based hand rubbing increased significantly from 1.5% (5/333) to 15.9% (233/1465) (p=0.001) and total compliance increased from 25.8% (86/333) to 33.3% (488/1465) (p=0.01) after intervention. Total incidence of infections decreased from 31 cases in 21,862 resident days (1.42 per 1,000 resident-day (rd)) to 33 cases in 50,441 resident days (0.65 per 1,000 resident-day) (p=0.002) and death rate due to infection decreased from 8 cases in 21,862 resident days (0.37 per 1,000 rd) to 5 cases in 50,441 resident days (0.1 per 1,000 rd) in the treatment group (p=0.01). Pneumonia significantly decreased by 0.63 per 1000 rd (p=0.001). In the control group, there were no changes in both antiseptic hand rubbing and hand washing. The total incidence of infections increased from 0.49 to 1.04 per 1000 rd (p=0.004) and no change in death rate due to infection (p=0.45). No outbreaks of influenza and norovirus occurred during the whole study in both groups. / SETTING: Six LTCFs for the elderly / The attitude of antiseptic hand rubbing on infection control increased significantly in the treatment group but there was no change under different situations in the control group. The self-reported compliance of antiseptic hand rubbing increased significantly in the treatment group. There were no changes on the self-reported compliances in the control group. The agreement of the direct observed results and the self-reported compliances was 75% (kappa coefficient = 0.5). / Yeung, Wing Kin. / Adviser: Tze Wai Wong. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 100-106). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Made available in DSpace on 2011-05-04T12:36:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / INTRODUÇÃO: O processo de transição demográfica vivenciado no Brasil apresenta características particulares. Grande parte da população idosa tem baixo nível socioeconômico e educacional, e devido à alta prevalência de doenças crônicas causadoras de limitações funcionais e de incapacidades, tornam-se dependentes. Este fato gera uma demanda importante com custos elevados para o sistema de saúde, com medicamentos, internações, sejam hospitalares ou em instituições de longa permanência para idosos (ILPI). O maior desafio na atenção à pessoa idosa é conseguir que, apesar das progressivas limitações, ela possa viver com a melhor qualidade possível, de maneira independente, junto da família ou ainda nas ILPI. OBJETIVO: Avaliar as condições de funcionamento das ILPI no Estado de Alagoas, procurando saber se estão adequadas ou não para o atendimento a idosos. Pretendemos contribuir com o fortalecimento dos sistemas de monitoramento, avaliação e institucionalização das ações avaliativas a fim de garantir o cumprimento da legislação vigente pelas ILPI. METODOLOGIA: Caracteriza-se por um estudo de casos, a partir de dados secundários obtidos por meio da análise dos roteiros das inspeções sanitárias efetuadas nos anos de 2007 e 2008 pela Vigilância Sanitária Estadual e dos Municípios. O objeto de estudo é constituído por dezessete ILPI situadas no Estado de Alagoas. RESULTADOS: A maioria das ILPI analisadas representava, no momento da inspeção, alto ou médio risco para saúde do idoso, não alcançando os padrões mínimos necessários para o seu funcionamento e não oferecendo, portanto, uma assistência adequada à saúde do idoso institucionalizado. / INTRODUCTION: The process of demographic transition experienced in Brazil presents particular characteristics. Much of the population has low educational and socioeconomic level, and due to the high prevalence of chronic diseases that cause of functional limitations and disabilities, they become dependent. This fact engenders an important demand with high costs for the health system, with medicines, hospital admissions, or is in Homes for the Aged (ILPI). The biggest challenge in the care of the elderly person is that, despite the progressive constraints, she can live with the best quality possible, of an independent way, with the family or in ILPI. OBJECTIVE: Evaluate the operating conditions of the ILPI in the state of Alagoas, seeking whether or not they are adequate to meet the elderly. We want to contribute to the strengthening of systems for monitoring, evaluation and institutionalization of evaluation activities to ensure compliance with current legislation by ILPI. METHODOLOGY: It is characterized by a case study from secondary data obtained from analysis of the roadmaps of health inspections conducted in the years 2007 and 2008 by the Health Surveillance State and the Municipalities. The object of study is composed of seventeen ILPI located in the State of Alagoas. RESULTS: Most ILPI was analyzed at the time of inspection, high or medium risk to health of the elderly, not reaching the minimum standards required for its operation and not offering therefore an adequate health care for the institutionalized elderly.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-20T20:08:47Z No. of bitstreams: 1 Rodolpho Cesar Cardoso de Paula.pdf: 962730 bytes, checksum: f8429a24e260b851a8c8c46c2b3c4724 (MD5) / Made available in DSpace on 2016-05-20T20:08:47Z (GMT). No. of bitstreams: 1 Rodolpho Cesar Cardoso de Paula.pdf: 962730 bytes, checksum: f8429a24e260b851a8c8c46c2b3c4724 (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / Objetivo: Analisar os Relatórios Circunstanciados do Departamento de Fiscalização quanto ao dimensionamento de pessoal de enfermagem existente nas Instituições de Longa Permanência para Idosos (ILPI). Foram identificados 159 Processos Administrativos referentes às Instituições fiscalizadas no período de Janeiro de 2010 até Dezembro de 2013. O instrumento de coleta de dados analisou itens relacionados ao dimensionamento de enfermagem existente e propostos, número de idosos atendidos, complexidade do atendimento presentes nos Relatórios Circunstanciados. Após a exclusão dos relatórios de fiscalização que não continham dados pertinentes para coleta de dados, a amostra final foi composta de 80 processos. Dos 92 municípios do Estado do Rio de Janeiro houve abrangência de 19 localidades, 61 (76,2%) instituições privadas, 17 (21,3%) filantrópicas e 02 (2,5%) públicas. Houve variabilidade quanto ao porte das instituições foi variado, de 08 a 300 leitos, com taxa de ocupação média de 91,5%, variando de 60 a 100%, quanto ao número de idosos na instituição de 06 a 300, com média de 48,1 e desvio padrão de 45,5, demonstrando uma distribuição heterogênea do número de idosos nas instituições. A proporção geral de ILPI com enfermeiro responsável técnico (RT) é de aproximadamente 92,5%. As 80 instituições possuem em média 1,2 enfermeiros, 6,7 técnicos de enfermagem e 2,3 auxiliares de enfermagem e em relação aos cuidadores de idosos foram identificados sua presença em 53 instituições (66,2%). Em relação à classificação dos idosos institucionalizados, 60,6% das instituições apresentavam classificação dos idosos. Segundo a Resolução 293 as instituições teriam que aumentar o quadro de Enfermeiros em 1348% e de Técnicos em 420%. Para o atendimento a Portaria 73 teria que aumentar o quadro de Enfermeiros em 224% e de técnicos em 73%, neste caso não atenderia a Lei 7498/86 em 62,5% das instituições. A nova proposta de dimensionamento apresentado neste estudo prevê o aumento do quadro de Enfermeiros em 580% e de Técnicos em 122%. Portanto, o Dimensionamento de Pessoal de Enfermagem em ILPIs, considerando a Portaria 73, a Resolução 293 e a nova proposta são diferentes entre si (p-valor 0,000). O produto desta dissertação fornece um instrumento de dimensionamento pessoal apropriado as ILPI, cumpre à Resolução 293, porém mais passível de ser executado. Recomenda-se o atendimento as legislações de enfermagem em relação ao dimensionamento de pessoal e a classificação dos idosos assistidos nas ILPIs, dado o vertiginoso aumento da população idosa, e conseguinte aumento dessa modalidade assistencial à sociedade civil. Ao estabelecer um cálculo de dimensionamento de enfermagem original para as instituições de idosos pode-se assegurar uma assistência segura e livre de danos. / Objective: To assess the Department of Supervision detailed reports on the design of existing nursing staff in long-stay institutions for the elderly. 159 Administrative Proceedings were identified relating to institutions under audit from January 2010 to December 2013. The data collection instrument discussed items related to existing nursing design and proposed number of elderly assisted, complexity of care present in detailed reports. After exclusion of inspection reports which did not contain relevant data for data collection, the final sample consisted of 80 cases. Of the 92 county in the state of Rio de Janeiro there was coverage of 19 locations, 61 (76.2%) private institutions, 17 (21.3%) philanthropic and 02 (2.5%) public. There was variability in the size of the institutions was varied, 08-300 beds with an average occupancy rate of 91.5%, ranging from 60 to 100%, as the number of elderly in the institution 06-300, averaging 48 , 1 and standard deviation of 45.5, showing a heterogeneous distribution of the number of elderly in institutions. The overall proportion of ILPI with technical charge nurse (RT) is approximately 92.5%. The 80 institutions have an average of 1.2 nurses, 6.7 and 2.3 nursing technicians nursing assistants and for the elderly caregivers have been identified its presence in 53 institutions (66.2%). Regarding the classification of the institutionalized elderly, 60.6% of homes had a classification of the elderly. According to Resolution 293 institutions would have to increase the Nurses framework% in 1348 and Technicians 420%. To meet the Ordinance 73 would have to increase the Nurses frame in 224% technical and 73% in this case would not meet the Law 7498/86 in 62.5% of the institutions. The proposed new design presented in this study provides for an increased Nurses frame at 580% and technicians by 122%. Therefore, the Nursing Staff Dimensioning in ILPIs considering Ordinance 73, Resolution 293 and the new proposal are different (p-value 0.000). The product of this work provides an appropriate personal sizing instrument the ILPI, complies with Resolution 293, but more likely to be executed. It is recommended to call the nursing legislation in respect of the staff sizing and classification of assisted elderly in ILPIs, given the rapid increase in the elderly population, and therefore increase this type of care to civil society. By establishing a unique nursing sizing calculation for the elderly institutions can ensure a safe and free assistance of damage.