Thesis (M.S.)--University of Wisconsin-Madison, 1992. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 48-50).

- / -

Thesis (Mnutr)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Objective: To assess the impact of a continuous auditing process on nutritional support in a tertiary paediatric intensive care unit. Design: Prospective, longitudinal audit initiated in 1994. Re-auditing took place almost every 2 years: 1994-1995, 1997-1998 and 2001, leading to completion of the audit cycle. Setting: An 8 bed Paediatric Intensive Care Unit (PICU) in StMary's Hospital London. Subjects: All ventilated patients admitted for more than a complete 24-hour period were included in the audit. The units' standard daily fluid charts were used for data collection. Data was collected until discharge from PICU or a maximum of 10 days. Incomplete and imprecise data was disregarded during the data analysis process. Outcome measures and interventions: The outcome measures include time taken to initiate nutritional support, the route of feeding and delivery of calories by day 3, judged by the Estimated Average Requirements (EAR) for energy. Feeding algorithms and protocols introduced after each audit: nasogastric feeding algorithm following the 1994-1995 audit, blind nasojejunal tube insertion technique and related feeding algorithms after the audit in 1997-1998. Results: Time taken to initiate enteral feeding was reduced from 15 hours (1994- 1995) to 5.5 hours (2001). The proportion of parenterally fed patients fell from 11% (1994-1995) to 1% (200 1 ). The proportion of enterally fed patients via the nasojejunal route rose from 1% (1994-1995) to 20% (2001). An increase was noticed in patients reaching 50% and 70% of energy requirement by day 3 following admission was documented: 7% in1994-1995 to 35% in 2001 for 70% of EAR (p = 0.0008) and 18% in 1994-1995 to 58% in 2001 for 50% of EAR. (p< 0.0001) Conclusion: This audit process demonstrates the effectiveness of continuous auditing in an intensive care unit in improving the quality of nutritional support. This is possible only with a multi-disciplinary team approach. / AFRIKAANSE OPSOMMING: Doel: Om die impak van 'n deurlopende ouditerings proses op die voedingsondersteuning in 'n tersi~re pediatriese intensiewesorg-eenheid te evalueer. · Studie Ontwerp: 'n Prospektiewe, longetudinale oudit is in 1994 geYnisieer. Herouditee·ring het ongeveer elke 2 jaar plaasgevind: 1994-1995, 1997-1998 en 2001. Dit het tot die voltooiing van 'n ouditering siklus gelei. Plek: 'n Agt-bed Pediatriese lntensiewesorgeenheid (PISE) in StMary's Hospitaal London, Engeland. Pasiente: Alle geventilleerde pasiente wat opgeneem was vir !anger as 'n volledige 24 uur-periode is by die oudit ingesluit. Die eenheid se standard daaglikse vogkaarte dokumentasie is gebruik vir data-insameling. Data-insameling het plaasgevind tot en met ontslag vanuit die PISE vir 'n maksimum van 10 dae. Onvolledige en onakkurate data is uitgesluit tydens die data analise proses. Uitkomste en Intervensie: Die uitkomste is gemeet deur die impak van die ouditerings proses te evalueer ten opsigte van tydsduur voordat daar voedings geYnisieer is, die voedingsroete en die hoeveelheid energie gelewer teen dag 3, vergelyk met die geskatte gemiddelde energie behoefte. Voedings-algoritmes en protokolle is geYmplementeer na elke oudit: nasogastriese voedings-algoritmes is na die 1994-1995 oudit geYmplimenteer, 'n blinde nasojejunale buisinplasingstegniek en I relevante voedings algoritmes het na die 1997-1998 oudit gevolg. Resultate: Die tydsduur om voedingondersteuning te inisieer het van 15 ure (1994- 1995) tot 5.5 ure (2001) verminder. Die persentasie pasiente wat parenterale voeding ontvang het, het gedaal van 11% (1994-1995) tot 1% (2001), met 'n toename in enterale voeding via die nasojejunale roete van 1 %(1994) tot 20% (2001). 'n Toename in pasiente wat meer as 50% en 70% van hul energie behoefte bereik het teen dag 3 is opgemerk: 7% in 1994-1995 en 35% in 2001 het meer as 70% van die geskatte gemiddelde behoefte vir energie ontvang. (p=0.0008) Agtien persent het in 1994-1995 en 58% in 2001 meer as 50% van hul gemiddelde energie behoeftes bereik (p < 0.0001). Gevolgtrekking: Hierdie ouditerings proses demonstreer die effektiewiteit van deurlopende ouditering in 'n intensiewesorg-eenheid deur die verbetering van die kwalitiet van voedingondersteuning. Dit is slegs moontlik met 'n multidissiplinere span benadering.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Malnutrition, as defined by the Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment (SGA), Nutritional Risk Screening Tool-2002 (NRS-2002), Short Nutritional Assessment Questionnaire (SNAQ), Nutritional Risk Indicator (NRI) and Malnutrition Screening Tool (MST), has been associated with adverse outcomes in hospitalised patients. Therefore nutritional risk screening is recommended for all hospitalised patients to improve the recognition and treatment of malnutrition. However, little is known about the use of screening tools in an intensive care unit (ICU) setting. The aim of this study was to assess which of these screening tools could best predict clinical outcomes in ICU patients and to comment on their feasibility, in order to make suggestions on their applicability for this patient population. Methods: Over an eight month study period all patients (>18years) with a surgical ICU stay of >48 hours were included. Patients were screened within 48 hours of admission using each of the seven screening tools. Clinical outcomes (mortality, APACHE II score, length of stay (LOS), length of ventilation (LOV), complications, serum-albumin, white cell count (WCC) and C-reactive protein) were recorded until discharge or death. Feasibility and applicability of the screening tools were also assessed. Results: A total of 206 patients (62.6% males) were included. The average age was 49.5 ±17.4 years and average LOS was 5.7 ± 5.5 days. Screening was not feasible in 18.3% of patients. The MUST classified 18.9% of patients as at risk of malnutrition and 30.1% as malnourished, but was not predictive of any clinical outcomes. According to the MNA-SF, 52.2% of patients were at risk of malnutrition and 16.5% were malnourished. This was associated with progressively decreasing serum-albumin levels (p<0.01) and WCC (p=0.01). The SGA classified 30.6% of patients as moderately and 18.4% of patients as severely malnourished and was significantly associated with LOS (p=0.03), LOV (p=0.01), mild complications (p=0.04) and serum-albumin (p=0.01). However, except for serum-albumin which progressively declined with a poorer nutritional status, the moderately malnourished patients showed the worst outcomes and the severely malnourished patients the best. According to the NRS-2002, 72.8% of patients were malnourished; and this correlated significantly with LOV (p=0.02) and the development of moderate (p=0.04) and total (p=0.01) complications. A non-significant but consistent trend for worse results in the malnourished group was also seen for the other outcomes studied. The SNAQ classified 35.9% of patients as malnourished or at risk thereof. This was associated with lower serum-albumin levels (p=0.04), but also with decreased LOV (p<0.01). The NRI classified 2.3% of patients as mildly malnourished, 21.0% as moderately malnourished and 75.0% as severely malnourished and only effectively predicted serum-albumin (p<0.01). The MST classified 78.2% of patients as malnourished and this was predictive of developing more complications (p<0.01). Almost all of the other variables also showed worse outcomes for the malnourished group, but this was not significant. Conclusion: Screening in an ICU seems to have only moderate feasibility and applicability and limited value. Only the NRS-2002 and MST showed potential for predicting clinical outcomes in ICU patients. / AFRIKAANSE OPSOMMING: Inleiding: Wanvoeding, soos gedefinineer deur die “Malnutrition Universal Screening Tool” (MUST), “Mini-Nutritional Assessment-Short Form” (MNA-SF), “Subjective Global Assessment” (SGA), “Nutritional Risk Screening Tool-2002” (NRS-2002), “Short Nutritional Assessment Questionnaire” (SNAQ), “Nutritional Risk Indicator” (NRI) en die “Malnutrition Screening Tool” (MST), is al met nadelige uitkomste in hospitaal pasiënte geassosieer. Daarom word voedings-risiko-sifting vir alle gehospitaliseerde pasiënte aanbeveel om die herkenning en behandeling van wanvoeding te verbeter. Daar is egter min bekend oor die gebruik van siftingshulpmiddele in ‘n intensiewe sorg eenheid (ISE) omgewing. Die doel van die studie was om te assesseer watter van hierdie siftingshulpmiddele kliniese uitkomste in ISE pasiënte die beste kon voorspel en om kommentaar te lewer op die uitvoerbaarheid daarvan, om sodoende voorstelle te maak oor die toepaslikheid daarvan vir hierdie pasiënt populasie. Metodes: Alle pasiënte (>18 jaar) met ‘n chirurgiese ISE verblyf van >48 uur gedurende ‘n ag maande studieperiode is ingesluit. Pasiënte is binne 48 uur na toelating gesif m.b.v. al sewe siftingshulpmiddele. Kliniese uitkomste (mortaliteit, APACHE II telling, lengte van verblyf (LVVer), lengte van ventilasie (LVVen), komplikasies, serum-albumien, witseltelling (WST) en C-reaktiewe proteïen) is genoteer tot en met ontslag of dood. Uitvoerbaarheid en toepaslikheid van die siftingshulpmiddele is ook geassesseer. Resultate: ‘n Totaal van 206 pasiënte (62.6% manlik) is ingesluit. Die gemiddelde ouderdom was 49.5 ±17.4 jare en die gemiddelde LVVer was 5.7 ± 5.5 dae. Siftings was onuitvoerbaar in 18.3% van die pasiënte. Die MUST het 18.9% van die pasiënte as wanvoeding-risikogevalle geklassifiseer en 30.1% as wangevoed, maar kon nie enige kliniese uitkomste voorspel nie. Volgens die MNA-SF was 52.2% van die pasiënte wanvoeding-risikogevalle en 16.5% was wangevoed. Dit was geassosieer met progressief dalende serum-albumienvlakke (p<0.01) sowel as WST (p=0.01). Die SGA het 30.6% van pasiënte as matig en 18.4% as erg wangevoed geklassifiseer en het ‘n beduidende assosiasie met LVVer (p=0.03), LVVen (p=0.01), ligte komplikasies (p=0.04) en serum-albumien (p=0.01) getoon. Behalwe vir serum-albumien wat progressief verlaag het met ‘n swakker voedingstatus, het die matig wangevoede pasiënte egter die swakste uitkomste getoon en die erg wangevoede pasiënte die beste. Volgens die NRS-2002 was 72.8% van die pasiënte wangevoed en dit het ‘n beduidende korrelasie met LVVen (p=0.02) en die ontwikkeling van matige (p=0.04) en totale (p=0.01) komplikasies gehad. ‘n Nie-beduidende, maar konsekwente neiging vir swakker resultate in die wangevoede groep is ook vir die ander studie-uitkomste gesien. Die SNAQ het 35.9% van pasiënte as wangevoed of as risikogevalle daarvoor geklassifiseer. Dit was geassosieer met laer serum-albumienvlakke (p=0.04), maar ook met ‘n korter LVVen (p<0.01). Die NRI het 2.3% van pasiënte as lig, 21.0% as matig en 75.0% as erg wangevoed geklassifiseer en het slegs serum-albumien effektief voorspel (p<0.01). Die MST het 78.2% van pasiënte as wangevoed geklassifiseer en dit het die ontwikkeling van meer komplikasies (p<0.01) voorspel. Amper al die ander veranderlikes het ook swakker uitkomste getoon in die wangevoede groep, maar dit was nie-beduidend. Gevolgtrekking: Dit blyk of sifting in ‘n ISE slegs matige uitvoerbaarheid en toepaslikheid en beperkte waarde het. Slegs die NRS-2002 en die MST het potensiaal gewys om kliniese uitkomste in ISE pasiënte te voorspel.

Made available in DSpace on 2015-05-14T12:47:11Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1045835 bytes, checksum: e46f94704730d71206de4c90e9160b1a (MD5) Previous issue date: 2012-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The Intensive Care Unit (ICU) environments are specialized in assisting the patient severely ill. The development of these units drastically reduced the hospital mortality rate, however, the complex procedures on their patients favors the emergence of serious infections such as sepsis, which predisposes to death. The present study aimed to provide a probabilistic decision model for the early diagnosis of sepsis. To this end, we analyzed the data contained in the records of 100 patients hospitalized in a general ICU of a public hospital in the state of Paraíba, in the period from March to September 2011. The information was recorded in a proper instrument made by the researcher being studied variables: age, gender, initial diagnosis of the participants, the minimum and maximum axillary temperature, heart rate and respiratory rate, partial pressure of oxygen and carbon dioxide, serum lactate , potassium, sodium, total leukocyte count, segmented rods and, among others. We used binary logistic regression to determine the prediction model. Data analysis was performed using SPSS version 19.0. The findings showed that 63% of study participants were male, with a mean age of 62.5 years. Explanatory variables were considered: axillary temperature minimum, maximum axillary temperature, partial pressure of carbon dioxide, lactate, leukocyte count and the number of rods. ROC curve was possible to identify the optimal cutoff point to classify individuals according to the presence or absence of disease, which contributed to the making of the rule of decision for the early diagnosis of sepsis. Was performed to compare the degree of agreement between blood culture result considered the gold standard for diagnosis of infection and the model presented in this study using the Kappa coefficient, obtained a percentage of agreement of 0.93 is considered excellent. Despite the unprecedented nature of the research, proved to be early detection of sepsis with the adoption of statistical models as presented, however, further studies with different populations of ICUs should be performed in order to provide a better sample, making the results found reproducible in different clinical situations daily. / As Unidades de Terapia Intensiva (UTI) são ambientes especializados na assistência ao paciente gravemente enfermo. O desenvolvimento dessas unidades reduziu drasticamente a taxa de mortalidade hospitalar, contudo, a realização de procedimentos complexos em seus pacientes favorece o surgimento de infecções graves como a sepse, o que predispõe ao óbito. O presente estudo teve como objetivo fornecer um modelo de decisão probabilístico para o diagnóstico precoce da sepse. Para tanto, foram analisados os dados contidos nos prontuários de 100 indivíduos internados em uma UTI geral de um hospital público do interior do estado da Paraíba, no período de março a setembro de 2011. As informações foram registradas em instrumento próprio confeccionado pelo pesquisador, sendo estudadas as variáveis: idade, gênero, diagnóstico inicial dos participantes, a temperatura axilar mínima e máxima, frequência cardíaca e respiratória, pressão parcial de oxigênio e de gás carbônico, nível sérico de lactato, potássio, sódio, contagem total de leucócitos, bastonetes e segmentados, dentre outras. Utilizou-se a regressão logística binária para determinação do modelo de predição. A análise dos dados foi realizada utilizando-se o software SPSS versão 19.0. Os achados demonstraram que 63% dos participantes do estudo eram do gênero masculino, apresentando uma idade média de 62,5 anos. Foram consideradas como variáveis explicatórias: a temperatura axilar mínima, a temperatura axilar máxima, a pressão parcial de gás carbônico, o lactato, a contagem de leucócitos e o número de bastonetes. Através da curva ROC foi possível identificar o ponto de corte ideal para classificação dos indivíduos quanto à presença ou ausência da doença, o que contribuiu para confecção da regra de tomada de decisão para o diagnóstico precoce da sepse. Realizou-se a comparação do grau de concordância entre o resultado da hemocultura considerado como padrão-ouro para o diagnóstico da infecção e o modelo apresentado no estudo utilizando-se o coeficiente Kappa, sendo obtido um percentual de concordância de 0,93 que é considerado como excelente. Apesar do caráter inédito da pesquisa, demonstrou-se ser possível a detecção precoce da sepse com a adoção de modelos estatísticos como o apresentado, entretanto, novos estudos com populações de diferentes UTIs devem ser realizados a fim de prover uma casuística melhor, tornando os resultados encontrados reproduzíveis em diferentes situações clínicas diárias.

Made available in DSpace on 2014-12-17T14:46:39Z (GMT). No. of bitstreams: 1 KatiaRBR.pdf: 328748 bytes, checksum: 9ccb7264eeae450fddca94907e4b0707 (MD5) Previous issue date: 2009-02-19 / In tertiary care, the Intensive Care Unit (ICU) is nowadays one of the most complex settings in providing care to critically ill patients and could make the difference in favor of life. Nevertheless, the stigma of death which pervades the imagination when the ICU is mentioned and the excessive importance placed on machines rather than on the human being end up by causing distress to some extent. As the purpose of this investigation is to understand the distress caused to a patient in an ICU, it has been grounded on the following question: What kind of distress does a patient go through during his/her experience in an ICU? This study has, therefore, an analytical and reflexive character embedded in a qualitative dimension of a phenomenological approach based on narratives. To this purpose, five patients were interviewed from November to December 2008. Out of the empirical material gathered from these narratives we were able to identify several factors that cause distress to ICU patients. Among them were: the certainty that they are critically ill and fear death, a closed room, too much lighting, a typical loneliness arising from being isolated from family members and dear ones, lack of communication with the professional staff, and noise; besides having to undergo therapeutic procedures. In summary, although the ICU is seen as a place of distress, in many aspects and in accord with this research, such distress can and should be relieved. On the other hand, being near to death leads them to a redefinition of life, said the patients. / Na aten??o terci?ria, ? a Unidade de Terapia Intensiva (UTI), na atualidade, um dos cen?rios de maior complexidade no atendimento ao paciente grave, podendo fazer a diferen?a em favor da vida. No entanto, o estigma da morte que permeia o imagin?rio da popula??o - quando se fala em UTI -, a supervaloriza??o da m?quina, em detrimento do ser humano, terminam impondo algum sofrimento. Tendo como objetivo compreender o que sofre o paciente em uma UTI, esta investiga??o pautouse no seguinte questionamento: O que sofre o paciente durante sua experi?ncia na UTI? Trata-se, portanto, de um estudo de car?ter anal?tico e reflexivo, inserido numa dimens?o qualitativa de abordagem fenomenol?gica, com base em narrativas. Com este prop?sito, foram entrevistados cinco pacientes entre os meses de novembro e dezembro de 2008. Do material emp?rico, resultante das referidas narrativas, pudemos identificar v?rios fatores que geram sofrimento em paciente na UTI, dentre os quais destacamos: a certeza da gravidade e o medo da morte, o ambiente fechado, a ilumina??o em excesso, a solid?o caracterizada pelo distanciamento dos familiares e entes queridos, a falta de comunica??o com os pr?prios profissionais, o barulho, al?m da submiss?o aos procedimentos terap?uticos. Em s?ntese, mesmo reconhecendo a UTI como um espa?o que leva ao sofrimento, em muitos aspectos, conforme a pesquisa, esse sofrimento pode e deve ser atenuado. Por outro lado, a proximidade da morte conduz a uma redefini??o da vida, conforme expressaram os pacientes

Made available in DSpace on 2014-12-17T14:46:48Z (GMT). No. of bitstreams: 1 TheoDC_DISSERT.pdf: 1103452 bytes, checksum: d35fccfc8efd5462605307cfa7f54aaf (MD5) Previous issue date: 2011-10-10 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The environment of Intensive Care Unit (ICU) is commonly referred to as a place where caring is inextricably linked to high technology. The care in ICU often changes the patient into a taxpayer being left apart from its complexity and sometimes seen through a reductionist perspective. Thus, studies circa the care process are needed oriented from a historical ransom, raising the prospect of a more centralized human care. Hence, this study aimed to analyze the care process in a nursing intensive care unit from the perspective of the professional, family and patients. The study is characterized from a qualitative, descriptive and exploratory methodological approach. The actors were participating nursing professionals, patients and family members of an intensive care unit of Mossor? / RN. Data were collected in the period of May-June 2011, through interviews and observation of activities performed by nursing professionals, and their records in the chart. Data analysis was divided into topics and subtopics representing the phases and shapes that formed the collection. The analysis and discussion of the interviews were based on Bardin's proposal, when we created categories from a process of sorting and grouping criteria adequately defined. The observation of nursing records intended to observe the emphasis which is described in those notes as well as their consistency with practice of FCN and resolution 358/2009. The analysis showed that the nursing staff also performs work focused on mechanized activities and technical-bureaucratic institution that seem to override the needs of patients. In an overview, the care provided by professionals occurs either fragmented or insipient, however there is a service that involves other aspects beyond technical-curative practice, considering that major attention is given to the family and patient, focused on the concern of Nursing guiding their actions in not only the performance of procedures. However, the process of humanizing not always ends with an engagement between professional and patient, which mischaracterizes the true meaning of human care. The records also showed a tendency to focus on caring in a positivist line, where, in most cases, the factors of the disease and the obligation to meet the productivity have overshadowed other relevant aspects to a holistic understanding of caring. Regarding FCN Resolution No. 358/2009, which guides a systematization of nursing care, it is confirmed a technical view, a fragmented and superficial view of the patient, as well as a weakness of care, caused by ignorance and unpreparedness of the entire team. The perspective of caring demonstrates a reality with dialectic between what is proposed in a humane nursing and what happens in this performance space. Besides, it was shown a daily full of important considerations that arise in professional practice, in their views and also those people who were participants in the process / O ambiente da Unidade de Terapia Intensiva (UTI) ? referido comumente como um local onde o cuidar est? intrinsecamente ligado ? alta tecnologia. O cuidar na UTI transforma, muitas vezes, o paciente em um sujeito passivo, sendo sua complexidade deixada ? parte e, por vezes, compreendida em uma perspectiva reducionista. Com isso, fazem-se necess?rios estudos voltados para o processo cuidar a partir de um resgate hist?rico, trazendo a perspectiva de uma assist?ncia mais centralizada no ser humano. Desta forma, este estudo teve como objetivo analisar o processo de cuidar em Enfermagem de uma unidade de terapia intensiva a partir da ?tica do profissional, do familiar e dos pacientes. O estudo caracteriza-se a partir de uma abordagem metodol?gica qualitativa do tipo descritivoexplorat?ria. Os atores participantes foram os profissionais de Enfermagem, os pacientes e os familiares de uma unidade de terapia intensiva de Mossor?/RN. Os dados foram obtidos, no per?odo de maio a junho de 2011,atrav?s de entrevistas e observa??o das atividades realizadas pelos profissionais da Enfermagem, bem como seus registros no prontu?rio. A an?lise dos dados foi dividida em t?picos e subt?picos representativos das fases e formas que delinearam a coleta. A an?lise e a discuss?o das entrevistas basearam-se na proposta de Bardin, em que criamos categorias a partir de um processo de classifica??o e agrupamento segundo crit?rios devidamente definidos. A observa??o dos registros de Enfermagem teve como ?nfase observar o que ? descrito nessas anota??es, bem como sua coer?ncia com sua pr?tica e a resolu??o 358/2009 do COFEN. A an?lise demonstrou que a equipe de Enfermagem ainda realiza um trabalho centrado em atividades mecanizadas e t?cnico-burocr?ticas da institui??o que parecem se sobrepor ?s necessidades dos pacientes. Em uma vis?o geral, o cuidado realizado pelos profissionais ocorre de forma fragmentada ou insipiente, por?m existe uma assist?ncia que envolve outros aspectos al?m do fazer t?cnico-curativo, considerando importante a aten??o que ? fornecida ? fam?lia e ao paciente, focalizada na preocupa??o da Enfermagem em n?o direcionar suas a??es somente ? realiza??o de procedimentos. Contudo, o processo de humanizar nem sempre se finaliza com um envolvimento entre profissional e paciente, o que descaracteriza o verdadeiro sentido do cuidar humano. Os registros tamb?m evidenciaram uma tend?ncia em focar o cuidar em uma linha positivista, em que, na maioria das vezes, os fatores da doen?a e a obriga??o de atender ? produtividade se sobrepuseram aos demais aspectos relevantes para uma compreens?o hol?stica de cuidar. Em rela??o ? resolu??o COFEN n? 358/2009, que norteia uma sistematiza??o da assist?ncia de Enfermagem, confirma-se uma vis?o tecnicista, fragmentada e superficial do paciente, bem como uma fragilidade da assist?ncia, causada pelo desconhecimento e despreparo de toda a equipe. A vis?o do cuidar que acontece nesse espa?o demonstra uma realidade com uma dial?tica entre o que se prop?e em uma Enfermagem humanizada e o que acontece nesse espa?o de atua??o. Al?m disso, mostrou-se um cotidiano repleto de considera??es importantes, que se apresentam na pr?tica do profissional, em suas concep??es e tamb?m naquelas pessoas que foram part?cipes do processo

Made available in DSpace on 2014-12-17T14:46:49Z (GMT). No. of bitstreams: 1 MabelMMP_DISSERT.pdf: 761729 bytes, checksum: de42f05921132674ae195fafe68cbe79 (MD5) Previous issue date: 2011-11-30 / This study aims to understand the feelings of patients admitted to the Intensive Care Unit (ICU) that experienced a change of shift at the bedside. The change of shift is one of the routines used by nursing in their work process and of great significance for the patient; therefore, deserves careful analysis in seeking to perfect themselves for the improvement of nursing care. It is a descriptive research, with a qualitative approach. The collection of information was performed using semi-structured interview, in August and September of 2011, after authorization from the Ethics Committee of the Federal University of Rio Grande do Norte, as opinion 290/2011. The analysis, based on interviews of patients, took the humanization as the thread of investigation backed by authors who deal on the subject and the theory of the gift of Marcel Mauss that sits on drug give-receive-return. The results indicate that the change of shift at the bedside but has not configured, the content of the speech of patients interviewed, as a moment that has generated fear and anxiety, could be deduced by the expression of silence, tears and other signs during interviews, how hard it is to live this experience. Nevertheless, despite this apparent tranquility, revealed uncertainty and apprehension face the speech of professional, during the visit at the bedside, particularly when referring to their health and their neighbors. On the other hand, the indifference to the participation of the patient at the time of the visit, expressing an attitude of merely technical nature, dehumanizes the act of taking care, the essence of nursing. And, for all the patients that we understand, about the visit to the bedside, as well as the ICU, we can infer that there is suffering for them. However, we understand your feelings and revelations seeking support in the theory of Mauss's gift: the patient receives the gift (care), and imbued with a feeling of gratitude, the rewards in the form of compliments and courtesies. Precisely for this reason, we need to sharpen our sensitivity to deal about the human condition in all its vulnerability. / O presente estudo tem como objetivo compreender os sentimentos de pacientes internados na Unidade de Terapia Intensiva (UTI) que vivenciam uma passagem de plant?o ? beira do leito. A passagem de plant?o constitui uma das rotinas utilizadas pela enfermagem no seu processo de trabalho e de grande significa??o para o paciente; por isso mesmo, merece uma an?lise cuidadosa na busca de seu aperfei?oamento para o aprimoramento da assist?ncia de enfermagem. Trata-se de um estudo descritivo explorat?rio, de natureza qualitativa. A coleta de informa??es foi realizada atrav?s de entrevista semiestruturada, nos meses de agosto e setembro de 2011, ap?s autoriza??o do Comit? de ?tica, da Universidade Federal do Rio Grande do Norte, conforme Parecer 290/2011. A an?lise, pautada nos depoimentos dos pacientes, tomou a humaniza??o como o fio condutor da investiga??o, apoiada em autores que tratam sobre o tema e na teoria da d?diva de Marcel Mauss que se assenta na tr?ade: dar-receber-retribuir. Os resultados apontam que a passagem de plant?o ? beira do leito embora n?o tenha se configurado, pelo teor das falas dos pacientes entrevistados, como um momento que tenha gerado medo e ansiedade, p?de-se depreender pelas express?es de sil?ncio, l?grimas e outras sinaliza??es, durante as entrevistas, o qu?o dif?cil ? vivenciar essa experi?ncia. Mesmo assim, apesar dessa aparente tranquilidade, revelaram incerteza e apreens?o diante das falas dos profissionais, por ocasi?o da visita ? beira do leito, particularmente, quando se referiam ao seu estado de sa?de e de seus vizinhos. Por outro lado, a indiferen?a em rela??o ? participa??o do paciente, no momento da visita, expressando uma atitude de cunho meramente t?cnico, desumaniza a a??o do cuidar, ess?ncia da enfermagem. E, por tudo que apreendemos dos pacientes, acerca da visita ? beira do leito, bem como da pr?pria UTI, podemos inferir que h? sofrimento para eles. No entanto, vamos compreender suas revela??es e sentimentos buscando apoio na teoria da d?diva de Mauss: o paciente recebe o presente (cuidado) e, imbu?do de um sentimento de gratid?o, o retribui em forma de elogios e gentilezas. Justamente por isso, precisamos agu?ar nossa sensibilidade para lidar com a condi??o humana, em toda a sua vulnerabilidade.

Made available in DSpace on 2014-12-17T14:46:55Z (GMT). No. of bitstreams: 1 ClaudiaCFM_DISSERT.pdf: 1372586 bytes, checksum: 77de00b4399140d63b436e07fb3d471d (MD5) Previous issue date: 2012-08-03 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study aimed to analyze stress on nursing staff of intensive care at the Teaching Hospital Onofre Lopes. The study sample consisted of thirty-eight (38) nursing professionals, including technicians and nurses working in the ICU of the hospital Data were collected between September to November 2011 in two stages.The first was the application of the Lipp Stress Symptoms Inventory (LSSI), which allowed us to measure the stress phase in which each team member was. After that, data were tabulated in Microsoft Excel spreadsheets and analyzed according to the 2010 inventory guidelines proposed by the author. After this analysis it was possible to complete the second phase of the research, which consisted of a semi-structured interview designed for those workers who were in the second phase of stress, resistance. Data analysis was based on Bardin 2004 content analysis, enabling the creation of categories based on grouping the ideas present in the interviewees' statements. It was found that the study population was mostly female (78.9%) aged from 30 to 39 years (50%), married (52.3%) and with dual-employment (65.7%). The most predominant phase, according to the Lipp inventory, was the stress resistance, present in 44.7% of the team and having as most predominant physical symptoms the constant feeling of physical exhaustion, verified in 16.8% of the participants, and psychological, the excessive irritability and emotional sensitivity in 26.3%. Regarding the qualitative data it was possible to establish three categories and four subcategories, with the following categories: the stressors of the workplace, overwork and the interpersonal relationships of the nursing staff in the ICU. And as subcategories: Routine care in the ICU; Pressures and Individual Charges; double journey: professional reflections on daily life, the night shift nursing staff and the body suffers, the manifestations of stress; deficient communication between team members. Thus, this study allowed the visualization of the stress phenomenon on nursing staff of the Teaching Hospital Onofre Lopes as a kaleidoscope of thoughts, feelings and experiences perceived by these professionals in different areas of their lives. It was also verified that the strengthening of the stress theme among nursing professionals need to be exploited and stimulated in several nursing areas of discussion so these workers are encouraged to take better care of themselves so they can take care of others health / Esta pesquisa teve como objetivo analisar o estresse na equipe de enfermagem da terapia intensiva do Hospital Universit?rio Onofre Lopes A popula??o estudada foi constitu?da por trinta e oito (38) profissionais de enfermagem, entre t?cnicos de enfermagem e enfermeiros que atuam na UTI do referido hospital. Os dados foram coletados no per?odo de setembro a novembro de 2011 em duas etapas distintas. Na primeira, foi feita a aplica??o do invent?rio de sinais e sintomas do estresse de Lipp (ISSL), o qual permitiu a mensura??o da fase do estresse em que cada membro da equipe se encontrava. Os dados foram tabulados em planilhas do Microsoft Excel 2010 e analisados conforme as diretrizes do invent?rio propostas por Lipp, 2000. Seguido a esta an?lise, foi realizada a segunda etapa da pesquisa, constitu?da por entrevista semiestruturada com aqueles trabalhadores que se encontravam na segunda fase do estresse, a de resist?ncia. A an?lise das entrevistas foi baseada na proposta de an?lise do conte?do de Bardin 2004, a qual permite a cria??o de categorias a partir do agrupamento de ideias presentes nas falas dos entrevistados. Como resultado, observou-se que a maior parte da popula??o estudada ? feminina (78,9%), na faixa et?ria entre 30 e 39 anos (50%), casadas (52,3%) e com duplo v?nculo empregat?cio (65,7%). Segundo o invent?rio de Lipp, a fase de maior predomin?ncia foi a de resist?ncia ao estresse, presente em 44,7% dos membros da equipe. O sintoma f?sico de maior predomin?ncia a sensa??o de desgaste f?sico constante, percebido em 16,8% dos participantes, e no ?mbito psicol?gico, as manifesta??es predominantes foram irritabilidade excessiva e a sensibilidade emotiva com escores iguais a 26,3%. A partir dos dados qualitativos, foi poss?vel delinear tr?s categorias e quatro subcategorias. As categorias foram: os estressores do ambiente de trabalho; o excesso de trabalho e o relacionamento interpessoal da equipe de enfermagem na UTI. E como subcategorias: A rotina do cuidado na UTI; Press?es e Cobran?as Individuais; Dupla jornada: reflexos no Cotidiano profissional; o trabalho noturno da equipe de enfermagem e o corpo que sofre: as manifesta??es do estresse e a comunica??o deficit?ria entre os membros da equipe. Assim, por meio desse estudo foi poss?vel visualizar o fen?meno do estresse na equipe de enfermagem do HUOL como um caleidosc?pio de reflex?es, sensa??es e experi?ncias percebidas por esses profissionais em diferentes ?reas de sua vida. Constatou-se, ainda, que o fortalecimento da tem?tica estresse dos profissionais de enfermagem precisa ser instrumentalizada e estimulada em diversos espa?os de discuss?o da enfermagem para que esses trabalhadores sejam incitados a cuidar melhor de si para, assim, cuidar da sa?de do outro

Made available in DSpace on 2014-12-17T14:47:08Z (GMT). No. of bitstreams: 1 NicelhaMGA.pdf: 739292 bytes, checksum: be41fabdbb6032a725b028c30f55516e (MD5) Previous issue date: 2007-02-05 / The purpose of the study was to understand the nurse s experience with human care in the Adult Intensive Care Unit (ICU). The objective was to describe the nurse s experience in caring for patients in the ICU and to analyze the nurse s perception of the care provided. The study is a descriptive inquiry of qualitative nature with a phenomenological approach. We interviewed eight nurses, 26 and 43 years of age, that provide care in the ICU of a private hospital in Natal/RN, during the manths of July and August of 2006. We analyzed the data acording to the method of Colaizzi. Four categories emerged from the data: The search for the maintenance of life, The technicalbureaucratic activities, The recognition of the patient s individuality, and the expression of the nurse s feelings.The analysis allowed us to describe the lived experience of the nurse s care the ICU and to comprehend the structural elements of this experience. The results showed that the nurse s experience presents itself as a process of the several actions and feelings that occur while the social relations between the patient and the nurse develop. Finally, we understand that although the study shows an experience based on a biological model of health, these nurses possess an initial idea on how to reach humanized care in its essence, needing, however, of an institutional policy that favors this practice, an educational formation that prepares her to recognize her field of work as a place of continuous learning and an understanding of the health model as an ally in the search of humanized care / O prop?sito do estudo foi compreender a experi?ncia do enfermeiro com o cuidado humano na unidade de terapia intensiva (UTI) adulto. Teve como objetivos descrever a viv?ncia do enfermeiro ao cuidar de pacientes na UTI, e analisar a percep??o deste acerca do cuidado que ele presta. Trata-se de uma investiga??o descritiva com abordagem fenomenol?gica. Entrevistamos oito enfermeiros na faixa et?ria de 26 a 43 anos, que desempenham suas atividades na UTI de um hospital privado de Natal/RN. Coletamos os dados nos meses de julho e agosto de 2006 e utilizamos o m?todo fenomenol?gico de an?lise de Colaizzi. Quatro categorias tem?ticas emergiram da an?lise compreensiva: A busca pela manuten??o da vida; as a??es t?cnico-burocr?ticas; a aproxima??o com as particularidades dos pacientes; e a expressividade dos sentimentos do enfermeiro. A an?lise permitiu descrevermos a viv?ncia do cuidar dos enfermeiros e de conhecermos os elementos estruturais da experi?ncia. A viv?ncia desses enfermeiros se apresenta como um processo composto por v?rias a??es e sentimentos que v?o surgindo ? medida que as rela??es sociais entre eles e os pacientes v?o acontecendo. Entendemos que o estudo mostra uma viv?ncia pautada num modelo de sa?de biologicista, mas, que esses enfermeiros j? possuem esbo?ado em si o caminho para se alcan?ar um cuidado humanizado na sua ess?ncia, precisando, no entanto, de uma pol?tica institucional que favore?a essa pr?tica, uma forma??o que desperte o enfermeiro para reconhecer seu campo de trabalho como um lugar de aprendizado cont?nuo e que o modelo de sa?de vigente passe a ser um aliado na busca de um cuidado humanizado