Living will is a multidisciplinary, ethical-law problem. When applied a legally competent patient as a lay person orders the medical staff as professionals how to treat him or her in case of him/her not being able, temporarily or permanently, to give an informed permission with a treatment or alternatively refuse such treatment. A patient has a right to express his/her wishes concerning a future health care for him/her-self in a time when he/she is no longer capable to decide on his/her own. The living will is a particular kind of an informed consent or decline targeted towards a future event which is to an extent uncertain. The presented thesis consists of two parts which are additionally divided into three chapters. The major aim of the first part is to give a comprehensive explanation of the Living will's position in the legal system of the Czech Republic. This part also analyses the relation of the modification embedded in the the Act on Health Services and Conditions of Their Provision and the Civil Code. The second part consists of two chapters: "The Living will's reflection in the intensive and palliative care" and " Care limitations, the Living will and a the legal responsibility of a medical doctor". It deals with the use of the Living will in intensive medicine and palliative care. These...

Orientadores: Roberta Cunha Rodrigues Colombo, Maria Cecilia Jayme Bueno Gallani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T16:08:54Z (GMT). No. of bitstreams: 1 Pinto_CristianoJoseMendes_M.pdf: 11508571 bytes, checksum: 3c11ab6f502e13fad691910fcd7f1e96 (MD5) Previous issue date: 2004 / Resumo: Este estudo teve como objetivo identificar, a partir da Teoria do Comportamento Planejado (TPB), os fatores que contribuem para a formação da intenção comportamental do enfermeiro para realizar o estudo hemodinâmico por meio do cateter de artéria pulmonar (CAP). Os dados foram obtidos por meio de entrevista semi-estruturada junto a 23 enfermeiros de Unidades de Terapia Intensiva de dois hospitais públicos e um privado do município de Campinas-SP. A natureza exploratória deste estudo com o emprego de questões abertas permitiu uma análise de caráter qualitativo dos dados coletados, que foram apresentados de acordo com as Unidades Temáticas Centrais: Crenças de Atitude, Normativas, de Controle e Gerais. A análise das entrevistas evidenciou que entre as Crenças de Atitude destacam-se as crenças afetivas negativas e positivas em relação ao comportamento e aquelas relativas às vantagens e desvantagens da realização do estudo hemodinâmico. Na unidade Crenças Normativas, foram evidenciados os referentes sociais positivos para a execução do comportamento: médico, enfermeiro, paciente, bem como os fatores estimuladores do comportamento: "responsabilidade do enfermeiro no cuidado do paciente" e "interesse na recuperação do paciente"; como referentes negativos: equipe médica e serviços de educação continuada, e, como fatores que desestimulam: "déficit de conhecimento", "dificuldades para execução do procedimento" e "pequena utilização dos dados do estudo hemodinâmico pela equipe médica". Dentre as Crenças de Controle, destacaram-se os fatores facilitadores e/ou dificultadores: material, equipamento, número de profissionais, conhecimento, tempo, sobrecarga de atividades, equipe de enfermagem e médica. Os dados obtidos subsidiarão a construção de uma escala psicométrica para a compreensão e predição do comportamento em estudo / Abstract: The purpose of this study was to identify, by means of the Theory of Planned Behavior (TPB), the elements leading to the development of nurses' behavioral intention when performing a hemodynamic study in patients through pulmonary artery catheter (PAC). Data were obtained by using semi-structured interviews made with 23 Intensive Care Unit nurses from two public and one private hospitais in the city of Campinas, São Paulo state, Brazil. The exploratory nature of this study allowed a qualitative sort of analysis of the data collected, which were then presented according to the following Central Theme-based Units: Attitude, Normative, Control and General Beliefs. The analysis of the interviews highlighted that, conceming the Attitude Beliefs, there are positive and negative aftective beliefs regarded to both behavior and to the advantages and disadvantages in carrying out the hemodynamic study. As to the Normative Beliefs Unit it is possible to emphasize some positive social references present in the behavioral response such as the physicians, nurses and patients, as well as some elements proved to stimulate behavior: nurses' responsibility towards the patients' care and interest in the patients' recovery; among the negative references are: the medical staft and continuing education services; regarding the non-stimulating elements we can mention: knowledge deficit, difficulties in carrying out the procedures and low use of the hemodynamic study data by the medical staft. The Control Beliefs displayed some elements which can either facilitate and I or make the behavior difticult: material, equipment, number of professional people, knowledge, time, tasks overload, nurse and medical staft. The data obtained will enable the creation of a psychometric scale which will be used to understand and predict the behavior presently studied. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

This diploma thesis deals with the psychical and physical stress of nurses working in anesthesiology and intensive medicine. In the theoretical part, the problems of psychical and physical stress are presented, as well as the role of nurses and their activities undertaken in the units of anesthesiology and intensive care. The practical part deals with a research that aims to obtain data revealing indicators of mental and physical stress of nurses working in anaesthesiology and intensive medicine. The research took place in four selected hospitals in their departments of anesthesiology and intensive care and intensive care units of neurosurgical clinics. Respondents were divided into two groups - respondents of anesthesiology and intensive care and respondents from department of neurosurgery. Groups were compared and results are presented in tables and graphs. Key words Anesteziology, intensit medicine, roles of nurses, physical stress, psychological stress, departemnt of ICU

Successful coping with adaptation process by a nurse newly joining an intensive medicine workplace is quite a complicated process. Mastering sophisticated instrumentation, specialist demands of nursing care provision and everyday physical load as well as psychical stress expose each newly coming nurse to a wide spectre of demands the unconditioned coping with which is a basic precondition of successful integration to an elite team. Each incoming nurse (not just at an intensive care workplace) should be particularly supported by her nurse manager in the far from easy adaptation process, who can substantially help a new nurse adapt to the new environment and become an equivalent team member. The Thesis is aimed at the role of a nurse manager in comforting an adaptation process of a nurse joining an ARD and an ICU. The aim of the Thesis was to map the role of a nurse manager in adaptation process of a nurse joining an ARD and an ICU and to find out how such a nurse manager helps a nurse joining an ARD or an ICU with adaptation. Further aims were to map the process of adaptation of a nurse joining an ARD or an ICU itself and to examine the factors that mostly influence the adaptation process of a nurse joining an ARD or an ICU. A combination of qualitative and quantitative research was applied to the research part of the Thesis. A semi-standardized interview conducted with ARD and ICU ward sisters in selected hospitals in Prague was chosen as the data collection technique for the qualitative part. A questionnaire designed for nurses working at ARDs and ICUs in selected Prague hospitals, who themselves were undergoing or have recently undergone such an adaptation process was chosen as the data collection technique for the quantitative part. The aims of the Thesis have been met. The research results clearly showed that the adaptation process of a new nurse is not only based on effective specialist training, but also in integration of the nurse into the existing working team. It is thus necessary for a nurse manager to take sufficient care to the adaptation process and help a new nurse become an equivalent member of the team, which will thus achieve the set goals of the department as well as the whole organization under her efficient guidance. The results of our research may thus contribute to better awareness of the individual motivation factors of the adaptation process among the involved public. Upon the information found about functioning of a nurse manager in the process of adaptation of a nurse joining an ARD or an ICU a thought map was created, which might help as inspiration or as a manual for execution of this highly demanding process itself.

Orientador: César Tadeu Spadella / Resumo: Bases científicas: O controle dos riscos associados à utilização dos equipamentos nos hospitais é de crucial importância na garantia da segurança dos pacientes e na qualidade dos serviços prestados pelos profissionais da saúde. Para este fim, é necessário conhecer todo o ciclo dos equipamentos nos hospitais, desde a sua seleção, aquisição, manutenção e uso, bem como das falhas e eventos adversos a eles associados. Monitores multiparamétricos (MM), bombas de infusão (BI) e ventiladores pulmonares mecânicos (VPM) são equipamentos de uso frequente em Unidades de Terapia Intensiva sendo, todavia, muito sujeitos a falhas técnicas, humanas e de processos, as quais podem causar sequelas e mesmo a morte dos pacientes. Objetivo: Avaliar os riscos assistenciais relacionados ao uso de MM, BI e VPM na Unidade de Terapia Intensiva de Adultos (UTI-A) de um hospital público da cidade de São Paulo, Brasil, procurando investigar as causas e providências relacionadas às queixas técnicas e eventos adversos a eles associados. Métodos: Foi realizado na UTI-A um estudo prospectivo, quantitativo, descritivo e observacional, durante um período de 12 meses, tendo por base a análise resultante de busca ativa e passiva dos processos envolvendo o uso dos equipamentos médicos hospitalares, incluindo: estrutura física e organizacional do ambiente, recursos humanos e recursos materiais disponíveis; programa de treinamento e educação continuada dos profissionais; etapas de higienização, desinfecção, esteril... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Scientific background: Risk control associated to device use in hospitals has major importance to ensure patient safety and quality in service delivered by healthcare professionals. For doing so, it´s necessary to know all the device cycle in the hospitals, from its selection, acquisition, maintenance and use, as well as its failures and the adverse events related to them. Multiparameter Monitors (MM), infusion pumps (IP) and mechanical ventilators (MV) are devices of frequent use in Intensive Care Units, being however subject to technical, human and process failures, which may pose harm and even cause death of patients. Objective: To evaluate care risks related to the use of MM, IP, and MV at an Adult Intensive Care Unit (AICU) of a public hospital in Sao Paulo city, Brazil, seeking to investigate the causes and providences related to technical complaints and adverse events associated to them. Methods: It was made an observational, descriptive quantitative prospective study through 12 months, based on an analysis resulting from active and passive search of processes involving the use of medical devices in hospitals, including physical and organizational structure of work environment, available human resources and material resources; training program and continuing education of professionals; sanitization, disinfection, sterilization and assembling stages of devices; planning on preventive and corrective maintenance of the devices; and management of hospital sanitary risk reg... (Complete abstract click electronic access below) / Doutor

Submitted by LORAINE MARTINS DIAMENTE null (loramdi@terra.com.br) on 2016-04-28T20:34:25Z No. of bitstreams: 1 Doutorado Loraine _28_2016_ (3) (1).pdf: 2798219 bytes, checksum: 0e28cd272eca61ac1f596d83701237bb (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-02T13:40:27Z (GMT) No. of bitstreams: 1 diamente_lm_dr_bot.pdf: 2798219 bytes, checksum: 0e28cd272eca61ac1f596d83701237bb (MD5) / Made available in DSpace on 2016-05-02T13:40:27Z (GMT). No. of bitstreams: 1 diamente_lm_dr_bot.pdf: 2798219 bytes, checksum: 0e28cd272eca61ac1f596d83701237bb (MD5) Previous issue date: 2016-02-22 / Bases científicas: O controle dos riscos associados à utilização dos equipamentos nos hospitais é de crucial importância na garantia da segurança dos pacientes e na qualidade dos serviços prestados pelos profissionais da saúde. Para este fim, é necessário conhecer todo o ciclo dos equipamentos nos hospitais, desde a sua seleção, aquisição, manutenção e uso, bem como das falhas e eventos adversos a eles associados. Monitores multiparamétricos (MM), bombas de infusão (BI) e ventiladores pulmonares mecânicos (VPM) são equipamentos de uso frequente em Unidades de Terapia Intensiva sendo, todavia, muito sujeitos a falhas técnicas, humanas e de processos, as quais podem causar sequelas e mesmo a morte dos pacientes. Objetivo: Avaliar os riscos assistenciais relacionados ao uso de MM, BI e VPM na Unidade de Terapia Intensiva de Adultos (UTI-A) de um hospital público da cidade de São Paulo, Brasil, procurando investigar as causas e providências relacionadas às queixas técnicas e eventos adversos a eles associados. Métodos: Foi realizado na UTI-A um estudo prospectivo, quantitativo, descritivo e observacional, durante um período de 12 meses, tendo por base a análise resultante de busca ativa e passiva dos processos envolvendo o uso dos equipamentos médicos hospitalares, incluindo: estrutura física e organizacional do ambiente, recursos humanos e recursos materiais disponíveis; programa de treinamento e educação continuada dos profissionais; etapas de higienização, desinfecção, esterilização e montagem dos equipamentos; planos de manutenção preventiva e corretiva dos aparelhos; e o gerenciamento do risco sanitário hospitalar, ligado à notificação e providências tomadas em relação às falhas técnicas, humanas e de processos, bem como os eventos adversos e incidentes a elas associados. Todos os dados coletados foram confrontados com a legislação brasileira e manuais técnicos vigentes, com a investigação da causa-raiz das falhas e dos eventos adversos ocorridos. Resultados: O estudo mostrou que o hospital apresenta falhas de infraestrutura e também, dos processos envolvidos nas diversas etapas do ciclo dos equipamentos as quais prevalecem sobre as falhas humanas. Dentre as nãoconformidades observadas estão incluídas: falhas no processo de licitação, que não tem a participação direta de profissionais médicos e de enfermagem da UTIA, para auxiliar na elaboração do edital, visando à melhor seleção e especificação dos produtos a serem adquiridos; inexistência de atuação do setor de Engenharia Hospitalar para monitorar as etapas de aquisição, recebimento, aceitação, manutenção e uso adequado dos instrumentos; inadequações da área física e das instalações dos equipamentos; deficiências na quantidade, qualificação, treinamento e capacitação dos profissionais para o manuseio correto dos aparelhos e cuidados aos pacientes; falhas no processo de higienização/desinfecção de componentes internos dos VPM; dificuldade de acesso a manuais técnicos dos aparelhos e aos procedimentos operacionais padrão pelos profissionais de saúde; inexistência de um inventário histórico e funcional dos equipamentos existentes; e a falta de programas de manutenção preventiva e corretiva com relações contratuais efetivas com os fabricantes e fornecedores. Os profissionais da UTI-A, não tem o hábito de notificar queixas técnicas e eventos adversos à Gerência de Risco Sanitário Hospitalar (GRSH), pois não foi registrada qualquer notificação espontânea advinda do setor no período analisado. Todavia, 74 notificações de queixas técnicas foram detectadas por busca ativa, sendo 64 relacionadas às BI, 6 aos MM e 4 aos VPM. No período, houve um único evento adverso relacionado a erro de medicação com BI, tendo sido atribuído à falha humana por erro na programação do sistema de infusão. Conclusões: O hospital apresenta oportunidades de melhorias para praticamente todas as etapas do ciclo dos equipamentos, uma vez que foram detectadas condições potencialmente capazes de acarretar riscos assistenciais relacionados à utilização dos MM, BI e VPM na UTI-A. As não-conformidades observadas elevam a probabilidade de ocorrência de falhas, incidentes e eventos adversos, colocando em risco a saúde e o bem-estar físico dos pacientes e dos profissionais da saúde. A falta de observação à legislação e normas técnicas e operacionais vigentes no país foi um evento sistemático, observado em todas as etapas do ciclo dos equipamentos no hospital, mas que se corretamente seguidas, poderá tornar esta UTI-A em ambiente mais seguro e com melhor qualidade na assistência à saúde dos pacientes. / Scientific background: Risk control associated to device use in hospitals has major importance to ensure patient safety and quality in service delivered by healthcare professionals. For doing so, it´s necessary to know all the device cycle in the hospitals, from its selection, acquisition, maintenance and use, as well as its failures and the adverse events related to them. Multiparameter Monitors (MM), infusion pumps (IP) and mechanical ventilators (MV) are devices of frequent use in Intensive Care Units, being however subject to technical, human and process failures, which may pose harm and even cause death of patients. Objective: To evaluate care risks related to the use of MM, IP, and MV at an Adult Intensive Care Unit (AICU) of a public hospital in Sao Paulo city, Brazil, seeking to investigate the causes and providences related to technical complaints and adverse events associated to them. Methods: It was made an observational, descriptive quantitative prospective study through 12 months, based on an analysis resulting from active and passive search of processes involving the use of medical devices in hospitals, including physical and organizational structure of work environment, available human resources and material resources; training program and continuing education of professionals; sanitization, disinfection, sterilization and assembling stages of devices; planning on preventive and corrective maintenance of the devices; and management of hospital sanitary risk regarding the report and actions towards technical, human and process failures occurred, as much as adverse events and incidents related to them. All the data collected was confronted to the current legislation and technical manuals. The root cause of failures and adverse events were investigated. Results: The study showed that Dr. Cármino Caricchio Municipal Hospital (HMCC) presents failures of infrastructure and/or the processes involved in the several stages of the device cycle which prevails on human failures. Among the non-conformities observed are included: failures in the bidding process, which doesn´t have the direct participation of AICU physicians and nurses, to provide support to elaborate Public Notice, focusing the best selection and specification of products to be acquired; lack of acting from the hospital engineering sector in order to monitor the stages of acquisition, receiving, acceptance, maintenance and appropriate use of devices; inadequacy of physical area and equipment installation; deficiencies in quantity, qualification, training, and capacitation of professionals for the correct handling of devices and patient care; failure in the process of sanitization/disinfection of MV internal accessories; the absence or difficulty to access the technical manuals of the equipments and the standard operating procedures by healthcare professionals; the absence of a historical and functional inventory of the current devices; and lack of preventive and corrective maintenance programs establishing effective contractual relations with manufacturers and suppliers. AICU professionals from HMCC also lack the practice of reporting technical complaints and adverse events to Gerência de Risco Sanitário Hospitalar (GRSH – Hospital Health Hazard Management), which hadn´t registered any spontaneous report from the sector throughout the period in analysis. Nevertheless, 75 reports on technical complaints were detected through active search, which 65 were related to IP, 6 to MM and 4 to MV. One single adverse event related to medication error with IP was observed in the period, which was rather attributed to human failure as for system programming error. Conclusions: HMCC presents failures and deficiencies in virtually all stages of hospital equipment cycle, that bring together conditions potentially capable to increase care risks regarding the use of MM, IP and MV at the AICU. This fact raises the probability of failure occurrence, incidents and adverse events, placing risk to patients´ as well as healthcare professionals´ health and physical wellness. Lack of compliance to legislation and technical and operational norms in the country was a systematic event observed in all the stages of hospital equipment cycle, but if they were strictly followed, it might turn the AICU of HMCC a safer place with better quality of healthcare for patients.