Bakgrund: Telefonrådgivning är ett av distriktssköterskans arbetsområden inom primärvården och innebär ett komplext och kort möte. Brister i kommunikationen är den vanligaste orsaken till att vårdskador uppstår och bristande kommunikation vid telefonrådgivning kan leda till felaktiga eller försenade diagnoser.     Syfte: Syftet med studien var att utifrån kärnkompetensen säker vård beskriva distriktssköterskors upplevelser av telefonrådgivning inom primärvården. Metod: Semistrukturerade intervjuer genomfördes med elva distriktssköterskor på fem olika vårdcentraler i södra Sverige. Intervjuerna spelades in, transkriberades och analyserades utifrån kvalitativ innehållsanalys med inspiration av Graneheim & Lundman. Resultat: Analysen resulterade i fem kategorier. Tillit till erfarenhet, utbildning och kollegialt stöd som distriktssköterskorna upplevde som en trygghet och som ett stöd. Att inte räcka till handlade om distriktssköterskornas upplevelser av att inte kunna hjälpa patienterna som de önskade och att inte kunna motivera dem.  Tillit till digitalt stöd innefattade att distriktssköterskorna upplevde tillgång och tillit till den digitala journalen och riktlinjer. Tidens betydelsefullhet handlade om att tidsbegränsningen och att kunna ta sig tid är betydelsefulla faktorer. En säkerhetsrisk att inte ha patienten framför sig handlar om att det är svårt att göra bedömningar när visuell kontakt med patienten saknas och/eller vid kommunikationssvårigheter. Slutsats: Studien kan bidra till en ökad medvetenhet om möjligheter och hinder i arbetet för distriktssköterskor i telefonrådgivningen inom primärvården samt att det finns förbättringsområden för att kunna säkerställa en säker vård.   Nyckelord: distriktssköterska, innehållsanalys, säker vård, telefonrådgivning, upplevelser / Background: Telephone consulting is one of the district nurses area of work within primary care and involves a complex and short meeting. Shortcomings in communication are the most common reason why healthcare injuries occur and lack of communication in telephone counseling can lead to incorrect or delayed diagnoses.    Aim: The aim of the study was to describe, based on the core competence of safe care, district nurses´ experiences of telephone counseling within primary care.   Method: Semi-structured interviews were conducted with eleven district nurses at five different health centers in southern Sweden. The interviews were recorded, transcribed and analyzed according to qualitative content analysis inspired by Graneheim & Lundman.   Results: The analysis resulted in five categories. Confidence in experience, education and collegial support showed that the district nurses experienced these factors as a security and as a support. Not being enough was about the district nurses´ experience of not being able to help patients as they would have wanted and not being able to motivate them. Trust in digital support included that district nurses experienced access and confidence in the digital journal and guidelines. The significance of time is about the fact that time constraints and time are important factors. A safety risk not to have the patient in front of you is about the difficulties to make judgements when visual contact with the patient is lacking and/or communication difficulties. Conclusion: The study may contribute to an increased awareness of opportunities and obstacles in the work of district nurses in telephone counseling in primary care and as it shows that there are areas for improvement in order to ensure a safe care.   Keywords: district nurse, content analysis, experiences, safe care, telephone consulting

Bakgrund: Säker vård är ett ämne som ständigt är aktuellt inom vården. För att skapa förutsättningar för säker vård är de basala hygienrutinerna en viktig del i omvårdnadsarbete. Patienter inom slutenvården i Sverige drabbas av vårdrelaterade infektioner (VRI) som bidrar till ökade kostnader för samhället, lidande för patienten och är ett hot mot säker vård. Undersökningar gjorda av Sveriges kommuner och landsting visar ett starkt samband mellan följsamheten av de basala hygienrutinerna och VRI.   Syfte: Att undersöka vårdpersonalens följsamhet till basala hygienrutiner på en medicinsk akutvårdsavdelning, med fokus på handhygien och dess betydelse för vårdrelaterade infektioner.   Metod: En kvantitativ empirisk långtidsuppföljning (2013-2018) har genomförts. Observationer har utförts på en medicinsk akutvårdsavdelning i södra Sverige. De yrkesgrupper som observerades var undersköterskor, sjuksköterskor och läkare. Samtlig data har hämtats från registret Mätning och analys (MOA). Deskriptiv data har sammanställts och analyserats genom statistikprogrammet SPSS.   Resultat: Vid analys framkom att följsamheten till handhygien skiljer sig mellan de olika yrkesgrupperna, undersköterskorna visar på högst följsamhet. Det moment där yrkesgrupperna visar på högst följsamhet var handsprit efter patientkontakt.   Slutsats: För att en god och säkervård ska kunna utföras bör vårdpersonal få möjlighet till en bredare kunskap om handhygien och smittspridning. Analysen av långtidsuppföljningen har bekräftat vad tidigare studiers resultat har visat kring följsamhet till handhygien.

Tidigare forskning kring hygienrutiner har visat att följsamheten hos vårdpersonal är bristande samt att bristande följsamhet leder till ökad förekomst av vårdrelaterade infektioner (VRI). Syftet var att undersöka följsamheten kring basala hygienrutiner hos sjuksköterskor och undersköterskor samt jämföra hur följsamheten skiljer sig personalkategorierna emellan samt före och efter patientkontakt, på en medicinsk akutvårdsavdelning i södra Sverige under åren 2013–2018. Studien hade empirisk utformning. Data samlades in genom observationer och analyserades med stöd av Statistical Package for the Social Sciences (SPSS). Det som observerades var följsamhet till korrekt användning av handdesinfektion, handskar, platsförkläde/skyddsrock och rätt klädsel. Totalt gjordes 564 observationer mellan åren 2013–2018. Resultatet visar att det finns rum för förbättring i följsamhet. Överlag visar undersköterskor på en högre grad av följsamhet genom alla observerade år. Märkbar skillnad sågs mellan följsamhet till handdesinfektion före och efter patientkontakt, där följsamheten i sistnämnda var bristande. Vidare interventioner behövs för att förbättra följsamheten till basala hygienrutiner, minska risken för vårdrelaterade infektioner och höja patientsäkerheten. / Title: Compliance of nurses and assistant nurses to guidelines regarding basic hygiene routines in a medical intensive care unit: A quantitative long-term study. Previous research has shown that compliance to hygiene routines among healthcare professionals is inadequate and that inadequate compliance is linked to increased prevalence of healthcare-associated infections (HCAI). The aim of this study was to examine the compliance of nurses and assistant nurses to guidelines regarding basic hygiene routines and to make an occupational comparison before and after patient contact, in a medical intensive care unit in southern Sweden over a period of six years. The study had an empirical approach. Data was collected through observations and was analyzed using Statistical Package for the Social Sciences (SPSS). Observed aspects included compliance to correct usage of hand rub, plastic gloves, aprons as well as proper clothing. A total of 564 observations were made during the years 2013–2018. The result shows that there is room for improvements to compliance, with assistant nurses overall showing a higher rate of compliance throughout all observed years. Noticeable differences in compliance were found between hand rub usage before and after patient contact, with a lack of compliance in the latter. Further interventions are needed in order to improve compliance rates to guidelines regarding hygiene to prevent HCAI and increase patient safety.

Ce projet contribue à développer la prochaine génération de nano-emballages en utilisant une approche plus sûre et éco-conçue avec des avantages directs à la fois pour l'environnement et la sécurité des consommateurs. Les emballages alimentaires constituent l’un des principaux secteurs d’applications des nanotechnologies avec des enjeux environnementaux prometteurs de substitution des pétro-plastiques par des bio-plastiques et de réduction des pertes et gaspillages alimentaires grâce à des emballages plus performants, de type actifs et intelligents. Dans le cas de matériaux nano-composites (matrice polymérique contenant des nano-particules) destinés au contact alimentaire, le risque majeur en terme de santé humaine est lié à leur impact sur la migration de composés indésirables de l’emballage vers l’aliment (stabilisants UV, antioxydants, plastifiants, etc) qui peuvent avoir des effets néfastes en fonction des doses et durées d’exposition. Ces interactions contenant/contenu sont soumises à une réglementation européenne dont l’objectif est la protection de la santé du consommateur en fixant des limites de migration spécifique pour tous les composés supposés entrer dans la composition des matériaux plastiques dédiés au contact alimentaire. Dans le cas des nanomatériaux, la présence de nanoparticules est susceptible de modifier les interactions entre le polymère et les additifs et par voie de conséquence leurs propriétés de transfert. Ainsi, la formalisation des phénomènes de migration de l’emballage vers l’aliment établie sur des matériaux plastiques ne contenant pas de nanoparticules ne peut pas être directement transposée au nano-matériaux. De plus la présence de ces nanoparticules peut profondément modifier l’éco-toxicité environnementale du système matrice- nanoparticule -additif.La présente étude vise à comprendre et contrôler l’impact des structures nanocomposites (matrice polymérique contenant des nano-particules) sur les propriétés de transport (diffusivité et solubilité) des nanoparticules et des additifs chimiques en condition d’usage. À cet égard, il est nécessaire de combler le déficit de connaissances dans a caractérisation de la structure 3D, des propriétés physico-chimique et des interactions aux interfaces entre nanoparticules et matrice dans les nanomatériaux. Devant la complexité du système étudié, la modélisation est indispensable pour représenter (simplifier sans pour autant perdre trop de connaissances) la structure 3D des nanomatériaux et simuler, reproduire puis prédire, l’évolution de leurs propriétés de transfert en fonction des paramètres structurels et en condition d’usage. La modélisation des transferts est également indispensable pour, dans une approche d’ingénierie inverse, éco-concevoir et dimensionner à façon des nano-emballages sûrs pour l’Homme et l’Environnement. Dans cette optique une démarche de modélisation multi-échelle des relations structure/propriétés de transfert de masse a été mise en place sur des matériaux nanocomposites ciblés choisis pour leur pertinence dans le domaine de l’emballage alimentaire. / The market of nanotechnologies is dominated by the food packaging area which amounts more than 20% of the total nanotechnologies market in 2015. However, the wide-scale use of nanomaterials raises important questions about environmental and safety issues that could hinder their development. In the case of plastics intended to be in contact with food, the risk of contamination concerns not only the nanoparticles but also all the chemical additives added during the material processing. The presence of nanoparticles is susceptible to modify the interactions between polymer and the additives with a possible change in their transport properties and therefore the food contamination.The present work aims at identifying the relationship between the structural characteristic and the transport properties (diffusivity and solubility) of nanoparticles and chemical additives incorporated in nanocomposites. In this regard, it is necessary to fill the gap of knowledge in 3D nanostructure characterization and a multi-scale modeling of mass transfer properties of nanocomposites in real usage conditions.In this way, polyethylene and nanoclay were selected based on the best compromise between real potential applications and the scientific knowledge previously published and eventually the nanocomposites were synthesized with LLDPE, Cloisite20 and a compatibilizer by melt intercalation method.The nanocomposite structure was characterized using TEM, X-ray nanotomography, TGA and XRD then submitted to migration tests undertaken in contact with different food simulants which represent various types of food (aqueous, acid, alcoholic) following the recommendation of the European regulation on the food contact material. To evaluate the positive or adverse effects of the nanomaterials on the contamination of the food by chemical additives which are usually incorporated with the plastic packaging, the virgin polymer and nanocomposite material were spiked with a mixture of the additives exhibiting various volatility, polarity and molecular weight. Then, the transport properties (i.e inertia) of nanocomposite structure was distinctively investigated on kinetic (apparent diffusion coefficient) and thermodynamic (partition coefficient) considerations.The results indicated that nanoclay addition in plastic materials favorably reduced the migration of additives by modifying both their diffusivity in the polymer and their partition between the polymer and the food simulant. However, while the partition coefficient of additives increases in nanocomposite in comparison to pure LLDPE for the samples in contact with all types of food simulants, the reduction of diffusion coefficient is significantly dependent on the nature of the food simulant in contact. Hence, it can be concluded that the major role in the migration of additives is not played by the imposed tortuosity path, but by the factors such as the affinity between the base polymer and simulants as well as the effects of simulants on swelling and crystallinity of the samples. Moreover, the effect of additive-related parameters and the structural parameters were assessed and put in perspective with their impact on the transport properties of nanostructures. Integrating the results of characterization and transfer properties led to an improved understanding of the influence of structure of nanocomposites on their mass transfer properties and therefore on the suitability of using them as food contact materials.

A atenção qualificada ao parto tem sido um dos principais focos de ação da Iniciativa Maternidade Sem Risco (IMSR), no intuito de se obter gestações e partos mais seguros para as mulheres e os recém-nascidos e consequentemente diminuir as taxas de morbimortalidade materno-infantil. Este estudo buscou conhecer a assistência que as mulheres, atendidas nos serviços públicos de saúde do município de São Carlos/SP, recebem durante o ciclo gravídico-puerperal, evidenciando as ações desenvolvidas pela equipe de enfermagem. Objetivos: Descrever o perfil dos profissionais de enfermagem que atuam na atenção ao ciclo gravídico-puerperal e identificar as ações desenvolvidas por estes na assistência ao pré-natal, trabalho de parto, parto e puerpério, correlacionando com as competências essenciais ao exercício básico da obstetrícia recomendadas pela Confederação Internacional das Parteiras (ICM). Metodologia: Trata-se de um estudo exploratório descritivo, com uma abordagem quantitativa, que utilizou para a coleta de dados a entrevista estruturada e a observação sistemática das ações desenvolvidas pelos profissionais de enfermagem na assistência ao ciclo gravídico-puerperal. A população estudada foi composta de 84 profissionais de enfermagem, sendo 37 da atenção básica que prestam assistência ao pré-natal e puerpério e 47 da maternidade, que prestam assistência ao parto. Foram observadas na atenção básica, 52 pré-consultas e 47 pós-consultas de pré-natal, 05 abertura de SISPRENATAL, 05 acolhimentos, 05 consulta de pré-natal e 02 consultas puerperais realizadas pelas enfermeiras. Na atenção ao parto foram observadas 22 avaliações obstétricas admissionais, 15 trabalhos de parto, 12 partos normais, 10 cesáreas, 18 recepções de recém-nascido e 18 assistências no alojamento conjunto. A estatística descritiva foi utilizada para descrever e sintetizar os dados. Resultados: Os profissionais são predominantemente do sexo feminino, média de 35,1 anos, casados (62,2%) e com filhos. A média de carga horária encontrada entre os profissionais de enfermagem que prestam assistência na atenção básica foi de 41,6 horas e de 53,9 horas na assistência ao parto, sendo que respectivamente 8,1% e 32% destes profissionais têm mais de um emprego. A média de salários dos auxiliares e técnicos de enfermagem que atendem a mulher no o pré-natal e no parto correspondem respectivamente a 43,2% e 37,3% da remuneração média das enfermeiras. Quanto à qualificação profissional, todas as enfermeiras entrevistadas na atenção básica do município referiram ter cursado ou estar cursando pós-graduação lato sensu, sendo 57,14% em saúde da família, 21,43% em enfermagem obstétrica, 7,14% em saúde da família e enfermagem obstétrica, 7,14% em saúde da família e saúde mental e 7,14% em administração hospitalar. Na maternidade, as seis enfermeiras eram especialistas em obstétrica. O tempo de experiência profissional no atendimento às mulheres no ciclo gravídico-puerperal entre os profissionais da atenção básica variou de 1 mês a 20 anos e na maternidade de 1 mês a 25 anos. Os resultados revelam que todos os profissionais são qualificados para a atenção ao ciclo gravídicopuerperal. Quanto às habilidades essenciais em obstetrícia, preconizadas pela ICM, muitas foram realizadas de forma incompletas e outras deixaram de ser realizadas. Conclusões: Na atenção básica as ações desenvolvidas pelo profissional de enfermagem no cuidado à mulher no pré-natal foram predominantemente de suporte, apoio e complementação da assistência médica, sendo discreta a participação da enfermeira na consulta de pré-natal. Na maternidade as enfermeiras atendem na admissão, acompanham o trabalho de parto e realizam a maior parte dos partos normais. Embora ainda existam habilidades específicas a serem realizadas, demonstraram ações moduladas por princípios da humanização, bem como da atenção qualificada. O estudo aponta a necessidade da reorganização da assistência ao pré-natal, inserindo efetivamente o enfermeiro, bem como que a assistência ao parto busque cada vez mais uma assistência qualificada e humanizada, com reconhecimento e autonomia do enfermeiro. / The qualified attention on childbirth has been one of the main focus on the Making Pregnancy Safer Initiative (MPR) in order to obtain safer pregnancies and childbirth to women and the newborns and consequently reduce the rates of maternal and newborns mortality. This study sought to know the assistance that women have in São Carlos/SP city during the puerperal pregnancy cycle spotlighting the nursing team. Objectives: Describe the profile of nursing professionals who work in puerperal pregnancy cycle and identify the actions developed for them in prenatal assistance, labour, childbirth and post-natal period correlating with the essentials competences to the obstetric basic exercising obstetrics recommended by the International Conferation of Midwives (ICM). Metodology: This study is a exploratory descriptive with a quantitative approach which used to collect data structured interview and systematic observation of the actions taken by nursing professionals in assisting puerperal pregnancy cycle. The studied population was composed of 84 nursing professionals being 37 of basic attention that provide assistance to prenatal and post-natal period and 47 of maternity that provide assistance to childbirth. Were observed in basic attention, 52 pre consults and 47 post consults, 05 SISPRENATAL opening, 05 receptiveness, 05 prenatal consults anda 05 puerperal consults undertaken by the nurses. On attention to childbirth were observed 22 admisions, 15 labours, 12 normal births, 10 cesarean, 18 newborn receipts and 18 assistances in accommodation set. It used the descriptive statistics describe and summarise data. Results: Professionals are predominantly female average 31,5 years, married (62,2%) and with children. The average of hourly charge between nursing professionals who provide assistance in basic attention was 41.6 hours and 53.9 hours on birth assistance being respectively 8,1% and 32% of these professionals have more than a job.The average salary of nursing assistants and technicians that assist women on prenatal and birth correspond respectively to 43.2% and 37,3% of the average remuneration of nurses. As vocational qualification, all nurses interviewed in city basic attention mentioned have attended or being attending a post graduation lato sensu being 57,14% in family health, 21,43% in obstetrical nursing, 7,14% in family health and obstetrical nursing, one 7,14% in family health and mental health and just one 7,14% in hospital administration. At maternity all the six nurses were obstetrical experts. Professional experience in assistance to women on puerperal pregnancy cycle between basic attention professionals ranged from 1 month to 20 years and at maternity from 1 month to 25 years.The results reveal that that all professionals are skilled attention to puerperal pregnancy cycle. As regards the essential skills in obstetrics, advocated by the ICM, many were so incomplete and other not performed. Conclusions: On basic attention the actions developed by nursing professionals on women prenatal care were predominantly of support and medical assistance complementation being discreet nurse\'s participation in prenatal consult. Maternity nurses serve in the admission, accompany labour and perform most normal births. Although there are specific skills to be performed, demonstrated actions modulated by principles of humanization as well as qualified attention. The study revels the need for reorganization of prenatal assistance inserting effectively the nurse as well as assistance to childbirth look increasingly a qualified and humanized assistance with recognition and autonomy of the nurse.

Com o objetivo de estudar o custo da produção segura, de salgados, em uma fábrica localizada no munícipio de Jundiaí, São Paulo, foi realizado um estudo de caso por observação de processos e registros, em planilhas de Excel, dos custos da produção do alimento seguro com a execução das Boas Práticas de Fabricação referente ao período de agosto de 2010 a julho de 2011 e posteriormente retirados os custos pertinentes as Boas Práticas de Fabricação para comparação entre ambas às situações. Também foram levantados os custos das obrigações legais e sua influência no resultado final do preço unitário. Para identificar os custos diretos de uma produção que assegura a qualidade do alimento, mantendo-o inócuo, foram utilizados os conceitos de custos variáveis. As contas foram agrupadas segundo seu destino de utilização. Foram estudadas também as mudanças de hábitos alimentares devido à mudança de comportamento, especialmente das mulheres que tem crescente participação nas atividades remuneradas, fora do lar. O perfil de consumo das famílias está mudando e com este o aumento de ocorrências de doenças causadas por contaminação alimentar, que segundo os autores estudados acontece com maior frequência do que se tem registrado de fato. Para entender melhor esta relação foi realizada uma pesquisa bibliográfica sobre a evolução do consumo, aumento da demanda de alimentos prontos para consumo, riscos de contaminação alimentar e doenças de origem alimentar, as normas técnicas, legislações e políticas públicas pertinentes à fabricação do alimento seguro que reúnem informações para melhorar a qualidade dos alimentos produzidos. Nos resultados encontrados os custos variáveis tiveram menor alteração em relação à simulação do não cumprimento das boas práticas de fabricação (BPF) e das obrigações legais, a maior influência foi sobre os custos fixos. A redução encontrada nos custos totais (soma dos custos variáveis com os fixos) para a situação onde os custos pertinentes ao cumprimento das BPF foram retirados foi de 5,8% e de 16,4% quando retirados os custos referentes às obrigações legais, que resulta na soma de 22,2% de diminuição dos custos, percentual este que favorece a produção caseira (informal), quando comparado com a produção formal. O resultado financeiro obtido quando cumpridas todas as exigências de BPF e obrigações legais foi negativo em 11,9% e na simulação da ausência destas práticas e exigências foi positivo em 17,5% (situação caseira e informal). Estes resultados estão relacionados com a utilização da capacidade produtiva instalada, que foi de 50%, equivalente a 43,9 t. e, portanto, existe ainda possibilidade de mudanças nos resultados ao atingir a capacidade ótima de produção. / With the aim of studying the cost of finger food safe production in a factory located in the municipality of Jundiaí, São Paulo, we conducted a case study by observation of processes and records, in Excel spreadsheets, of the cost of food safe production with the implementation of Good Manufacturing Practices for the period from August 2010 to July 2011 and subsequently withdrawn the costs involved with Good Manufacturing Practices for comparison between the two situations. We also raised the costs of legal obligations and its influence on the final result of the unit price. To identify the direct costs of production, which ensures the quality of food, keeping it harmless, we used the concepts of variable costs. The accounts were grouped according to their destination of use. We also studied the changes in eating habits due to behavior change, especially women who have increased participation in paid work outside home. The profile of household consumption is changing and consequently increased occurrences of diseases caused by contaminated food, which according to the authors studied happens more frequently than thought. To better understand this relationship we conducted a search on consumption trends, rising demand for ready to eat foods, risks of food contamination and foodborne diseases, technical standards, legislation and public policy pertinent to the manufacture of safe food to gather information to improve the quality of food produced. In the results the variable costs had less changes in relation to the simulation of non-compliance with good manufacturing practices (GMP) and legal obligations, the greatest influence was on the fixed costs. The reduction found in the total costs (sum of variable costs with fixed) where the costs pertaining to the enforcement of GMP were removed was 5.8% and 16.4% when taken out costs related to legal obligations, which sum results in a 22.2% decrease in costs, which favors home production (informal) when compared with the formal production. The financial result when met all the requirements of GMP and legal obligations was negative in 11.9% and in simulation and practical absence of these requirements was positive in 17.5% (homely and informal). These results are related to the utilization of the production capacity of 50%, equivalent to 43.9 tons, and therefore there is a possibility of changes in the results if optimum production is achieved.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-05-11T15:13:54Z No. of bitstreams: 1 Raquel Von Hohendorff_.pdf: 10228081 bytes, checksum: f4227256dee4ed80e5dd7d192e5b4481 (MD5) / Made available in DSpace on 2018-05-11T15:13:54Z (GMT). No. of bitstreams: 1 Raquel Von Hohendorff_.pdf: 10228081 bytes, checksum: f4227256dee4ed80e5dd7d192e5b4481 (MD5) Previous issue date: 2018-03-16 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta Tese tem como tema a gestão dos riscos nanotecnológicos com foco na autorregulação a partir do safe by design, em busca dos objetivos de sustentabilidade do milênio, no contexto da improbabilidade da comunicação inter-sistêmica entre o Direito e Ciência. Atualmente a ampliação do uso das nanotecnologias é uma das principais novidades que vem ocorrendo no setor de produção no mundo inteiro, fazendo parte da Quarta Revolução Industrial, trazendo conjuntamente uma série de preocupações em relação aos aspectos éticos, legais e sociais, bem como acerca dos riscos à saúde e ao meio ambiente. Cabe lembrar que as mesmas características que tornam os nanomateriais diferenciados e benéficos também geram dúvidas e inquietações acerca de seu comportamento especialmente quanto a sua interação com o ecossistema. Em decorrência desta nova realidade, provocada pela ascensão nanotecnológica e seus potenciais riscos, especialmente em relação à saúde humana e ao meio ambiente objetivou-se analisar as possibilidades da contribuição da ferramenta do safe by design, como uma forma de acoplamento entre o Sistema do Direito e o Sistema da Ciência, permeada pelo conceito de pesquisa e inovação responsáveis Responsible Research and Innovation (RRI), preocupada também com os aspectos éticos, sociais e jurídicos - Ethical, Legal and Social Aspects (ELSA), na estruturação autorregulatória regulada da gestão dos riscos nanotecnológicos, visando a sustentabilidade, em seus diferentes aspectos, aplicada à inovação, no contexto dos Objetivos de Desenvolvimento do milênio, projetados pela Organizações das Nações Unidas (ONU) até 2030. Para tanto, utilizou-se a perspectiva metodológica sistêmico-construtivista, a partir das contribuições de Niklas Luhmann, Gunther Teubner e Leonel Severo Rocha, que considera a realidade como uma construção de um observador, analisando todas as peculiaridades implicadas na observação, tratando-se de uma forma de reflexão jurídica sobre as próprias condições de produção de sentido, bem como as possibilidades de compreensão das múltiplas dinâmicas comunicativas diferenciadas em um ambiente complexo, como é o gerado pelas nanotecnologias. Desta forma, o safe by design pode ser entendido como um possível acoplamento estrutural entre os Sistemas da Ciência e do Direito, potencializando a comunicação inter-sistêmica sobre o risco, como uma forma prática e criativa de aplicação das ideias de RRI e ELSA e, mais ainda, como uma modalidade de autorregulação regulada, na gestão dos riscos nanotecnológicos, organizando e estabilizando as expectativas e induzindo comportamentos em busca da sustentabilidade na inovação, no horizonte projetado pelos Objetivos de Sustentabilidade do Milênio. Assim, demonstra-se a necessária imersão do Sistema do Direito na observação sobre risco nanotecnológico, contribuindo com mais um passo rumo à discussão das possibilidades e desafios que o uso das nanotecnologias já está gerando para as atuais e futuras gerações. / This Thesis deals with nanotechnological risk management with a focus on self-regulation based on safe by design, in pursuit of the millennium sustainability goals, in the context of the improbability of inter-systemic communication between Law and Science. Currently, the expansion of the use of nanotechnologies is one of the main innovations that occurring in the production sector worldwide, as part of the Fourth Industrial Revolution, bringing together a number of concerns regarding ethical, legal and social aspects, as well as the risks to health and environment. It should be remembered that the same characteristics, which make nanomaterials differentiated and beneficial, also generate doubts and concerns about their behavior especially regarding their interaction with the ecosystem. As a result of this new reality, provoked by the rise in nanotechnology and its potential risks, especially in relation to human health and environment, the objective was to analyze the possibilities of the contribution of the safe by design tool as a form of coupling between the Law System and the Science System, permeated by the concept of Responsible Research and Innovation (RRI), which is also concerned with - Ethical, Social and Legal Aspects (ELSA), in the self-regulatory structuring of nanotechnology risk management, aiming at the sustainability, in its different aspects, applied to innovation, in the context of the Millennium Development Goals, projected by the UN until 2030. For that, the systemic-constructivist methodological perspective was used, based on the contributions of Niklas Luhmann, Gunther Teubner and Leonel Severo Rocha, considering reality as a construction of an observer, analyzing all the peculiarities involved in the observation, treating it is a form of juridical reflection on the conditions of production of meaning as well as the possibilities of understanding the multiple differentiated communicative dynamics in a complex environment, such as that generated by nanotechnologies. In this way, safe by design can be understood as a possible structural coupling between the Systems of Science and Law, enhancing inter-systemic communication about risk as a practical and creative way of applying the ideas of RRI and ELSA, moreover, as a modality of regulated self-regulation, in the management of nanotechnology risks, organizing and stabilizing expectations and inducing behaviors in search of sustainability in innovation, within the horizon projected by the Millennium Sustainability Goals. Thus, it is demonstrated the necessary immersion of the Law System in the observation on nanotechnological risk, contributing with one more step towards the discussion of the possibilities and challenges that the use of nanotechnologies is already generating for the present and future generations.

Made available in DSpace on 2016-04-26T20:22:09Z (GMT). No. of bitstreams: 1 Nivaldo Aparecido Pedro Monteiro.pdf: 837970 bytes, checksum: b0d96d319627e60b89f4b03ca93a3248 (MD5) Previous issue date: 2013-10-16 / This research aims to demonstrate that the Criminal Code and the Consumer Protection (Law 8.078/90) are many times ignored by owners, employees and customers of gastronomic ventures. Since July 2010, all the shops and services in the country are required to keep available for consultation with clients the Code of Consumer Protection, in a conspicuous and easily accessible. The study will classify the probable frauds committed by eating establishments and identifying the penalties that should be imposed on the author in case of noncompliance with the law. Will be checked also the possible use of the Code of Criminal Procedure, Law No. 12.403, of May 4, 2011 amending the provisions of Decree-Law No. 3,689, of October 3, 1941, relating to procedural arrest, bail, temporary freedom and other precautionary measures beyond the application of adequate alternative measures that guide the ways to prevent and deter these crimes, increasing their effectiveness in protecting the consumer. It is also necessary to apply the Criminal Code against any illegal practices committed by entrepreneurs in this sector, that hurt consumer relations and thus identify the standards applicable to food establishments that may charge penalties when these entrepreneurs are not observed / Esta pesquisa tem como objetivo demonstrar que o Código Penal e o Código de Defesa do Consumidor (Lei 8.078/90) são por muitas vezes ignorados por proprietários, funcionários e clientes de empreendimentos gastronômicos. Desde julho de 2010, todos os estabelecimentos comerciais e de prestação de serviços do país estão obrigados a manter disponíveis para a consulta dos seus clientes o Código de Defesa do Consumidor, em local visível e de fácil acesso. O estudo irá classificar as prováveis fraudes cometidas por estabelecimentos de alimentação e identificar as penas que devem ser impostas ao autor no caso de descumprimento da lei. Será verificada também a possível utilização do Código de Processo Penal, da Lei nº 12.403, de 4 de maio de 2011 que altera dispositivos do Decreto-Lei nº 3.689, de 3 de outubro de 1941, relativos à prisão processual, fiança, liberdade provisória e demais medidas cautelares além da aplicação das medidas alternativas adequadas, que norteiam os caminhos para evitar e deter estes crimes, alcançando sua eficácia na proteção do consumidor. É necessário também aplicar o Código Penal contra eventuais práticas ilegais cometidas pelos empresários desse setor, que ferem as relações de consumo e assim identificar as normas aplicáveis aos estabelecimentos de alimentação que podem imputar sanções penais aos empreendedores quando tais não forem observadas

Bakgrund: Tidigare forskning visar på en stressig arbetsmiljö för sjuksköterskor med flera komplexa arbetsuppgifter. Behovet av att delegera arbetsuppgifter ökar i och med detta och kraven på att delegera patientsäkert beskrivs som centralt. Den tidigare forskningen ger ingen klar bild över vem som har vilket ansvar i delegeringsfrågan. Syfte: Syftet med examensarbetet var att undersöka sjuksköterskors ansvar vid delegering av hälso- och sjukvårdsinsatser i kommunal verksamhet. Metod: Studien följer en kvalitativ ansats med en innehållsanalys. Insamlingen av data skedde via inspelade semistrukturerade intervjuer. För examensarbetet blev sex sjuksköterskor intervjuade. Resultat: Tre kategorier utformades av resultatet: ansvar gentemot patienten vid delegering, ansvar under delegeringstillfället och ansvar efter utförd delegering. Gemensamt hade informanterna ett standardiserat – webbaserad – delegeringsrutin. Dock fanns det lite till ingen uppföljning på delegeringar. Slutsats: delegeringsprocessen är komplex med oklar ansvarsbild. Sjuksköterskan ansvarar för att patienten i slutänden får god och säker vård även om det är helg, kväll eller sjukdomsfall i personalgruppen. / Background: Previous studies show a stressful work environment for nurses with complex job assignments. The demand to delegate job assignments is increasing as an aftermath and the requirement to delegate job assignments with patient safety in mind is described as a central factor. The previous studies gave no clear image of who has the responsibility in delegations. Objectives: The aim of this study was to examine the registered nurses’ experiences of responsibility during delegations. Method: The study has a qualitative approach and is assembled in content analysis. Data has been collected through semi structured interviews. For the study six nurses have been interviewed. Result: The manifested results formed up in three categories: responsibility towards patients when delegating, responsibility during the delegation and responsibility after the delegation. The informants had in common that they were following a standardized web-based delegation routine. Though there was slight to no follow up on the delegations. Conclusion: The delegation process is complex with unclear responsibility. The nurse is responsible for ensuring that the patient receives good and safe care in the end, even if it is weekend, evening or illness in the staff group.

Bakgrund: Överrapportering av patienter inom slutenvården är ett vanligt förekommande moment för sjuksköterskor. Det finns strategier och faktorer som har betydelse för patientsäkerheten vid överrapportering av patienter mellan sjuksköterskor inom sluten hälso- och sjukvård. Genom att uppmärksamma strategier och faktorer som har betydelse för överrapportering av patienter inom slutenvården kan en säkrare patientvård bedrivas. Syfte: Att belysa strategier och faktorer som har betydelse för patientsäkerheten vid överrapportering av patient mellan sjuksköterskor inom sluten hälso- och sjukvård. Metod: Designen som använts var en litteraturöversikt. Litteraturöversikten grundade sig på 15 vetenskapliga artiklar som var av kvalitativ, kvantitativ eller mixad metod. Datainsamling har gjorts via PubMed och Cinahl. Resultat: Resultatet av inkluderade artiklar visade att strategier och faktorer hade betydelse för patientsäkerheten vid överrapportering. Strategier som var viktiga att belysa var "förberedelse inför rapport, frågor, bedside handover och rapporteringsmallar som Situation, Bakgrund, Aktuellt och Rekommendation (SBAR) och head to toe". Faktorer som beskrevs i resultatet var "rapportens innehåll, tidsbrist, teamsamarbete och attityder, miljö och teknik". Slutsats: Litteraturöversikten slutsats kom fram till att flera strategier hade en inverkan på överrapportering, dessa var "förberedelse inför rapport, frågor, bedside handover och rapporteringsmallar som SBAR och head to toe". Faktorer hade också en inverkan på överrapportering och dessa var "rapportens innehåll, tidsbrist, teamsamarbete och attityder, miljö och teknik." Dessa strategier och faktorer har positiv och negativ inverkan på sjuksköterskans arbete mot en säker vård och patientsäkerhet. / Background: Reporting of a patients within inpatient healthcare was a common occuring moment for nurses. By paying attention to strategies and factors of relevance for reporting of should it be possible with a more safe patient care. Aim: To illustrate strategies and factors of relevance patient safety when reporting of patients between nurses within inpatient healthcare. Method: The design used was literature review. The review was based on 15 scientific articles of qualitative, quantitative or mixed method. The data have been collected from PubMed and Cinhal. Result: The result showed that strategies and and factors was of importance for the patient safety when reporting of. Strategies important to focus on was "preparation before reporting of, questions, bedside handover and reporting forms as Situation, Background, Assessment and Recommendations (SBAR) and head to toe. Factors described in the result were " content of the report, lack of time, team cooperation and attitudes, environment and technique. Conclusion: The conclusion of the literature review was that a number of strategies have impact on reporting of. These strategies are "preparation before reporting of, questions, bedside handover and reporting forms as SBAR and head to toe". Even factors have an impact on reporting of. Theses are "reporting content, lack of time, team cooperation and attitudes, environment and technique. These strategies and factors have impact on the work nurses conduct to secure healthcare and patient safety.