Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 176-188). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 113-132). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Made available in DSpace on 2015-12-06T23:47:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2007 / Introdução: O fortalecimento da cidadania reforça os instrumentos de defesa dos direitos individuais. Os atuais modelos de atenção à saúde minimizam a comunicação entre médicos e pacientes. Cresce o número de queixas formalizadas contra atitudes médicas. É grande o impacto social dessas denúncias. Faltam estudos, no Brasil, que lhes dêem significado. Objetivo: Este trabalho pretende quantificar e qualificar as reclamações apresentadas ao Conselho Regional de Medicina do Estado de Goiás contra médicos ali inscritos. Método: Estudo descritivo, retrospectivo, sobre as denúncias formalizadas em Goiás, entre 2000 e 2006. Leitura interpretativa da evolução processual das queixas ajuizadas no CREMEGO e cálculo da eficácia das ações dali decorrentes. Resultado: Foi significativa a flutuação na freqüência de reclamações entre 2000 e 2006, no Estado de Goiás; 62% das queixas alegaram incompetência do profissional e inadequada relação médico/paciente. O número de queixas contra as especialidades de Cirurgia Plástica e Ortopedia representam 50% das queixas em relação a todos os especialistas. Houve 73 denúncias contra quatro profissionais da cirurgia plástica e um médico foi denunciado 49 vezes. Em 60% dos casos a denúncia foi feita por pessoa física. Discussão: Foram considerados improcedentes 17% das denúncias e 35% das restantes se transformaram em processos éticos (10% arquivados); O julgamento levou à advertência e censura em alguns casos e suspensão (5%) e cassação do exercício profissional (3%). Mais de 90% dos casos anuais foram resolvidos. Conclusão: O problema tem sido abordado com eficácia e eficiência, apesar de imperfeições na gestão do banco de dados, que impedem algumas análises qualitativas da questão. / Introduction: The strengthening of citizenship reinforces the instruments to defend the individual rights. The health care models currently used minimize the communication between doctors and patients. The number of formal complaints against attitudes of doctors has been increasing. The social impact of these accusations is great, but there is lack of studies in Brazil and in the state of Goiás to make them meaningful. Objective: This work was intended to quantify and qualify the complaints presented to the Regional Medical Council of the state of Goiás against medical acts. Methodology: Descriptive, retrospective study of the denouncement formally registered in the state of Goiás between 2000 and 2006; interpretative reading of the processual evolution of the complaints formalized in the Regional Medical Council of the state of Goiás and calculation of the efficacy of the actions resulting from this. Results: The variation in the complaint frequency between 2000 and 2006 was not high; 62% of the complaints concerned professional incompetence and inadequate doctor–patient relationship. The number of complaints regarding plastic surgery and orthopedics corresponded to 50% of the ones related to specialists. There were 73 charges against four plastic surgeons and one doctor was denounced 49 times. In 60% of the cases the accusations were made by individuals. Discussion: The Regional Medical Council considered 17% of the charges groundless and 35% of the remaining accusations turned into ethical processes (10% of which were filed). The Regional Medical Council session resulted in admonition and censure in some cases, suspension (5%), and cancelation of the register to practice medicine (3%). Over 90% of the annual cases were solved. Conclusion: This problem has been effectively and efficiently approached, in spite of imperfections in data base management, which prevents qualitative analyses of this matter. / BV UNIFESP: Teses e dissertações

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-06T14:03:58Z No. of bitstreams: 2 Dissertação - Polyana Cristina Vilela Braga - 2014.pdf: 1561423 bytes, checksum: 5cafde1e5e7d5c6d08decc3acf3cd07c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-06T14:38:51Z (GMT) No. of bitstreams: 2 Dissertação - Polyana Cristina Vilela Braga - 2014.pdf: 1561423 bytes, checksum: 5cafde1e5e7d5c6d08decc3acf3cd07c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-11-06T14:38:51Z (GMT). No. of bitstreams: 2 Dissertação - Polyana Cristina Vilela Braga - 2014.pdf: 1561423 bytes, checksum: 5cafde1e5e7d5c6d08decc3acf3cd07c (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-08-05 / The use of vaccines is among the greatest advances observed in health care around the world, enabling eradication and/or control vaccine-preventable diseases. However, with increasing number and variety of vaccine doses applied also increases the incidence of post-vaccination adverse events. OBJECTIVE: To analyze and describe the post-vaccination adverse events in children under five years of age. METHODS: This is a retrospective study with a descriptive analysis of secondary data. The data source was the universe of all 353 records of reporting post-vaccine adverse events and monitoring reports of children inadvertently vaccinated with the human rotavirus vaccine reported to the Immunization Division of the County Health of Goiânia for the period vaccination of July 1, 2012 to June 30, 2013. Statistical analysis was performed using SPSS, version 19.0 for Windows. The study was approved by the Ethics in Research Committee and regulatory standards of Resolution 466/2012 have been obeyed. RESULTS: The study identified 373 post-vaccination adverse events, with 313 (83.9%) adverse events temporally related to vaccination (AETV) and 60 (16.1%) programmatic errors. Both AETV as programmatic errors were more common in male infants (56.23% and 58.34% respectively) and in children under one year of age (78.60% and 86.67% respectively). It is noteworthy that 44.10% of total AETV presented by the children were due to the administration of only one vaccine, especially Pentavalent vaccine (20.76%) and Influenza (10.54%). However, it was found that 55.9% of AETV occurred when there was more than one vaccine in the same vaccine opportunity, with 31.95% with four vaccines, 12.80% with two and 10.50% with three. Inactivated Polio vaccine (IPV) and Pentavalent showed the highest percentages of AETV. The most common systemic reactions were fever (32.93%), persistent crying (18.62%) and altered level of consciousness/hypotonia/lethargy (11.92%). As for programming errors, the largest incidence were related to the implementation of the Yellow Fever vaccine (9.12/10,000 applied doses) and Oral Polio vaccine (OPV) (3.72/10,000 doses applied). As for the types of errors were identified the use of wrong immunobiological (26.70%) and administration of the vaccine outside the recommended age (18.30%). CONCLUSION: The post-vaccination adverse events identified were the type AETV and programmatic errors and hit mostly children under one year of age. The AETV were related to IPV and Pentavalent vaccines and programmatic errors with the application of the Yellow Fever vaccine and OPV. The analysis of reported post-vaccination adverse events can direct managers for planning and execution of measures for improvement in the structure and work processes, enabling notifications of events identified with complete information, and promoting a safer immunization for children. / A utilização de vacinas está entre os maiores avanços observados na área da saúde em todo o mundo, possibilitando erradicar e/ou controlar doenças imunopreveníveis. Entretanto, à medida que aumentam o número e variedade de doses de vacinas aplicadas, também aumenta a incidência de eventos adversos pós-vacinação. OBJETIVO: Analisar e descrever os eventos adversos pós-vacinais ocorridos com crianças menores de cinco anos de idade. METODOLOGIA: Trata-se de um estudo retrospectivo com a análise descritiva de dados secundários. A fonte de dados foi o universo de todas as 353 fichas de notificação de eventos adversos pós-vacinais e fichas de acompanhamento de crianças vacinadas inadvertidamente com a vacina de Rotavírus humano encaminhadas à Divisão de Imunização da Secretaria Municipal de Saúde de Goiânia, referente ao período de vacinação de 1º de julho de 2012 a 30 de junho de 2013. A análise estatística foi realizada no programa SPSS, versão 19.0 for Windows. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa e foram obedecidas as normas regulamentadoras da Resolução 466/2012. RESULTADOS: O estudo identificou 373 eventos adversos pós-vacinais, sendo 313 (83,90%) eventos adversos temporalmente relacionados à vacina (EATV) e 60 (16,10%) erros programáticos. Tanto os EATV quanto os erros programáticos foram mais frequentes nas crianças de sexo masculino (56,23% e 58,34% respectivamente) e em menores de um ano de idade (78,60% e 86,67% respectivamente). Destaca-se que 44,10% do total dos EATV apresentados pelas crianças foram em decorrência da administração de apenas uma vacina, principalmente, da vacina Pentavalente (20,76%) e da Influenza (10,54%). Entretanto, verificou-se que 55,90% dos EATV ocorreram quando houve administração simultânea de mais de uma vacina na mesma oportunidade vacinal, sendo 31,95% com quatro vacinas, 12,80% com duas e 10,50% com três. As vacinas inativadas contra Poliomielite (VIP) e Pentavalente apresentaram as maiores incidências de EATV. As reações sistêmicas mais frequentes foram febre (32,93%), choro persistente (18,62%) e alteração do nível de consciência/hipotonia/letargia (11,92%). Quanto aos erros programáticos, as maiores incidências estiveram relacionadas com a aplicação da vacina Febre Amarela (9,12/10.000 doses aplicadas) e vacina oral contra Poliomielite (VOP) (3,72/10.000 doses aplicadas). Quanto aos tipos de erros foram identificados a utilização de imunobiológico errado (26,70%) e administração da vacina fora da idade recomendada (18,30%). CONCLUSÃO: Os eventos adversos pós-vacinais identificados foram do tipo EATV e erros programáticos e atingiram, principalmente, crianças menores de um ano de idade. Os EATV estavam relacionados às vacinas VIP e Pentavalente e os erros programáticos com a aplicação da vacina Febre Amarela e VOP. A análise dos eventos adversos pós-vacinais notificados pode direcionar os gestores para o planejamento e efetivação de medidas de melhoria na estrutura e nos processos de trabalho, possibilitando notificações das ocorrências identificadas com informações completas, e promovendo uma imunização mais segura para as crianças.

Medical errors have been detrimental in the field of medicine. They have impacted both patients and doctors. While physicians recognized that error disclosure was an ethical and professional obligation, most remained silent when mistakes happened for different reasons. Guided by the theory of planned behavior and Kant's deontological theory, the purpose of this quantitative study was to investigate the perceived barriers affecting physicians' willingness to report major medical errors. An association was tested between the independent variables physician fear of disclosure of errors, organizational culture toward patient safety, physician apology, professional ethics and transparency, physician education, and the dependent variable physician willingness to disclose major medical errors. Using a cross-sectional method, 122 doctors out of 483 surveyed, completed the online and paper-based survey. Multiple linear regression and descriptive statistics models were used to analyze and summarize the data. The results showed there was a statistically significant relationship between the independent variables organizational culture toward patient safety, physician apology, professional ethics and transparency, and physician education and the dependent variable physician willingness to disclose major medical errors. There was no relationship between the independent variable fear of disclosure of errors and the dependent variable. The findings added to the knowledge base regarding barriers to physicians' medical errors disclosure. The results and recommendations could provide positive social change by helping hospitals raising doctors' awareness regarding major medical errors disclosure.

Research has shown that 400,000 people die every year due to preventable medical errors. Medical error reporting and safety is a responsibility of all members of a health care organization. Creating an environment that addresses and prevents potential or actual safety problems can help reduce the incidence of medical errors made by nurses in the workplace. The purpose of this quantitative research study was to determine if nurses' perceptions of safety problems and error-preventing procedures and systems affected their comfort in reporting safety problems and intent to leave. High-reliability theory was the theoretical foundation for this study. Data were obtained from 1,171 surveys completed by newly licensed registered nurses located in 51 different metropolitan statistical areas and 9 counties. SPSS Version 25 was used to conduct a secondary data analysis including descriptive statistics, bivariate analysis, and multiple logistic regression for each variable. Themes that emerged from the data analysis included the importance of education on safety protocols and improving nurse satisfaction and nurse retention. The findings of the study might contribute to social change by creating an increased awareness for nurse leaders, managers, and newly licensed registered nurses in ensuring that there is improved comfort of reporting and appropriate error-preventing procedures and system in the health care environment. Increased awareness will allow for action and improved protocols to enhance the overall safety and quality of care for nurses and their patients.

No description available.

Submitted in fulfillment of the requirements of the degree of Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The study evaluated the culture of patient safety and the factors that contribute and influence patient safety as a critical element, to healthcare in a public hospital in Kwa-Zulu Natal, through a predesigned questionnaire with the objectives of establishing the current status of the culture of patient safety in the said hospital, evaluating responses from nurses and doctors and other healthcare professionals, exploring the effectiveness of communication and teamwork within units and hospital. Methods The study evaluated the culture of patient safety and the factors that contribute and influence patient safety as a critical element, to healthcare in a public hospital in Kwa-Zulu Natal, through a predesigned questionnaire with the objectives of establishing the current status of the culture of patient safety in the said hospital, evaluating responses from nurses and doctors and other healthcare professionals, exploring the effectiveness of communication and teamwork within units and hospital. Results The resultant data from the predesigned questionnaire was divided into components of teamwork within and between units, hospital and supervisor management support for patient safety, communication openness and feedback regarding errors, non-punitive response to errors, hospital handover of information staffing and overall patient safety grade. The study was compared to the studies in the US and three other countries across the European continent, Netherland, Taiwan, and US [Wagner et al. 2013]. The findings as possible strengths of the study were teamwork within units, learning in the organization, feedback and communication, and manager and supervisor support for patient safety. The areas that needed attention were teamwork across units, communication openness, staffing, non-punitive response to errors and overall patient safety grade, handover of information between units. Conclusions The findings, reflective of a developing country, compared to the findings from similar studies in developed countries such as the USA and countries in transition such as Netherlands and Taiwan. In reference to the precincts that face a developing country such as South Africa, certain highlights emerged from the comparison, as areas of strength, areas requiring attention, and a preliminary insight into current practices within the South African context which can be viewed as an opportunity to sustain current good practices and inform future research. / M

This thesis deals with the role of nurses in the administration of drugs in the intensive care unit. The goal is to find consistency between the legal and factual state of drug administration, ie analyze, what are the non-medical healthcare professionals authorized in accordance with applicable legislation and internal regulations of the medical device to do and what they are actually able to perform safely. The theoretical part defines the terms related to the administration of medicines. I deal with the skills of paramedical staff, indications of medicines, their administration, pharmacotherapy, mistakes and evaluation of the quality and safety of health services. The theoretical part deals with the current status of this issue and also provides insight into the history of drug administration. In the empirical part of the thesis I work with the results that I received questionnaires. Respondents are nurses, paramedics, nurses of leading nursing management and physicians. Individual items are analyzed and used to answer defined research questions. The research implies that the nurse of nursing management are able to organize an intensive care unit activities and maintain procedures, to ensure quality and safe administration of medicines. General nurses and paramedics are able to meet the doctor's...

A prática da medicina vem mudando rapidamente. Nos últimos 20 anos os profissionais de saúde tem se preocupado cada vez mais com os erros que ocorrem durante o processo de cuidado dos pacientes enquanto trabalham duramente para preveni-los e mitigá-los. Tão importante quanto o erro em si é a maneira como o evento adverso é discutido e a maneira como os profissionais envolvidos no erro são abordados. O objetivo da pesquisa foi aplicar um questionário sobre erro e abordagem do erro. O instrumento foi originalmente publicado em língua inglesa e validado em português pelo método de Brislin. Responderam ao questionário 161 profissionais de saúde (enfermeiros, técnicos de enfermagem, médicos e fisioterapeutas) provenientes de 19 diferentes unidades de terapia intensiva adulto públicas e privadas da cidade de São Paulo (Estado de São Paulo - Brasil).Os resultados revelaram que profissionais do sexo masculino são mais propensos a reconhecer que cometem erros em relação a profissionais do sexo feminino com uma razão de chances de 0,21 (0,07-0,65); que profissionais oriundos de unidades públicas reportam com mais frequência que ameaça de processos {RC 0,23 (0,11 - 0,48)}, ameaça à estabilidade no emprego {RC 0,49 (0,24 - 0,99)} e personalidade de outros membros da equipe {RC 0,22 (0,09 - 0,51)} são motivos para que os erros não sejam discutidos tampouco abordados adequadamente. Estas informações levantam possíveis oportunidades para aprofundar a discussão e o tratamento de eventos adversos em unidades de terapia intensiva / The practice of medicine is changing quickly. In the last 20 years, health professionals have increasingly worried about errors that occur during the process of patient care while working hard for its prevention and mitigation.As important as the error itself is the way each adverse event is discussed as well as each professional involved in an error is approached .The goal of the research was applying a survey about error and its approach. The tool was originally published in english and afterwards validated in portuguese by the Brislin method. The survey was answered by 161 health professionals (nurses, nurse technicians, intensive care physicians and physiotherapists) coming from 19 different adult intensive care units both public and private in the city of São Paulo (São Paulo - Brazil). The results revealed that male professionals are more likely to recognize having made an error than female professionals with a odds ratio of 0.21 (0.07-0.65). It also showed that professionals coming from public units report more often that the threat of litigation {RC 0.23 (0.11 - 0.48)}, threat of unemployment {RC 0,49 (0,24 - 0,99) } and other team members personality {RC 0.22} (0.09 - 0.51) are reasons for problems not being discussed or addressed. The informations collected on this survey raise opportunities to improve the study and treatment of adverse events in intensive care units