Este estudo tem como objeto o cuidado de Enfermagem e suas memórias e representações sociais para enfermeiros hospitalares inseridos nas unidades de referências para pessoas que viviam com o HIV/aids no Rio de Janeiro, no decorrer de 1980 a 1991. Os objetivos específicos foram: identificar a memória social do cuidado de enfermagem implementado pelos enfermeiros aos acometidos pelo HIV/aids no Município do Rio de Janeiro; descrever as práticas de cuidado pelos enfermeiros no contexto do recorte temporal adotado no estudo; descrever o processo de enfrentamento da epidemia da aids pelos enfermeiros, tanto no contexto do cuidado de enfermagem no espaço hospitalar, quanto nas relações sociais estabelecidas; analisar as memórias e representações sociais de enfermeiros acerca do cuidado de Enfermagem prestado às pessoas com HIV/aids em situação de hospitalização na primeira década da epidemia. Trata-se de uma pesquisa descritiva, de campo, com abordagem qualitativa, baseada nos pressupostos teóricos da memória social propostos por Sá em sua interface com a teoria de representações sociais no campo da Psicologia Social. Realizada com 30 enfermeiros que atuaram em hospitais considerados de referência para o tratamento de clientes que viviam com HIV/aids. Os dados foram coletados por uma entrevista semiestruturada e a visualização de 12 fac-símiles escolhidos de forma aleatória na imprensa. A população de estudo é predominantemente do sexo feminino e com idade entre 51 a 60 anos. Os principais resultados apontam que a memória social do cuidado de enfermagem se constitui a partir de diferentes objetos representacionais (cuidado de enfermagem, aids e biossegurança), instâncias da memória social (pessoal, pública, prática, coletiva, comuns, histórica oral e histórica documental) e diversos elementos que constituem esta memória (ambiente de cuidado e relações sociais, familiares e laborais, dentre outras). Emergiram sete categorias de análise: O processo do cuidado de Enfermagem: do enfrentamento, da capacitação e do desenvolvimento; Sentimentos dos enfermeiros e dos clientes descritos pelos participantes no processo de cuidar; O processo de cuidado direto ao cliente no início da epidemia; Memórias da autoproteção profissional e da proteção ao cliente no contexto do HIV/aids; Os contextos do cuidado: ambiente, materiais e recursos humanos; Memórias dos enfermeiros sobre os clientes acometidos pelo HIV e Relacionamento interpessoal. Destaca-se que a memória do cuidado de enfermagem se mostra ligada à construção representacional da aids (não familiar/familiar), do cuidado de enfermagem (sem controle/sob controle) e à constituição de um grupo social com forte identidade, o dos enfermeiros da aids. Concluímos que o estudo mostrou o trabalho pioneiro dos enfermeiros com o HIV/aids no ambiente hospitalar. Esses profissionais tiveram que cuidar desses clientes em meio à possibilidade de contaminação, ao mesmo tempo em que desenvolviam um autocuidado, em alguns momentos exagerados devido ao desconhecimento sobre a síndrome, como forma de preservação da sua saúde, bem como de sua família. A memória social como conceito guarda-chuva mostrou-se pertinente para a análise dos dados, permitindo recuperar, ao menos em parte, a dinâmica do cuidado de enfermagem nos primeiros anos da síndrome. / The present study is concerned with the provision of care as well as with memories and social representations from nurses who worked in reference hospitals where HIV/aids patients were admitted to, in the city of Rio de Janeiro, from 1980 to 1991. It specifically aims to: Identify social memories related to nursing practices implemented by nurses and directed to HIV/aids patients in Rio de Janeiro; Describe nursing practices in the timespan aforementioned; Describe how nurses faced up to the epidemic in the professional context of the hospital where patients were being treated as well as regarding the social relationships that were established and, Analyse memories and social representations of care practitioners related to the nursing care provided to hospitalized HIV/aids patients in the decade following the onset of the epidemic. This descriptive field study has a qualitative approach based on the theoretical presuppositions of memory proposed by Sá in its interface with the theory of social representations from the field of Social Psychology. It has been conducted with the collaboration of 30 nurses who worked in facilities considered to be reference hospitals where HIV-infected patients were treated at the time. Data were collected by means of a semi-structured interview and from the subjects watching of 12 fac-símiles randomly chosen from the mass media. Subjects were predominantly females from 51 to 60 years of age. The main findings suggest that the social memory of nursing care is constructed from different representational objects (nursing care, aids and biosafety), instances of social memory (personal, public, practice, collective, common, verbal historical and documentational historical) as well as from several elements encompassed in that memory (care environment, family and work relationships, among others). Seven categories of analysis emerged: The process of nursing care: facing up to, capacitation and development; nurses and patients feelings described by care providers; the care provided directly to the patients in the beginning of the epidemic; memories of professional self-protection and protection to the patients; the contexts of the provision of care: environment, materials and human resources; Memories related to HIV patients, and interpersonal relationships. We highlight that the memories associated with the provision of care by nurses seem to be linked to the representational construction of aids (not-familiar/familiar), of the nursing care in itself (not in control/in control) and to the formation of a social group with a strong identity: the aids nurses group. We conclude that the study shows the pioneering aspect of the work performed by nurses who were in charge of HIV/aids patients in a hospital environment. These professionals provided care to HIV-infected patients while accounting for the possibility of contamination and developing auto-care practices (albeit sometimes exaggerated due to the lack of knowledge about the syndrome) as a means to protect their own health and the health of their families. Social memory as the umbrella concept of this study proves itself to be adequate to the data analysis, allowing to retrieve, at least partially, the dynamics of the nursing care in the first years of the syndrome.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Na década de 80 dramáticas ocorrências atingiram o país e o mundo na área da saúde com a descoberta da Síndrome da Imunodeficiência Adquirida (Aids) síndrome, causada pelo Vírus da Imunodeficiência Humana (HIV). O objetivo deste estudo foi descrever as representações sociais do HIV/Aids e as memórias sociais do cuidado de enfermagem construídas na década de 80 pela equipe de enfermagem. Optou-se por uma abordagem qualitativa, embasada na teoria de representações sociais e nos conceitos do campo da memória social. Os sujeitos do estudo foram 20 profissionais de enfermagem de serviços ambulatoriais e/ou da atenção básica, atuantes em 11 instituições públicas de saúde da cidade do Rio de Janeiro que possuem o Programa Nacional de DST/Aids. A coleta de dados foi realizada através de entrevista semiestruturada e questionário de caracterização sócio profissional. A análise dos dados deu-se em duas etapas, a primeira atraves da técnica de análise de conteúdo temática destinada a identificar nos depoimentos dos entrevistados os conteúdos discursivos relativos a década de 80. Posteriormente os trechos selecionados foram submetidos à análise lexical pelo software Alceste 4.10. Obteve-se três classes temáticas que abordaram: As percepções e as ações do cuidado de enfermagem na década de 80; Os primeiros contatos profissionais e pessoais com HIV/Aids e A mídia e a construção das representações sociais do HIV/Aids. Na primeira classe os profissionais de enfermagem relatam as memórias referentes aos cuidados prestados na década de 80, descrevendo como esse cuidado era prestado, o medo da contaminação e os profissionais que atuavam na prestação de serviços. Na classe 2 os sujeitos resgatam as primeiras vivências com as pessoas com HIV/Aids e os sentimentos experimentados neste primeiro contato. As características físicas, os aspectos emocionais, a introdução do AZT e o abandono familiar são elementos destacados. Na classe 3 são relatas as memórias referentes ao início da epidemia de HIV/Aids, com destaque para as ancoragens representacionais do surgimento do vírus, tendo especialmente o macaco como hospedeiro. Os meios de comunicação surgiram como formadores das memórias do início da epidemia, veiculando imagens, como a do cantor Cazuza, fortemente citado pelos sujeitos. Conclui-se que este estudo permitiu compreender, através das memórias e das representações, como se constituiu a atuação dos profissionais no início da epidemia, assim como a permanência de elementos simbólicos até hoje nas representações sociais do HIV/Aids. / In the 80s dramatic events reached Brazil and the whole world in health area with the discovery of the Acquired Immune Deficiency Syndrome (Aids), caused by Human Immunodeficiency Virus (HIV). The aim of this study is to describe social representations of HIV/Aids and the social memories of nursing care constructed in the 80s by nursing staff. A qualitative approach was chosen based on theory of social representations and the concepts in the field of Social Memory. The subjects of this study were 20 nursing professionals of outpatient clinic and/or of basic attention, who acted in 11 public health institutions at Rio de Janeiro where the National Program of STD/Aids exists. The data collection was achieved by an interview structured in questions about social and professional profile. The data analysiswas performed in two stages first, by an analysis of contents to identify, at the speeches of the professionals asked, the discursive contents in the 80s; after, the pages selected were submitted to an analysis by the software Alceste 4.10. Were acquired three thematic classes which approached: the perceptions and actions of nursing care in the 80s; the first professional and personal contacts with HIV/Aids; the media and the construction of social representations of HIV/Aids. In the first class, the nursing professionals relate memories which refer to the care developed in the 80s, describing how this care were rendered, the fear of contamination and the professionals who acted rendering the tasks. In the second class, the subjects rescue first experiences with the people who have the HIV/Aids and the feelings experienced at this first contact. The material characteristics, emotional aspects, the introduction of AZT and the abandon by family are contrasted elements. In the third class, the memories are related in the beginning of HIV/Aids epidemic and detach representational anchorages by appearance of the virus having, specially, the monkey as a harbored. The Medias appeared as creator of memories in the beginning of epidemic conveying pictures, as some of the singer Cazuza, strongly referred by the subjects. Concluding that this study enables to comprehend, by the memories, how were constituted the acting of professionals at the beginning of epidemic, so as how the permanence of symbolic elements since then until today in social representations of Aids.

Esta pesquisa provém da dissertação de mestrado do Programa de Pós-Graduação em Enfermagem da Universidade do Estado do Rio de Janeiro (ENF/UERJ) e apresenta como objeto de estudo as práticas dos enfermeiros na Estratégia de Saúde da Família (ESF) sob a ótica do Agente Comunitário de Saúde (ACS). Este estudo está vinculado às pesquisas Práticas de cuidado no SUS: o papel do enfermeiro na Atenção Básica e Abordagem interdisciplinar das novas relações e processos de trabalho em saúde: o caso dos agentes comunitários de saúde. O interesse em estudar tais práticas decorreu da vivência como enfermeira de família, atuando com a assistência aos usuários e como chefe de equipe, surgindo reflexões e inquietações em torno das práticas de saúde realizadas pelo enfermeiro e como estas são vistas pelo agente de saúde. Sendo assim, surge o questionamento: Qual a visão dos agentes comunitários de saúde em relação às praticas de saúde desenvolvidas por enfermeiros na Estratégia de Saúde da Família? A fim de responder esta questão, definiu-se como objetivo geral: analisar as práticas dos enfermeiros da Estratégia Saúde-Família do município do Rio de Janeiro, sob a ótica dos Agentes Comunitários de Saúde e objetivos específicos: identificar as práticas de saúde desenvolvidas por enfermeiros na perspectiva do Agente Comunitário de saúde e conhecer os fatores determinantes destas práticas e sua correlação com o trabalho na Estratégia de Saúde da Família. Trata-se de um estudo descritivo com abordagem qualitativa, tendo sido realizado no município do Rio de Janeiro, de 2008 a 2010. A fonte dados foi um conjunto de narrativas de ACS do estudo Abordagem Interdisciplinar dos Novos Processos e Condições de Trabalho em Saúde: o Caso dos Agentes Comunitários de Saúde do Rio de Janeiro. A seleção dos sujeitos foi realizada a partir de uma varredura do banco de narrativas, selecionando aquelas nas quais os ACS discorrem sobre as práticas dos enfermeiros. De um total de 60 ACS, foram selecionados 7 agentes. As narrativas analisadas formaram tres categorias: cuidados do enfermeiro na ESF; práticas do enfermeiro na ESF; fatores que influenciam a prática do enfermeiro na ESF. Com a análise foi possível identificar que o ACS enxerga o enfermeiro como cuidador, através do acolhimento, resolução de problemas e consultas de enfermagem. A prática do enfermeiro é vista pelo agente de saúde através da supervisão, como educador em saúde e através das visitas domiciliares. Entretanto, tais práticas são determinadas por fatores que as facilitam ou a dificultam. As facilidades de atuação do enfermeiro estão em gostar da profissão, a criação do vínculo entre o profissional e o usuário e a presença de uma equipe completa na ESF. Já as dificuldades são encontradas quando o enfermeiro não tem a equipe completa, falta de infraestrutura e recursos materiais no serviço. Ao olhar as práticas de saúde dos enfermeiros na ESF foi possível identificar como elas são desenvolvidas na visão de outros membros da equipe, neste caso os ACS, contribuindo na compreensão de como obter uma melhoria do cuidado à família, de forma qualitativa e humanizada. / This research comes from the dissertation of the Graduate Program in Nursing at the State University of Rio de Janeiro (ENF / UERJ) and has as its object of study the practices of nurses in the Family Health Strategy (FHS) from the viewpoint the Community Health Agent (CHA). This study is linked to the research "Care Practices in SUS: the role of nurses in Primary Care" and "Interdisciplinary approach new relationships and work processes in health: the case of community health workers." The interest in studying these practices resulted from the experience as a family nurse practitioner, acting with the assistance of users and as chief of staff, emerging thoughts and concerns about health practices performed by nurses and how they are seen by a health worker. Thus, the question arises: What is the vision of community health workers in relation to health practices developed by nurses in the Family Health Strategy? To answer this question, we defined general objective is to analyze the practices of nurses-Family Health Strategy of the municipality of Rio de Janeiro, from the perspective of Community Health Workers and specific objectives: to identify health practices developed by nurses from the perspective of Community Health Agent and know the determinants of these practices and their correlation with work in the Family Health Strategy. This is a descriptive study with a qualitative approach and was conducted in the municipality of Rio de Janeiro, 2008-2010. The data source was a series of narratives of the ACS study "Interdisciplinary Approach of New Processes and Working Conditions in Health: The Case of Community Health Workers of Rio de Janeiro." The selection of subjects was made from a scan of bank accounts, selecting those in which ACS discuss about the practices of nurses. From a total of 60 ACS were selected 7 agents. The narratives analyzed formed three categories: nursing care in the FHS; practices of nurses in the FHS; factors that influence the practice of nursing in the FHS. With the analysis, we found that the ACS sees the nurse as caregiver, through acceptance, problem solving and nursing consultations. The practice of nursing is seen by a health worker through supervision, as health educators and through home visits. However, such practices are determined by factors that facilitate or hinder. The facilities of the nurse are like the profession, creating the link between the professional and the user and the presence of a full team at FHS. Yet the difficulties are encountered when the nurse has a full staff, lack of infrastructure and material resources in the service. When looking at health practices of nurses in the FHS was possible to identify how they are developed in view of other team members, in this case the ACS, contributing to the understanding of how to achieve a better family care, both qualitatively and humanized.

The diploma thesis deals with neonatal abstinence syndrome which occur to newborns whose mothers were on addictive illegal drugs in the time of pregnancy. The most frequently taken drugs are canabinoids, stimulancias, opiods and opiates, halucinogens, and drugs taken during substitutional therapy. Neonatal abstinence syndrome is a multisystem disorder that frequently affects central nervous system, gastrointestinal system, respiratory system and autonomic system. To diagnose neonatal abstinence system is the most important careful monitoring of baby in the first days of its life. There are different scoring systems which have been developed for assessing the severity of neonatal abstinence syndrome, we use the Finnegan scoring system. Treatment of neonatal abstinence syndrome is mainly supportive and pharmacological therapy. There are also social serious consequences of this problems; mothers are usually not able to take care of babies and children live in children's homes. The aims of this study were to find out special needs of newborns born to mothers using addictive illegal drugs during pregnancy, to find care interventions which help newborns with neonatal abstinence syndrome in their first days of life and to discover interventions helping mothers stop using addictive illegal drugs. The theoretical part of this study is based on research of already presented scientific studies. The practical part of the study problems of neonates of mothers using addictive illegal drugs in first days after delivery. We have used Virginia Henderson's need theory to evaluate neonate's need. We have chosen only the most important elementary components out of 14 components in Virginia Henderson's need theory. I was also trying to find out if nurses know how to help neonates with neonatal abstinence syndrome and what nursing interventions have positive influence to neonates. Another goal was to know how nurses communicate with mothers and if they have positive influence on mothers. The method of communication with mother using addictive illegal drugs was semistructured interview. I wanted to know what kind of addictive drugs mothers were using during pregnancy and if mothers tried to solve their problem in pregnancy, before delivery. Results are sorted into categories and subcategories and showed in diagrams and tables. Neonates of mothers using addictive illegal drugs during pregnancy have problems in all investigated needs such as breathe, eat and drink adequately, sleep and rest, thermoneutral zone and social need. I also found out that some nursing intervences have positive influence on neonates with neonatal abstinence syndrome. Very important intervenes were individual contact with each neonate and quick reaction to every change in behavior. It is also necessary to respect their sleep and rest time, take nursing and medical care together in blocks, use non-pharmacological treatment of pain, feed them individually according to their needs and also try different techniques of feeding, put babies into the right position and eventually nestle, rock or touch them. In last part of the study we discuss mothers who use addictive illegal drugs. We found out that nurses did not speak with them very actively, did not offer them to breast-feed in special conditions, did not tell them about possibility to be with neonate together in the hospital until a discharge. On the other hand, mothers were not interested in the breast-feeding or staying with babies. The goal of the study was to create brochure with information of negative consequences of taking addictive drugs on babies. This brochure is convenient for education of mother and students as well.

Abstract The aim of the thesis: To determine most common causes of pertussis in childhood is the aim of this submitted research thesis. It also describes the possibilities of child prevention from the point of view of nurses. The other aims are description the specifics of nursing care for children with pertussis. Five research questions have been defined in relations to these objectives. The way of achieving the aim: The qualitative research method was chosen to achieve the objectives of the thesis. This method was implemented through in-depth interviews. On the basis of identified research questions, individual categories have been formulated in order to get answers to individual questions. For selection of communication partners the method of intentional selection was chosen. Research was realized at Jihlava Hospital in Children's Department. Anonymous interviewing was attended by a total of 20 communication partners. All of them have a nursing education and have performed nursing care for a child with a pertussis disease. In-depth interviews with parents were carried out in General Practitioner for children and adoration. Anonymous survey were agreed by 7 parents whose children suffered from pertussis. Scientific benefits of the thesis: This research study deals with the current issue of pertussis as an omitted infection. The scientific results of the research are intended for both the lay and professional public. The research study presents a complex and comprehensive overview of nursing care for children with pertussis. It will find use in both preventive care and also in taking care of the patient directly on the bed. Part of the scientific thesis is application into practice. The lessons learned and conclusions: Diseases of pertussis are most at risk for newborns and infants, for whom their parents pose a significant threat of infection without the parents becoming aware of it. One of the main measures is to vaccinate not only children but also parents and close relatives who come to close contact with the newborn. Parents are often unaware of adult vaccination in the prevention of childhood illness. Nursing care for a child with pertussis disease has its specificities in that it is highly contagious illness and can endanger the life of the child.

Arterial hypertension is a lifestyle disease that is one of the most common cardiovascular diseases. It is also the most frequent cause of mortality and morbidity in the Czech Republic. Hypertension is often asymptomatic, so that is why it is crucial to communicate the risk factors of high blood pressure to the general public. The diploma thesis is divided into a theoretical and an empirical part. The theoretical part defines blood pressure and hypertension and describes the risk factors, examination methods, treatment and complications of high blood pressure. Next, it also focuses on the role of nurses in preventing hypertension, education of patients with hypertension and incidence of hypertension among various age groups. BothCzech and foreign scholarly sources from the field of nursing, medicine, psychology and sociology were used. Three objectives were chosen based on the obtained information. The first objective was to determine whether people in specific age groups are aware of risk factors affecting hypertension. The second objective was to identify whether people in specific age groups are educated on hypertension prevention. The last objective attempted to find out whether adults in specific age groups follow preventive measures. Five research questions were identified following these objectives. The information relating to this issue was obtained through a qualitative research survey. A semi-structured interview was chosen as a data collection method. The research group consisted of 12 general nurses, 16 people without hypertension and 16 patients with hypertension. With the consent of the respondents, the interviews were recorded on recording equipment. If the respondents did not agree with recording, the interviews were noted in record sheets. The interviews were carried out until the responses were saturated. The recorded conversations and the data in the record sheets were subsequently transcribed. The obtained data were coded and divided into categories and subcategories. For the purpose of clarity, these categories were processed into schemas using SmartArt. The final schemas were then described. The results showed that half of the people without hypertension in all age groups were usually informed about the risk factors of hypertension by their general nurse and doctor. The second half of the respondents were never informed about the risk factors of hypertension. Hypertensive patients most often reported that they were informed about the risk factors by their doctor. However, interviews with the general nurses showed that most nurses inform all people about the risk factors of hypertension. According to the nurses, older people need more information that needs to be repeated because they are worse at understanding. The interviews also showed that most nurses participating in the research educate adults about hypertension prevention. However, most of the people not suffering from hypertension as well as hypertensive patients in all age groups indicated that they have never been informed about the prevention of hypertension. Four general nurses stated that patients follow preventive measures. Other nurses said that it depends on the person some people follow these measures or follow them sometimes and some do not follow them at all. I assume that since the interviewed adults, who have been divided into selected age groups, do not have any information about the prevention of hypertension, they cannot follow any preventive measures. The output of the diploma thesis is an educational brochure that can help patients not suffering from hypertension as well as hypertensive patients to understand the aspects of this disease. This brochure can be used by nurses to educate people about the risk factors of hypertension. In addition, this diploma thesis could be used as a study material for students of the Faculty of Health and Social Sciences at the University of South Bohemia.

Children heart diseases can be divided into congenital and acquired heart defects. The acquired heart defects can be further divided into acquired heart defects, heart rhythm disorders, including hypertension, inflammatory heart diseases and heart failure. Children heart diseases can occur at any age, even if it is a congenital heart defect that is less severe. The diploma thesis should bring nurses closer to the problems of nursing care of children with heart diseases hospitalized at the ICU. The goal of this thesis was to find out the specifics of nursing care of children with heart diseases who are hospitalized at the ICU and to find out the most common nursing diagnoses according to NANDA II taxonomy, and their treatment in case of children with heart diseases who are hospitalized at the ICU. During the realization of the research part, a qualitative research survey was used using semi-structured interviews with the nurses involved in the observation. And a summarization that provides a more comprehensive view of the composition of children with heart diseases hospitalized at the ICU. The interviews were conducted with the nurses at the children's ICU, where the participant observation took place as well. In the research section the most common nursing interventions in case of these children were described and how much they differ from interventions in case of children with other illnesses that are also hospitalized at the ICU. Further, we have also found out the most common nursing diagnoses of children with heart diseases hospitalized at the ICU.

Current situation: Educated and qualified nurse can fully do her job, give a patient bio-psycho-social-spiritual needs and satisfy them. This can happen only if optimal conditions are given to her, which means the optimal number of nursing staff. The aim of the study was to set the optimal number of nursing staff at surgical department in the Hospital of the Vysočina region, which was chosen. A standardized methodology of Pochylá and Pochylý (1999 and 2008) was used. Methodology and the research complex: Quantitative-qualitative method was used in the research. Detailed interviews were used in the first part of the study while talking to nurses of the surgical department of the Hospital of the Vysočina region. In phase two, 26 special nursing procedures were selected and divided into four thematic parts. 520 measurements were made in total, average time of making each special nursing procedure was set. In phase three, average values of nursing one patient in 12 hours at surgical department were set. Daily shots of the procedures were being taken for 14 days (Monday-Sunday). Optimal numbers of nursing staff and their qualified substitution in the Hospital of the Vysočina region were set in the last stage of the research. Results: The research question and three hypotheses were answered by performing and processing the research. The result is that there are statistically major differences in average value of basic and special nursing. 21 patients in average were treated in the hospital in the first week of research. The average nursing time for this number of patients in 12 hours was 3585 minutes 1027 minutes of basic nursing care and 1718 minutes of special nursing procedures. In the second week of research, 24 patients were treated at the department in average. The average nursing time for this number of patients was 3647 minutes in 12 hours 1036 minutes of basic nursing care and 1675 minutes of special nursing procedures. Statistically major differences were confirmed even during special nursing procedures. The longest average time was measured while incoming of patients, transferring, discharging (14,31 minutes) and the shortest average time was measure while applicating medicine into body cavities (0,5 minutes). Based on the research we can say that the number of staff at selected department is for a 12-hour shift optimal. Recommended number of full-time employees is 5, the real number is 5,4. Conclusion and recommendation: The output of this thesis is recommendation for management of nursing care regarding the issue of getting and maintaining the optimal number of nursing staff.

Submitted by Karina Alexandra Batista da Silva Freitas null (karinaf@fmb.unesp.br) on 2016-02-12T11:39:21Z No. of bitstreams: 1 dissertação 16 de dezembro.pdf: 2240200 bytes, checksum: 52c103a34ed04e5d4c2be64c0cf6440b (MD5) / Approved for entry into archive by Sandra Manzano de Almeida (smanzano@marilia.unesp.br) on 2016-02-12T16:06:36Z (GMT) No. of bitstreams: 1 freitas_kabs_me_bot.pdf: 2240200 bytes, checksum: 52c103a34ed04e5d4c2be64c0cf6440b (MD5) / Made available in DSpace on 2016-02-12T16:06:37Z (GMT). No. of bitstreams: 1 freitas_kabs_me_bot.pdf: 2240200 bytes, checksum: 52c103a34ed04e5d4c2be64c0cf6440b (MD5) Previous issue date: 2015-12-16 / Introdução. Os pacientes submetidos à quimioterapia antineoplásica necessitam de um acesso venoso adequado. Como a via endovenosa é a mais utilizada, o acesso venoso periférico é comumente empregado, podendo trazer alguns problemas como o extravasamento. O extravasamento consiste na infusão de agentes antineoplásicos para fora do vaso causando grande toxicidade dermatológica local. São classificados como irritantes, não vesicantes e vesicantes. A prevenção do extravasamento deve ser estimulada afim de garantir a qualidade da assistência ao paciente submetido a essa terapêutica. Objetivo. Traçar o perfil e o conhecimento em quimioterapia dos enfermeiros de unidades de internação de um Hospital Universitário e desenvolver estratégias para administração segura dos antineoplásicos. Material e métodos. Pesquisa exploratório – descritiva, de abordagem quantitativa, realizada com 30 enfermeiros de um Hospital Público Universitário e de Ensino do interior do Estado de São Paulo. Aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu / UNESP - Parecer 820.619. A pesquisa foi realizada em duas etapas. A primeira levantou-se o conhecimento dos enfermeiros através de questionário com questões objetivas abordando conteúdo relacionado sobre administração de quimioterapia e extravasamento. A coleta foi realizada nos meses de novembro e dezembro de 2014. Na segunda, elaborou-se as estratégias para administração segura dos antineoplásicos que constam de rótulos que contemplam as recomendações da literatura atual e que fornecem subsídios para os enfermeiros identificarem o quimioterápico de acordo com seu potencial de lesão, um Procedimento Operacional Padrão para administração de quimioterápico endovenoso e um Manual de Extravasamento de Antineoplásicos. Resultados/Discussão: Observou-se que 93% dos enfermeiros não possuíam capacitação em quimioterapia, 60% tinham tempo de Instituição menor ou igual a 5 anos. Nenhum entrevistado apresentava especialização na área de oncologia, apenas 17% sabem diferenciar a quimioterapia pelo potencial de lesão (irritantes, não vesicantes e vesicantes), porém todos concordam que deve haver uma diferenciação através dos rótulos. Com a implantação dos produtos na Instituição de estudo, houve a mudança de rotina na administração de quimioterapia, trazendo um novo conceito no que diz respeito a qualidade do atendimento e a segurança do paciente, conforme preconizado na RDC 36 de 25/07/2013 e almejado pela Instituição. Foi fornecida aos enfermeiros da Instituição uma capacitação sobre administração de quimioterapia. Produtos Elaborados: Foram elaborados um Protocolo Operacional Padrão para administração de quimioterápico endovenoso, diferentes rótulos para identificação do antineoplásico de acordo com seu potencial de lesão (vermelho, amarelo e verde) e um Manual de Extravasamento de Antineoplásicos contendo um fluxograma das principais ações de enfermagem após um extravasamento e sua documentação, podendo ser acessado na forma de e-book na internet e intranet da Instituição pelo endereço: www.hcfmb.unesp.br/bibliotecadigital. Conclusão: O extravasamento é uma das complicações mais graves do tratamento quimioterápico endovenoso. A administração segura dos antineoplásicos deve ser estimulada visando a segurança do paciente submetido a essa terapêutica. Esse estudo possibilitou a implementação de estratégias para a prática segura da administração dos antineoplásicos, bem como de estabelecer uma rotina para o atendimento dos extravasamentos, visto que a Instituição almeja a qualidade da assistência prestada e segurança do paciente. / Introduction. Patients undergoing cancer chemotherapy needs an adequate venous access. As the an intravenous administration is the most used, the peripheral venous access is commonly used and may cause some issues as extravasation. Extravasation consists in an infusion of antineoplastic agents out of the vase causing extensive dermatological local toxicity. They are classified as irritant, not vesicant and vesicant. The prevention of extravasation must be stimulated to ensure the quality of patient care submitted to this treatment. Objective. Make the profile and knowledge of the chemotherapy nurses from inpatient units of a university hospital and develop strategies for safe administration of antineoplastic. Material and methods. Exploratory descriptive research with a quantitative approach, carried out with 30 nurses of a public University Hospital and in São Paulo School. Approved by the Research Ethics Committee of the Medical School of Botucatu / UNESP - Opinion 820,619. The research was conducted in two stages. First were put the knowledge of nurses through a questionnaire with objective questions addressing related content on chemotherapy administration and overflow. The data collection was conducted in November and December of 2014. In the second, it was made strategies for safe administration of antineoplastic that contained labels that include the recommendations of the current literature and provide subsidies for nurses identify the chemotherapy according to its potential to damage a Standard Operating Procedure for intravenous chemotherapy administration and extravasation Manual of antineoplastic agents. Results / Discussion: It was observed that 93% of nurses had no training in chemotherapy, 60% had a low time of Institution not exceeding five years. None of the interviewed had expertise in oncology, only 17% know the difference between chemotherapy by injury potential (irritant, not vesicant and vesicant), although all agree that should be a differentiation through the labels. With the implementation of the products in the study institution, there was a routine change in the administration of chemotherapy, bringing a new concept about the quality of care and patient safety, as recommended in the DRC and 36 of 25.7.2013 desired by the institution. It was provided to the institution nurses a training course about chemotherapy administration. Prepared Products: It were elaborated a Standard Operating Protocol for intravenous chemotherapy administration, different labels to identify the anticancer according to their injury potential (red, yellow and green) and an extravasation Manual of antineoplastic agentes containing a flow chart of the main nursing actions after a leak and its documentation and can be accessed in the form of e-book on the internet and intranet of the institution by the address: www.hcfmb.unesp.br/bibliotecadigital. Conclusion: The extravasation is one of the most serious complications of chemotherapy intravenous treatment. The safe administration of the antineoplastic should be stimulated aiming the patient safety submitted to this therapy. This study enabled the implementation of strategies for safe practice of the administration of antineoplastic agents, as establish a routine for the care of extravasation, whereas the institution strives for quality of care and patient safety.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Systemic arterial hypertension is a chronic non-communicable disease considered an important public health problem both in the global and national levels. Its repercussions exceed the biological dimension, because, it involves the subjectivity and the social constructions of the person, family and community where they live. Thus, among the scenarios that have been focus of attention and care in health are the ones that comprehend the population that lives in the countryside. It is essential that in these places the care from the cultural perspective is identified and comprehended, allowing the professionals of health to act professionally and efficiently with the people of different cultures. So, it is essential to comprehend the practices of care of people with hypertension that live in the countryside. From this question, we outlined as objective of this study to analyze the way how the people with systemic arterial hypertension that live in the countryside understand and live the practices of care. It is a field research, qualitative, exploratory and descriptive, performed with 13 people with hypertension that live in the countryside, covering the period from May to June of 2015. The data collection was performed by means of participant observation of moderated kind and semi-structured interview. The data was worked by Guide of phases of Data Analysis from the method of etno-nursing suggested by Leininger and McFarland. The research followed the ethical principles of the Resolution number 466/2012 and obtained approval by the Research Ethics Committee with the Approval Certificate for Ethical Assessment number 41156015.7.0000.5346. The results were organized in two categories and three subcategories discussing from the beliefs and experiences in the disease process and the daily care practices. Regarding the experience of living with "high pressure" are revealed trajectories performed to diagnosis, the meanings attributed the etiology of the disease, the changes and the difficulties stemming from living with hypertension, as well as representations of illness resulting from that experience. Also, care practices were discussed from the aspects that concern the habits, uncertainties and possibilities in food, strategies were also identified from the replacement, reduction or elimination partial or total food with potential for worsening health. Another approached practice was the use of medicines and teas as medicines used to control blood pressure levels. Also addressed were the careful design combined with the care practices in general as protection against bad weather, hygiene, interaction with other people, games, leisure activities and social support network as forms of care and welfare. So to understand care practices is critical recognition and appreciation of different existing cultures and the elements present in everyday life. / A hipertensão arterial sistêmica é uma doença crônica não-transmissível considerada um importante problema de saúde pública, tanto em âmbito mundial como nacional. Suas repercussões ultrapassam a dimensão biológica, pois envolve a subjetividade e as construções sociais da pessoa, da família e da comunidade onde vivem. Sendo assim, dentre os cenários, que têm sido foco de atenção e cuidado em saúde, estão os que compreendem a população que vive no campo. Torna-se indispensável que no campo o cuidado, a partir da perspectiva cultural, seja identificado e compreendido, permitindo aos profissionais de saúde atuações diferenciadas e eficientes com pessoas de diferentes culturas. Logo, é importante compreender as práticas de cuidado de pessoas com hipertensão que vivem no campo. A partir dessa problemática, delineou-se como objetivo deste estudo analisar o modo como as pessoas com hipertensão arterial sistêmica que vivem no campo entendem e vivenciam as práticas de cuidado. Trata-se de uma pesquisa de campo, qualitativa, exploratória e descritiva, realizada com 13 pessoas com hipertensão que vivem no campo, no período de maio a junho de 2015. A coleta de dados realizou-se por meio de observação participante do tipo moderado e entrevista semiestruturada. Os dados foram trabalhados pelo Guia das Fases de Análise de Dados do método da etnoenfermagem sugerido por Leininger e McFarland. A pesquisa seguiu os princípios éticos da Resolução número 466/2012 e obteve aprovação do Comitê de Ética em Pesquisa com o Certificado de Apresentação para Apreciação Ética número 41156015.7.0000.5346. Os resultados foram organizados em duas categorias e três subcategorias que discutem desde as crenças e experiências no processo de adoecimento bem como as práticas cotidianas de cuidados. Em relação a experiência de viver com pressão alta são reveladas as trajetórias realizadas até o diagnóstico, os significados atribuídos a etiologia da doença, as mudanças e as dificuldades advindas do viver com hipertensão, bem como as representações da doença advindas dessa experiência. Também, foram discutidas as práticas de cuidado a partir dos aspectos que tangem a os hábitos, incertezas e possibilidades na alimentação, ainda foram apontadas estratégias a partir da substituição, redução ou eliminação parcial ou total de alimentos com potencial de agravamento para saúde. Outra prática abordada foi a utilização de medicamentos e chás como remédios utilizados para o controle dos níveis pressóricos. Ainda foram abordadas a concepção de cuidado aliada as práticas de cuidado em geral como proteção contra as intempéries climáticas, higienização, interação com outras pessoas, jogos, atividades de lazer e a rede social de apoio como formas de cuidado e bem-estar. Sendo assim, para entender as práticas de cuidado é fundamental o reconhecimento e valorização das diversas culturas existentes bem como dos elementos presentes no cotidiano.