Submitted by Flávia Carraro Zopi (flaviazopi@hotmail.com) on 2016-04-05T16:16:25Z No. of bitstreams: 1 Dissertação FLÁVIA CARRARO ZOPI FINAL.pdf: 1473869 bytes, checksum: 3aed21a2194b0e1d6d2899fba047facd (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-04-07T18:41:25Z (GMT) No. of bitstreams: 1 zopi_fc_me_bot.pdf: 1473869 bytes, checksum: 3aed21a2194b0e1d6d2899fba047facd (MD5) / Made available in DSpace on 2016-04-07T18:41:25Z (GMT). No. of bitstreams: 1 zopi_fc_me_bot.pdf: 1473869 bytes, checksum: 3aed21a2194b0e1d6d2899fba047facd (MD5) Previous issue date: 2016-02-24 / O dimensionamento de pessoal de enfermagem constitui-se como importante ferramenta do gerenciamento que visa promover condições ideais para a efetivação da atenção à saúde. Porém, no contexto da atenção básica, percebem-se poucos estudos que abordam os instrumentos utilizados para dimensionar a equipe de enfermagem. O objetivo da pesquisa foi investigar a prática do dimensionamento de pessoal de enfermagem e analisar a adequação da equipe à carga média de trabalho das atividades nas Unidades de Saúde de uma Região de Saúde. Trata-se de um estudo exploratório, descritivo e de abordagem quantitativa. Esta pesquisa teve como contexto as Unidades Saúde da Família e Unidades Básicas de Saúde da Região de Saúde Polo Cuesta, inseridas no Departamento Regional de Saúde de Bauru. Para a coleta de dados, utilizou-se um questionário elaborado para essa pesquisa, disponível na plataforma FormSUS do DATASUS. Embora a maioria (91,38%) dos entrevistados considerou importante a utilização de um instrumento para dimensionar a equipe de enfermagem, notou-se que boa parte (39,65%) não utiliza nenhum método de dimensionamento. Dentre os desafios encontrados para dimensionar a equipe, foram citados: falta de governabilidade para contratação, sobrecarga de trabalho e falta de conhecimento sobre o assunto. Grupos educativos em saúde e visitas domiciliares são atividades que deixam de serem executadas devido à escassez de profissionais. Verificou-se variação na carga média de trabalho em Unidades do mesmo modelo de atenção ou diferente modelo. / The Nursing personnel downsizing, constitutes an important management implement to promote ideal conditions for the processing of health care. However in the context of primary health care are perceived few studies that address the instruments used to scale the nursing staff. This research aimed to investigate the practice of nursing personnel and review the adequacy of staff to the demand for activities in the health units of a Health Region. This is an exploratory, descriptive and quantitative study. The context of this research is Healthcare Units of the Region Health Polo Cuesta, included in the Regional Health Department of Bauru. To collect data, we used a questionnaire prepared for this survey, available in FormSUS platform DATASUS. Although the majority (91.38%) of the interviewee considered important to use a method to scale the nursing staff, it was noted that most (39.65%) does not use any scaling method. Among the challenges to scale the staff were cited: lack of governance for hiring, work overload and lack of knowledge on the subject. Educational groups in health and domiciliary visits are activities that fail to be executed due to the shortage of professionals. There was variation in demand for activities in units of the same type of attention or different model.

Orientador: Carmen Maria Casquel Monti Juliani / Resumo: O dimensionamento de pessoal de enfermagem constitui-se como importante ferramenta do gerenciamento que visa promover condições ideais para a efetivação da atenção à saúde. Porém, no contexto da atenção básica, percebem-se poucos estudos que abordam os instrumentos utilizados para dimensionar a equipe de enfermagem. O objetivo da pesquisa foi investigar a prática do dimensionamento de pessoal de enfermagem e analisar a adequação da equipe à carga média de trabalho das atividades nas Unidades de Saúde de uma Região de Saúde. Trata-se de um estudo exploratório, descritivo e de abordagem quantitativa. Esta pesquisa teve como contexto as Unidades Saúde da Família e Unidades Básicas de Saúde da Região de Saúde Polo Cuesta, inseridas no Departamento Regional de Saúde de Bauru. Para a coleta de dados, utilizou-se um questionário elaborado para essa pesquisa, disponível na plataforma FormSUS do DATASUS. Embora a maioria (91,38%) dos entrevistados considerou importante a utilização de um instrumento para dimensionar a equipe de enfermagem, notou-se que boa parte (39,65%) não utiliza nenhum método de dimensionamento. Dentre os desafios encontrados para dimensionar a equipe, foram citados: falta de governabilidade para contratação, sobrecarga de trabalho e falta de conhecimento sobre o assunto. Grupos educativos em saúde e visitas domiciliares são atividades que deixam de serem executadas devido à escassez de profissionais. Verificou-se variação na carga média de trabalho em Unidades do... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Nursing personnel downsizing, constitutes an important management implement to promote ideal conditions for the processing of health care. However in the context of primary health care are perceived few studies that address the instruments used to scale the nursing staff. This research aimed to investigate the practice of nursing personnel and review the adequacy of staff to the demand for activities in the health units of a Health Region. This is an exploratory, descriptive and quantitative study. The context of this research is Healthcare Units of the Region Health Polo Cuesta, included in the Regional Health Department of Bauru. To collect data, we used a questionnaire prepared for this survey, available in FormSUS platform DATASUS. Although the majority (91.38%) of the interviewee considered important to use a method to scale the nursing staff, it was noted that most (39.65%) does not use any scaling method. Among the challenges to scale the staff were cited: lack of governance for hiring, work overload and lack of knowledge on the subject. Educational groups in health and domiciliary visits are activities that fail to be executed due to the shortage of professionals. There was variation in demand for activities in units of the same type of attention or different model. / Mestre

The aim of this thesis was to acquire knowledge about patient participation in everyday life of persons with dementia living in SCUs in nursing homes. Data collection and analysis in studies I-III was carried out according to Grounded Theory. Data was collected by open non- participant observations during 51 hours, and conversations with 8 residents and 17 health care personnel (I), interviews carried out twice with 12 relatives (II) and 11 nursing personnel (III), and by a study specific questionnaire based on the findings from study I-II to 233 relatives (IV). Descriptive and non-parametric statistics were used (IV). Presence of nursing personnel in body, mind and morality was found to be the prerequisite for patient participation (I). This required personnel with high competence in dementia care, commitment to and interest in the resident, and continuity in their work (I, III). Wellbeing and dignity in the resident’s everyday life was found to be the most important goal, not necessarily a high level of patient participation (II-III). The level of participation had to be adjusted to the resident’s ability and wish to take part in decisions in the very moment. However, the level was often primarily adjusted to suit the personnel’s ideas about how to carry out daily care (I, III). Relatives had an important role in the participation process by interacting, and exchanging information, with the personnel. By forming a basis for individualised care in this way, relatives made a difference to the resident’s everyday life and contributed to their wellbeing and dignity (II-IV). The SCU’s context also affected patient participation (I-IV). Patient participation must be given attention by leaders and be prioritised in dementia care. Nursing personnel can enhance patient participation by promoting relatives’ partaking in the participation process, as this has potential for further contributing to quality of care.

Thesis (MPA.) --University of Limpopo, 2005 / Refer to the document

Abstract The purpose of this study was to develop the patient classification at the Oulu University Hospital, establish the validity and reliability of the patient classification from the perspective of nursing care quality standards. The data were collected at the Oulu University Hospital through the use of content experts judgements (n=36) and by gathering inter-rater classifications (n=8129), by nursing care activity study (n=17599), focus-group interviews (n=8) and through the international literature review. Data were analyzed and described using Excel and SPSS programs and data driven content analysis. The inter-rater reliability was tested using per cent agreement, weighted per cent agreement, Gronbach’s alfa correlation coefficient, Phi correlation coefficient, ICC-(intraclass-coefficient) and Kappa coefficient. Associations between the variables in the amount of time spent with various activities were tested using chi-square test within and between medical and surgical wards. There was notable consensus among the experts showing that the items and categories of Oulu patient classification represented the known content of nursing care at the wards of the Oulu University Hospital. The agreement and the weighted agreement provided evidence of an acceptable level of agreement concerning the intensity of nursing care. Nurses performed inter-rater classifications regularly. The agreement between raters had approved during the study at many wards. However, the agreement between raters had also declined at some wards. The declining trend of inter-rater classifications showed problems in the consistent patient classification. The problems may due to changes of the environment affecting nursing care. Nurses performed most of their time with medication and patient physical nursing care activities. The nursing personnel spent least of their time with emotional support and guidance. The indirect nursing care activities consisted of charting and reporting. The study results indicate that the nurses do not use the patient classification for matching caregiver skills and patients or for anticipating the workload shift-by-shift. There are problems with using Oulu-patient classification for classifying the nursing care provided if the patient classification does not account the patients’ actual individual needs for nursing care. The basic question is does the nursing care provided respond to patients’ actual individual needs. If it does not, the patient classification does not quarantee high quality of nursing care. If it is possible to prove that the nursing care provided respond to patients’ individual needs, the patient classification information can be used in staffing and nursing cost accounting. The information obtained from the study can be used to assure the quality of nursing processes based on individual needs of the patients. / Tiivistelmä Tämän tutkimuksen tehtävänä oli kehittää hoitoisuusluokitus Oulun yliopistolliseen sairaalaan, arvioida hoitoisuusluokituksen luotettavuus hoitoisuuden mittaamiseen ja arvioida hoitoisuusluokitus hoitotyön laatuvaatimusten näkökulmasta. Tutkimusaineistot kerättiin Oulun yliopistollisessa sairaalassa asiantuntija-arvioinneilla (n=36) ja rinnakkainluokituksilla (n=8129), ajanhavainnoinnilla (n=17599), ryhmähaastattelulla (n=8) ja kansainvälisellä kirjallisuuskatsauksella. Aineistojen analyysissa käytettiin Excel- ja SPSS-ohjelmistoja sekä sisällön analyysiä. Luokitusten vastaavuuden testaamisessa käytettiin yksimielisyysindeksiä, painotettua yksimielisyysprosenttia, yksisuuntaista varianssianalyysia (ANOVA), Cronbachin alfaa, Phin korrelaatiota, ICC- (intraclass-coefficient) kerrointa ja Kappa-tunnuslukua. Khiin neliön testiä käytettiin osoittamaan eroja sairaanhoitajien ajankäytössä kirurgisten ja sisätautien osastojen välillä. Oulu-hoitoisuusluokitus kattoi hoitotyön sisällön vuodeosastopotilaan hoidossa yliopistosairaalassa tutkimuksen lähtötilanteessa hyvin ja vastasi näkemystä hoitotyöstä. Rinnakkainluokituksia tehtiin säännöllisesti. Useilla osastoilla luokitusten välinen vastaavuus oli kehittynyt parempaan suuntaan tutkimusaikana. Luokitusten välinen vastaavuus oli toisaalta heikentynyt joillakin osastoilla. Tulosten aleneva trendi monilla osastoilla osoitti ongelmia luokituksen yhtenäisessä käytössä. Ongelmat voivat johtua ainakin osittain muutoksista toimintaympäristössä ja niiden vaikutuksesta hoitotyöhön. Eniten hoitohenkilökunnan aikaa kului lääkehoidon ja fyysisen hoidon toteuttamiseen. Vähiten aikaa käytettiin potilaan psyykkiseen tukemiseen ja potilaan ohjaukseen. Välillisessä hoitotyössä kaikilla osastoilla eniten aikaa käytettiin potilaan hoidon suunnitteluun ja raportointiin. Tulosten perusteella näytti kuitenkin siltä, että luokitusta ei hyödynnetty työvuoroittain päivittäin osaamisen kohdentamisessa tai työkuormituksen ennakoimisessa. Oulu-hoitoisuusluokituksen käyttäminen toteutuneen hoitotyön luokittelussa oli ongelmallista, jos luokitus ei ottanut huomioon potilaan yksilöllisiä hoitotyön tarpeita. Olennainen kysymys on, vastasiko toteutunut hoito potilaiden todellisia yksilöllisiä tarpeita. Jos toteutunut hoito on vastannut potilaiden yksilöllisiä tarpeita, on hoitoisuusluokitustietoja voitu käyttää myös henkilöstösuunnittelussa ja kustannusten selvittämisessä. Tutkimustuloksia voidaan hyödyntää potilaan yksilöllisen ja tarpeenmukaisen hoitotyön kehittämisessä.

The thesis analyses causes of the lack of medical workers providing nursing care in inpatient facilities and observes in broader connections the progress of present staff condition. By means of managerial methods for determining number of nursing staff, it discovers, whether it is possible to define the number of nurses in inpatient medical facilities as insufficient, or whether the present number of nurses is critical with its origin in lack of other nursing employees. This thesis is supposed to show that the lack of nurses is not only a problem in the last few years, but it has been here since the beginning of the 20th century and it has been connected with all social events to present days. Starting point of the evaluation of the situation will be a brief historical excursus with a brief analysis of professional, legislative and social impacts which influenced the number of nursing employees in the past and their consequences up to now. It studies the methods of determining, attracting and hiring the nursing emplyees. The theoretical part will state and analyse determination of necessary nursing employees for inpatient wards according to managerial viewpoint. After 1989, there was an attempt to change the planned health care system by implementing modern namagerial activities. In the end, the...

Objetivos. Este estudo teve como objetivos avaliar a capacidade para o trabalho, a estrutura temporal do sono, da 6-sulfatoximelatonina e do cortisol em trabalhadores em turnos da área de enfermagem. Métodos. Foram realizados dois estudos. Um estudo transversal para analisar a capacidade para o trabalho e o envelhecimento funcional precoce, através de questionários de condições de vida e trabalho e sintomas de saúde, da qual participaram 696 profissionais da área de enfermagem. E um cronobiológico com 19 trabalhadores do sexo feminino. Neste foram avaliados: o ciclo vigília-sono, através de actígrafos e protocolos diários de atividades; as concentrações da 6-sulfatoximelatonina e do cortisol; e a ritmicidade circadiana (avaliada utilizando a metodologia do ajuste dos parâmetros ritmométricos pela curva cosseno, método cosinor). Foi realizada coleta de urina em dois períodos de 4 dias consecutivos (com dias de trabalho e de folga,) para os trabalhadores noturnos, submetidos a turnos de 12 horas seguidas de 36 horas de descanso; e em um período de 8 dias consecutivos para os trabalhadores diurnos (6 dias de trabalho e 2 de folga). O grupo de 19 pessoas também foi analisado segundo a maior e menor tolerância ao trabalho em turnos. A tolerância ao trabalho em turnos foi avaliada utilizando 9 indicadores de saúde (escore de sonolência e fadiga, escore de concentração e atenção, escore da fadiga projetada sobre o corpo, escore geral da fadiga, SRQ20, escore de insônia, sonolência no trabalho, escore de problemas de sono) e disponibilidade do tempo livre. Resultados. A idade média da população era de 34,9 anos (dp + 9,5 anos), e esta era predominantemente feminina (87,8%), sendo que 40,6% começou a trabalhar antes dos 18 anos. As variáveis ligadas à capacidade para o trabalho inadequada foram: 1) sócio-demográficas: ter a responsabilidade pela renda familiar sozinho (OR=1,922), ter filhos ou menores sob a guarda (OR=1,558) e ter menos de 40 anos (OR=1,400). 2) ligadas ao trabalho: referir desconforto térmico (OR=1,548), referir ter sofrido abuso verbal pelo menos duas vezes no último ano (OR=1,670). 3) variáveis ligadas à saúde foram referir obesidade (OR=2,714), doenças de sono (OR=1,681), e fadiga (OR>3,771). No segundo estudo, as trabalhadoras noturnas apresentaram maior duração, e também melhor qualidade de sono noturno. Estas também referiram níveis de alerta significantemente mais elevados quando puderam cochilar durante o turno de trabalho. Foi encontrada uma grande variabilidade nos parâmetros rítmicos ao longo dos dias de trabalho e de folga. As concentrações médias de 6-sulfatoximelatonina e cortisol das trabalhadoras noturnas foram estatisticamente menores do que as encontradas em trabalhadores diurnos (p<0,001). Quando as trabalhadoras foram classificadas como mais e menos tolerantes ao trabalho em turnos, as trabalhadoras noturnas menos tolerantes referiram menor qualidade de sono e menores níveis de alerta. As concentrações médias de 6-sulfatoximelatonina e cortisol ao longo dos dias de trabalho e de folga variaram de modo distinto nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos. Conclusões. A capacidade de trabalho inadequada é resultado da associação de variáveis de múltiplas naturezas, tais como condições de vida e trabalho, hábitos e estilos de vida e à organização do trabalho. O cochilo durante o turno noturno de trabalho mostrou ser efetivo na manutenção dos níveis de alerta durante o trabalho noturno. As trabalhadoras noturnas apresentaram menores concentrações médias de 6-sulfatoximelatonina quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à exposição à luz durante o turno noturno de trabalho. As trabalhadoras noturnas apresentaram menores concentrações de cortisol quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à maior fadiga referida por estas trabalhadoras. Os ritmos de 6-sulfatoximelatonina e cortisol têm comportamentos diferentes nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos, mas nenhum padrão pode ser definido, uma vez que existe uma grande variabilidade individual. / Objectives. The aim of this study was to evaluate work ability and biological rhythms of health care shiftworkers. Methods. To evaluate the work ability it was designed an epidemiological approach using a comprehensive questionnaire which included working and living conditions and health symptoms. 696 health care shiftworkers participated in this study. A sub sample of 19 female registered nurses and nurse aides/technicians were invited and agreed to participate in the chronobiological evaluation. Workers answered daily logs and wore actigraphs (Ambulatory Monitoring) to monitor activity and evaluate rest and waking periods along data collection. Urine samples were collected and voided volumes were measured during two periods of four consecutive days (working days and days off) of night workers, submitted to 12 hour night shifts followed by 36 hour off, and during one period of 8 consecutive days (six working days and two days off). It was also evaluated the 6-sulphatoxymelatonin and cortisol concentration, and their circadian rhythmicity using the Cosinor method. These 19 nurses were evaluated as more or less tolerant to shiftwork. The tolerance to shiftwork was evaluated by 9 health scores(dull and sleepy score, decline of working motivation, projection of fatigue to some parts of the body, general fatigue score, Self-Report Questionnaire (SRQ-20 score), insomnia score, sleepiness score, sleep disturbances score) and availability of free time. Results. Mean age of the respondents was 34.9 years, most of them female (87.8%) and 40.6% entered labor force before 18 years old. The socio-demographic factors associated to inadequate work ability were: income responsibility - sole breadwinner (OR=1.922), raising kids (OR=1.558), age group (under 40 years old) (OR=1,400). Factors associated with working conditions were: thermal discomfort (OR=1.548), and verbal abuse (OR=1.670). Obesity (OR=2.14), sleep problems (OR=1.681) and fatigue (OR>3.771) were health outcomes associated to inadequate work ability. Night workers showed longer mean sleep duration and referred better sleep quality to nocturnal sleep. These workers also reported higher alertness level when they nap during the night shift. Mean concentration of 6-sulphatoxymelatonin and cortisol among night workers were significantly lower than the day workers concentrations (p<0,001). When workers were classified into more and less tolerant to shiftwork, the less tolerant night workers referred worst sleep quality and lower alertness levels. The mean concentration of 6-sulphatoxymelatonin and cortisol, during working days and days off, showed distinct behavior in the two groups. It was found a great variability of the rhythmic parameters during working days and days off. Conclusions. Inadequate work ability was associated with a number of variables present at work and living conditions. Strategy of taking naps during night work was effective to maintain the alertness levels during work. Night workers 6-sulphatoxymelatonin mean concentrations were lower than day workers concentration. This might be related to light exposure during the night shift. The higher reported fatigue by these workers might explain the lower cortisol mean concentration presented by night workers when compared to day workers. The rhythms of 6-sulphatoxymelatonin and cortisol showed different behaviors when compared more and less tolerant workers, but any standard behavior could be observed since there is a great individual variability.

Objetivos. Este estudo teve como objetivos avaliar a capacidade para o trabalho, a estrutura temporal do sono, da 6-sulfatoximelatonina e do cortisol em trabalhadores em turnos da área de enfermagem. Métodos. Foram realizados dois estudos. Um estudo transversal para analisar a capacidade para o trabalho e o envelhecimento funcional precoce, através de questionários de condições de vida e trabalho e sintomas de saúde, da qual participaram 696 profissionais da área de enfermagem. E um cronobiológico com 19 trabalhadores do sexo feminino. Neste foram avaliados: o ciclo vigília-sono, através de actígrafos e protocolos diários de atividades; as concentrações da 6-sulfatoximelatonina e do cortisol; e a ritmicidade circadiana (avaliada utilizando a metodologia do ajuste dos parâmetros ritmométricos pela curva cosseno, método cosinor). Foi realizada coleta de urina em dois períodos de 4 dias consecutivos (com dias de trabalho e de folga,) para os trabalhadores noturnos, submetidos a turnos de 12 horas seguidas de 36 horas de descanso; e em um período de 8 dias consecutivos para os trabalhadores diurnos (6 dias de trabalho e 2 de folga). O grupo de 19 pessoas também foi analisado segundo a maior e menor tolerância ao trabalho em turnos. A tolerância ao trabalho em turnos foi avaliada utilizando 9 indicadores de saúde (escore de sonolência e fadiga, escore de concentração e atenção, escore da fadiga projetada sobre o corpo, escore geral da fadiga, SRQ20, escore de insônia, sonolência no trabalho, escore de problemas de sono) e disponibilidade do tempo livre. Resultados. A idade média da população era de 34,9 anos (dp + 9,5 anos), e esta era predominantemente feminina (87,8%), sendo que 40,6% começou a trabalhar antes dos 18 anos. As variáveis ligadas à capacidade para o trabalho inadequada foram: 1) sócio-demográficas: ter a responsabilidade pela renda familiar sozinho (OR=1,922), ter filhos ou menores sob a guarda (OR=1,558) e ter menos de 40 anos (OR=1,400). 2) ligadas ao trabalho: referir desconforto térmico (OR=1,548), referir ter sofrido abuso verbal pelo menos duas vezes no último ano (OR=1,670). 3) variáveis ligadas à saúde foram referir obesidade (OR=2,714), doenças de sono (OR=1,681), e fadiga (OR>3,771). No segundo estudo, as trabalhadoras noturnas apresentaram maior duração, e também melhor qualidade de sono noturno. Estas também referiram níveis de alerta significantemente mais elevados quando puderam cochilar durante o turno de trabalho. Foi encontrada uma grande variabilidade nos parâmetros rítmicos ao longo dos dias de trabalho e de folga. As concentrações médias de 6-sulfatoximelatonina e cortisol das trabalhadoras noturnas foram estatisticamente menores do que as encontradas em trabalhadores diurnos (p<0,001). Quando as trabalhadoras foram classificadas como mais e menos tolerantes ao trabalho em turnos, as trabalhadoras noturnas menos tolerantes referiram menor qualidade de sono e menores níveis de alerta. As concentrações médias de 6-sulfatoximelatonina e cortisol ao longo dos dias de trabalho e de folga variaram de modo distinto nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos. Conclusões. A capacidade de trabalho inadequada é resultado da associação de variáveis de múltiplas naturezas, tais como condições de vida e trabalho, hábitos e estilos de vida e à organização do trabalho. O cochilo durante o turno noturno de trabalho mostrou ser efetivo na manutenção dos níveis de alerta durante o trabalho noturno. As trabalhadoras noturnas apresentaram menores concentrações médias de 6-sulfatoximelatonina quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à exposição à luz durante o turno noturno de trabalho. As trabalhadoras noturnas apresentaram menores concentrações de cortisol quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à maior fadiga referida por estas trabalhadoras. Os ritmos de 6-sulfatoximelatonina e cortisol têm comportamentos diferentes nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos, mas nenhum padrão pode ser definido, uma vez que existe uma grande variabilidade individual. / Objectives. The aim of this study was to evaluate work ability and biological rhythms of health care shiftworkers. Methods. To evaluate the work ability it was designed an epidemiological approach using a comprehensive questionnaire which included working and living conditions and health symptoms. 696 health care shiftworkers participated in this study. A sub sample of 19 female registered nurses and nurse aides/technicians were invited and agreed to participate in the chronobiological evaluation. Workers answered daily logs and wore actigraphs (Ambulatory Monitoring) to monitor activity and evaluate rest and waking periods along data collection. Urine samples were collected and voided volumes were measured during two periods of four consecutive days (working days and days off) of night workers, submitted to 12 hour night shifts followed by 36 hour off, and during one period of 8 consecutive days (six working days and two days off). It was also evaluated the 6-sulphatoxymelatonin and cortisol concentration, and their circadian rhythmicity using the Cosinor method. These 19 nurses were evaluated as more or less tolerant to shiftwork. The tolerance to shiftwork was evaluated by 9 health scores(dull and sleepy score, decline of working motivation, projection of fatigue to some parts of the body, general fatigue score, Self-Report Questionnaire (SRQ-20 score), insomnia score, sleepiness score, sleep disturbances score) and availability of free time. Results. Mean age of the respondents was 34.9 years, most of them female (87.8%) and 40.6% entered labor force before 18 years old. The socio-demographic factors associated to inadequate work ability were: income responsibility - sole breadwinner (OR=1.922), raising kids (OR=1.558), age group (under 40 years old) (OR=1,400). Factors associated with working conditions were: thermal discomfort (OR=1.548), and verbal abuse (OR=1.670). Obesity (OR=2.14), sleep problems (OR=1.681) and fatigue (OR>3.771) were health outcomes associated to inadequate work ability. Night workers showed longer mean sleep duration and referred better sleep quality to nocturnal sleep. These workers also reported higher alertness level when they nap during the night shift. Mean concentration of 6-sulphatoxymelatonin and cortisol among night workers were significantly lower than the day workers concentrations (p<0,001). When workers were classified into more and less tolerant to shiftwork, the less tolerant night workers referred worst sleep quality and lower alertness levels. The mean concentration of 6-sulphatoxymelatonin and cortisol, during working days and days off, showed distinct behavior in the two groups. It was found a great variability of the rhythmic parameters during working days and days off. Conclusions. Inadequate work ability was associated with a number of variables present at work and living conditions. Strategy of taking naps during night work was effective to maintain the alertness levels during work. Night workers 6-sulphatoxymelatonin mean concentrations were lower than day workers concentration. This might be related to light exposure during the night shift. The higher reported fatigue by these workers might explain the lower cortisol mean concentration presented by night workers when compared to day workers. The rhythms of 6-sulphatoxymelatonin and cortisol showed different behaviors when compared more and less tolerant workers, but any standard behavior could be observed since there is a great individual variability.

Any factor that interferes with a child’s ability to interact with the environment in a normal manner is a potential source of, or contributing factor to, the presence of a developmental delay (Rossetti, 2001). According to Bam (2001) the Human Immunodeficiency Virus (HIV) is considered as an established risk factor under the category of serious infections and does not only have a negative effect on the normal development of a child, but also leads to serious audiological complications (Bankaitis&Schountz, 1998). Heterogeneity of auditory manifestations in individuals with HIV/AIDS is a feature of this virus (Friedman&Noffsinger, 1998). When considering the wide spectrum of audiological problems associated with pediatric HIV/AIDS, the role of the audiologist in the treatment of these children are highlighted (Bankaitis, 1998). Effective treatment of this heterogeneous population can however only take place within a team of medical professionals as their complex needs require a wide spectrum of skills (McNeilly, 2000). In South Africa nursing personnel play an important role in the early identification of a hearing loss and other audiological abnormalities (Thathiah, 2001). Part of a nurse’s job involve the provision of services in hearing health care, therefore they can serve as assistants for the audiological profession (Thathiah, 2001). Although rehabilitation services in rural areas are limited, developmental disabilities can be prevented or minimized if it is identified early. Early identification of hearing losses and other audiological abnormalities associated with HIV/AIDS can however only take place if nursing personnel have the necessary knowledge and skills to address these problems efficiently. To thus provide optimal audiological services to children with HIV/AIDS nursing personnel must be able to function as a link between the audiologist and the community. In the light of the current government involvement with the provision of optimal health care service to people with HIV and Acquired Immune Deficiency Syndrome (AIDS), it is necessary to recognize and address the audiological needs of these individuals. The aim of this study was to determine the perception of nursing personnel, working in state hospitals in North West, regarding the audiological manifestations of HIV/AIDS in the pediatric population. A quantitive research design was employed in the form of a descriptive survey. The knowledge of 156 nursing personnel, working in fifteen different state hospitals in North West, was assessed through the use of a self-constructed questionnaire. This research concluded that the majority of the nursing personnel do not have sufficient knowledge regarding hearing health care and HIV/AIDS within the pediatric population. The assumption can thus be made that these children don’t get sufficient and effective intervention services and this will effect their development as well as quality of life negatively. Furthermore, respondents appeared not to have fully realized the importance of their role as health workers within the audiological context. The nursing personnel identified a need for information regarding the audiological manifestations of HIV/AIDS in the pediatric population and there appears to be a specific role for the audiologist in training the nurses regarding this above mentioned issue. This study emphasizes the importance of early identification and intervention of hearing disorders in children, especially children with HIV, within South Africa and indicates the need for further research with regards to this population. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted