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Elabora??o e valida??o de conte?do de um instrumento para identifica??o de viol?ncia contra crian?aRevor?do, Luciana da Silva 22 July 2016 (has links)
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Previous issue date: 2016-07-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / A atua??o das equipes multiprofissionais de sa?de ? fundamental para a preven??o e a identifica??o precoce de situa??es de viol?ncia. Entretanto, observa-se que ainda existe grande dificuldade entre os profissionais quanto ao rastreamento de abusos contra crian?a. Assim, observa-se a necessidade de um instrumento validado que possa ser utilizado por profissionais de sa?de, de maneira pr?tica e objetiva, no rastreamento de neglig?ncia e maus tratos em infantes no cotidiano da pr?tica cl?nica. Neste sentido, esta pesquisa objetivou elaborar e validar o conte?do de um instrumento para identifica??o de viol?ncia contra crian?a. Trata-se de estudo metodol?gico composto por duas etapas: a primeira foi a elabora??o do instrumento, a partir de revis?o da literatura; a segunda, de valida??o de conte?do, mediante a avalia??o do instrumento por 25 especialistas, na primeira fase, 22 ju?zes na segunda, e 21 na terceira rodada. Para an?lise, adotaram-se coeficiente Kappa ?0,61 e ?ndice de validade de conte?do ?0,75. Na primeira rodada, 39 (62,90%) apresentaram Kappa ?0,61 e ?ndice de Validade de Conte?do ?0,79. Nos demais itens (n=23; 37,10%), foram encontrados baixos ?ndices de concord?ncia Kappa e, por isso, receberam reformula??es. O instrumento recebeu avalia??o geral de Kappa de 0,62 e ?ndice de Validade de Conte?do de 0,85, que s?o considerados bons resultados. No que diz respeito ? segunda rodada, ap?s as altera??es sugeridas pelos especialistas, o instrumentou passou a possuir 50 itens. Destes, 49 apresentaram ?ndice de Validade de Conte?do entre 0,81 e 1,00, e Kappa entre 0,61 e 0,99. Apenas um item teve Kappa >0,61 (K=0,50; IVC=0,81). A insufici?ncia de concord?ncia entre os especialistas ocasionou na exclus?o dele, em uma terceira rodada. O instrumento foi avaliado de forma positiva, obtendo Kappa igual a 0,85 e ?ndice de Validade de Conte?do de 0,95, na segunda fase Delphi. Por fim, na ?ltima etapa, os ?ndices gerais de Kappa e de IVC do instrumento foram 0,98 e 0,99, respectivamente O instrumento apresentou ?ndice de validade de conte?do satisfat?rio e pode ser utilizado para identificar os sinais de suspeita de viol?ncia e auxiliar os profissionais de sa?de na assist?ncia ? crian?a. / The role of multidisciplinary health teams is key for the early prevention and identification of situations of violence. However, there is still great difficulty among professionals regarding the tracking of child abuse. Thus, there is need for a validated instrument that can be used by health professionals in a practical and objective way in the tracking of neglect and ill-treatment in infants in routine clinical practice. The aim of this study was to develop and validate the contents of an instrument for identifying violence against children. This is a methodological study consisting of two stages: the first was the development of the instrument from the literature review; the second was the content validation with evaluation of the instrument by 25 experts in the first phase, 22 in the second, and 21 in the third phase. In order to promote a multidimensional investigation of violence through a comprehensive understanding of human beings and contextualized in the phenomenon, was used the bio-ecological theory of human development. In this sense, the objective of the questionnaire is to track signs of abuse and ill-treatment of the four natures of violence - physical, psychological, sexual, neglect/abandonment - by means of the following dimensions: behavioral signs of the child; signs of physical violence; Munchausen syndrome by proxy (induction of symptoms and diseases in children by parents/caregivers); signs of sexual violence; and signs of neglect. For analysis, were adopted Kappa coefficient ?0.61 and content validity index (CVI) ?0.75. In the first round, of the 62 items, 39 (62.90%) showed Kappa ?0.61 and content validity index ?0.79. In the others (n = 23; 37.10%) were found low Kappa indexes, hence there were reformulations. The instrument received Kappa overall evaluation of 0.62, and content validity index of 0.85, which are considered good results. In the second round after the adjustments suggested by the experts, the instrument included 50 items in total. Of these, 49 had content validity index between 0.81 and 1.00, and Kappa between 0.61 and 0.99. Only an item had Kappa >0.61 (K = 0.50; CVI = 0.81). The lack of agreement among experts resulted in the exclusion of this item in a third round. The instrument was evaluated positively, reaching Kappa of 0.85, and content validity index of 0.95 in the second Delphi phase. In the last phase, the overall indices of Kappa and content validity of the instrument were 0.98 and 0.99, respectively. The instrument presented satisfactory content validity index and can be used to identify signs of suspected violence and help health professionals in child care.
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Condi??es de sa?de e de trabalho de profissionais que atuam na aten??o b?sicaRocha, Anna Luisa Alkmin 16 December 2014 (has links)
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Previous issue date: 2014 / As condi??es do trabalho, a organiza??o, a concep??o e o ambiente das atividades laborais aos quais os profissionais da aten??o b?sica do Sistema ?nico de Sa?de est?o inseridos podem ter grande influ?ncia sobre a condi??o de sa?de devido ? complexidade do servi?o. Assim, a avalia??o das condi??es de trabalho e sa?de torna-se importante instrumento de an?lise com possibilidades de interven??o em busca de melhoria da qualidade de vida dos trabalhadores. Objetivou-se, assim, conhecer a condi??o de sa?de e de trabalho dos profissionais da aten??o b?sica dos quinze munic?pios que comp?em a Regi?o de Sa?de de Diamantina/MG, atrav?s de um estudo transversal com base em um question?rio semiestruturado e com an?lises antropom?tricas. A Organiza??o Mundial da Sa?de proclama os trabalhadores de sa?de como seu mais valioso recurso, assim, como profissional da aten??o b?sica ? necess?rio que esse desperte para a pr?pria condi??o de sa?de, reconhecendo e analisando situa??es que possam influenciar e determinar a qualidade de vida. Participaram da pesquisa 290 profissionais da Estrat?gia Sa?de da Fam?lia, 42,4% atuam na aten??o b?sica por contrato tempor?rio; 84% com dedica??o exclusiva; 94,8% referem realizar carga hor?ria de 40 horas semanais. A taxa de absente?smo no servi?o nos 12 meses anterior ? pesquisa foi de 40,7% com destaque para as doen?as osteomusculares, a preval?ncia de morbidade foi relatada por 34,8% dos profissionais. Entre os participantes, 55,2% afirmam que o trabalho interfere na condi??o de sa?de. Destaca-se que 54% dos trabalhadores encontram-se acima do peso adequado e que 28,7% das mulheres e 8,6% dos homens apresentam risco aumentado para desenvolver doen?as cardiovasculares. O acidente de trabalho foi relatado por 15,5% dos participantes. A automedica??o foi relatada por 60,7% e a participa??o em atividades de promo??o ? sa?de por 24,8%. Assim, foi poss?vel verificar a condi??o de trabalho e sa?de dos profissionais que atuam na aten??o b?sica com o prop?sito que os resultados possam subsidiar a tomada de decis?o para que a sa?de do trabalhador fortale?a e seja valorizada no ?mbito da gest?o da sa?de. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2014. / ABSTRACT
Working conditions, organization, conception and the environment to which basic health care professionals are subjected to while working in the Single Health System (Sistema ?nico de Sa?de ? SUS) can have a great effect on their health conditions, due to the complexity of the service. Thus, an assessment of health and working conditions is an essential instrument of analysis, with the possibility of interventions, in the search for improvements in the quality of life of workers. Therefore, the aim of the present study was to assess the health and working conditions of basic healthcare professionals in the fifteen (15) districts that make up Health Region of Diamantina/MG (Brazil). This was a cross-sectional study based on a semi-structured questionnaire and anthropometric analysis. The World Health Organization has stated that healthcare workers are its most valuable resource. Thus, the welfare of basic healthcare professionals needs to be recognized and situations that can affect and determine their quality of life must be analyzed. In total, 290 Family Health Strategy professionals participated in the present study: 42.4% were involved in basic healthcare on temporary contracts; 84% were exclusively dedicated to basic healthcare; 94.8% reported a weekly workload of 40 hours. The rate of absenteeism in the area during the 12 months prior to the study was reported as 40.7%, with a significant number of osteomuscular diseases cited. Morbidity was reported by 34.8% of the professionals. Among the participants, 55.2% stated that their job affected their health. It is notable that 54% of these workers were overweight, with 28.7% of women and 8.6% of men in the high risk category for the development of cardiovascular diseases. Accidents in the workplace were reported by 15.5% of the participants. Self-medication was reported by 60.7%, whereas participation in health-promoting activities was reported by 24.8%. Therefore, it was possible to determine the health and working conditions of basic healthcare professionals. The results of the present study could subsidize the decision making process so that health actions for workers are consolidated and valued in the environment of health management.
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Insatisfa??o com o trabalho e ocorr?ncia de transtornos mentais comuns entre trabalhadores de Sa?deSousa, Camila Carvalho de 31 May 2017 (has links)
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Previous issue date: 2017-05-31 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Job dissatisfaction is a complex phenomenon and depends on internal and external influences to the work environment. It is closely related to the physical and mental health of the worker. However, the association between job dissatisfaction and mental illness has been little explored in the literature. The present study aimed to analyze the job dissatisfaction, referred to by the health care workers of basic care and medium complexity, considering their determinants and effects on mental health (occurrence of common mental disorders - CMD), with specific objectives: describe job dissatisfaction according to sociodemographic aspects and general characteristics of work; to estimate levels of dissatisfaction; to estimate the frequency of CMD; to investigate the association between occupational stress and job dissatisfaction; investigating the association between job dissatisfaction and CMD; considering gender differentials in the estimated associations. A cross-sectional study was conducted in five counties, in Bahia, with 3084 health workers from the medium complexity and primary care services between 2011 and 2012. The results of this dissertation are presented in the format of three scientific articles. In the first article, the job dissatisfaction was evaluated considering the sociodemographic characteristics and general information about the work, the analysis was stratified by gender. It was verified that aspects related to the sexual division of work were positively associated with the levels of job dissatisfaction. In the second article, was evaluated the association of psychosocial aspects of work and job dissatisfaction, based on the combination of occupational stress models (Effort-Reward Imbalance - ERI (mensured by Effort-Reward Imbalance Scale) and Demand-Control Model
?DCM (measured by Job Content Questionnaire - JCQ). The combination of the models proved to be advantageous in investigating the outcome. The third article, analyzed the relationship between job dissatisfaction, referred to by health care workers of basic care and medium complexity, and the occurrence of CMD, using modeling of structural equations. The job dissatisfaction had a direct and positive effect on CMD. The findings reinforce the impact of psychosocial aspects on job dissatisfaction and the impact of job dissatisfaction onmental health with women being the group in which these relationships were more expressive, indicating greater exposure. / A insatisfa??o com o trabalho ? um fen?meno complexo e dependente de influ?ncias internas e externas ao ambiente laboral, podendo estar intimamente relacionada ? sa?de f?sica e mental do trabalhador. Contudo, a associa??o entre insatisfa??o com trabalho e o adoecimento mental, tem sido pouco explorada na literatura. O presente estudo objetivou analisar a insatisfa??o com o trabalho, referida pelos trabalhadores dos servi?os de sa?de da aten??o b?sica e de m?dia complexidade, considerando seus fatores determinantes e os efeitos sobre a sa?de mental (ocorr?ncia de transtornos mentais comuns - TMC), sendo objetivos espec?ficos: descrever a insatisfa??o com o trabalho segundo aspectos sociodemogr?ficos e caracter?sticas gerais do trabalho; estimar os n?veis de insatisfa??o com o trabalho; estimar a frequ?ncia de TMC; investigar associa??o entre estresse ocupacional e insatisfa??o com o trabalho; investigar associa??o entre insatisfa??o com o trabalho e TMC; considerar diferenciais de g?nero nas frequ?ncias e associa??es estimadas. Estudo transversal, conduzido em cinco munic?pios baianos, com 3084 trabalhadores de sa?de dos servi?os de m?dia complexidade e da aten??o b?sica, entre os anos de 2011 a 2012. Os resultados desta disserta??o s?o apresentados no formato de tr?s artigos cient?ficos. No primeiro artigo a insatisfa??o com o trabalho foi avaliada considerando-se as caracter?sticas sociodemogr?ficas e informa??es gerais sobre o trabalho, a an?lise foi estratificada por g?nero, verificou-se que aspectos relativos a divis?o sexual do trabalho se associaram positivamente aos n?veis de insatisfa??o com o trabalho. No segundo artigo, foi avaliada associa??o dos aspectos psicossociais do trabalho e insatisfa??o com o trabalho em sa?de,com base na combina??o de modelos de estresse ocupacional Effort-Reward Imbalance ? ERI (mensurado atrav?s da Escala Desequil?brio Esfor?o-Recompensa) e Modelo Demanda-Controle - MDC, (mensurado pelo Job Content Questionnaire - JCQ). A combina??o dos modelos revelou-se mais vantajosa na investiga??o do desfecho. O terceiro artigo analisou a rela??o entre insatisfa??o com o trabalho e ocorr?ncia de TMC, com emprego de modelagem de equa??es estruturais e estratifica??o da amostra por sexo. A insatisfa??o com o trabalho exerceu efeito direto e positivo sobre os TMC. Os achados refor?am o impacto dos aspectos psicossociais sobre a insatisfa??o com o trabalho e da insatisfa??o sobre a sa?de mental, sendo as mulheres o grupo em que essas rela??es foram mais expressivas, evidenciando maior exposi??o.
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Vitimiza??o percebida e vivenciada por trabalhadores da sa?de: Viol?ncia no ambiente de trabalho e das rela??es sociaisCasaes, Fabiana Mandelo 07 April 2017 (has links)
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Previous issue date: 2017-04-07 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Objective: To identify factors associated with violence witnessed and experienced by health workers in Bahia municipalities. Method: This is an exploratory cross-sectional study, which is part of the multicentric research "Working conditions, conditions of employment and health of health workers in Bahia", carried out in the Basic Attention and Medium Complexity services in the Sanitary District of Historic Center of Salvador and in the municipalities of Feira de Santana, Santo Ant?nio de Jesus, Jequi? and Itabuna, in the years 2011 and 2012. The population of the study was constituted by 6,191 workers. In this study, the dependent variable was the violence experienced by the worker outside the workplace and the violence witnessed by health workers in their workplace. The analysis was made through Hierarchical Logistic Regression based on the conceptual hierarchical model for violence outside work and the multivariate analysis with Poisson Regression for violence witnessed in the workplace. Results: The analysis showed a positive association between age, marital status, schooling, professional category and respiratory diseases for the violence experienced by health workers outside work. The violence witnessed by health workers remains statistically associated with high school / technical education, higher education, post-graduation, threatened personal security, Cap X, health unit. Final Considerations: It has been found that in all contexts, a prevalence of violence is an important fact and that it is an observatory with caution, both on the part of the workers, with the management of public powers. The factors that contributed the most to the dissemination of problems, both in the national and international literature, and ratify the importance of this work. This study was developed with the health team because of the importance of its native role in the entire population, but it is worth mentioning an eminence of future work on the problem, which is that you know the expansion of study places, expanding to other states And Municipalities, in order to compare the reality in which health workers live, as a study population, is already an issue that involves all members of society without distinction. / Objetivo: Identificar fatores associados ? viol?ncia presenciada e vivenciada por trabalhadores da sa?de em munic?pios baianos. M?todo: Trata-se de um estudo de corte transversal, explorat?rio, integrante da pesquisa multic?ntrica ?Condi??es de trabalho, condi??es de emprego e sa?de dos trabalhadores da sa?de na Bahia?, realizado nos servi?os de Aten??o B?sica e de M?dia Complexidade no Distrito Sanit?rio do Centro Hist?rico de Salvador e nos munic?pios de Feira de Santana, Santo Ant?nio de Jesus, Jequi? e Itabuna, nos anos 2011 e 2012. A popula??o do estudo foi constitu?da por 6.191 trabalhadores. Neste estudo a vari?vel dependente foi a viol?ncia vivenciada pelo trabalhador fora do local de trabalho e a viol?ncia presenciada pelos trabalhadores de sa?de no seu local de trabalho. A an?lise foi feita atrav?s da Regress?o Log?stica Hierarquizada baseada no modelo hier?rquico conceitual, para a viol?ncia fora do trabalho e a an?lise multivariada com Regress?o de Poisson para a viol?ncia presenciada no local de trabalho. Resultados: A an?lise mostrou associa??o positiva entre faixa et?ria, situa??o conjugal, escolaridade, categoria profissional e doen?as no aparelho respirat?rio para a viol?ncia vivenciada pelos trabalhadores de sa?de fora do trabalho. A viol?ncia presenciada pelos trabalhadores de sa?de permaneceu estatisticamente associadas a escolaridade ensino m?dio/t?cnico, ensino superior, p?s-gradua??o, seguran?a pessoal amea?ada, Cap X, unidade de sa?de. Considera??es Finais: Verificou-se que, em todos os contextos, a preval?ncia da viol?ncia ? um dado importante e que deve ser observado com cautela, tanto por parte dos trabalhadores, com da gest?o e dos poderes p?blicos. Os fatores associados a viol?ncia confirmam os achados de v?rios outros estudos, tanto na literatura nacional, como internacional e ratificam a import?ncia desse trabalho, advertindo sobre a necessidade de enfrentamento desse problema. Este estudo foi realizado com trabalhadores de sa?de pela import?ncia do seu papel na assist?ncia a toda a popula??o, mas vale destacar a emin?ncia de trabalhos futuros acerca da problem?tica, tanto no que se refere a amplia??o de locais de estudo, se expandindo para outros Estados e munic?pios, afim de comparar a realidade em que vive os trabalhadores de sa?de, como a pr?pria popula??o de estudo, j? ? um tema que envolve todos os membros da sociedade, sem distin??o.
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Aspectos psicossociais do trabalho e transtornos mentais comuns em trabalhadores da aten??o b?sicaPereira, Thalles da Costa Lob? 30 April 2012 (has links)
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Previous issue date: 2012-04-30 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Primary health care structure the Unified Health System in Brazil. However, the primary health care workers experience increasing demands, repetitive tasks, fast pace and lack of autonomy on their jobs. These are organizational factors, which can be grouped by psychosocial work characteristics of demand-control model. Demand-control model has assessed job stress and mental and physical illness. Then this study examined the association between psychosocial work characteristics and common mental disorders (CMD) in primary health care workers of Belo Horizonte, Brazil. This study examined the association between psychosocial work characteristics and common mental disorders (CMD) in primary health care workers of the city of Belo Horizonte, Southeastern Brazil. A cross-sectional study was conducted. A stratified random sampling method was used to select 1,808 health workers. A total of 1,024 participants worked in primary care services. Psychosocial work characteristics were assessed using the demand control model, while common mental disorders were evaluated with the Self-Reporting Questionnaire. The association measures were crude and adjusted prevalence ratios, 95% confidence intervals and p-values. The prevalence of CMD was 27.9% (95%CI = 25.1%-30.7%). Associations were found between common mental disorders and demands (p < 0,001), control (p = 0,008) and social support (p < 0,001). High strain was strongly associated with CMD after adjusting for confounders (PR = 2,52, 95%CI = 1.55-4.08). There was a high prevalence of CMD among primary health care workers. In this study, psychological demands and control had the same influence on mental health. It is recommended that changes should be made in the work characteristics of primary health care. Additionally, the quality of health services will not improve while workers? health policies are not applied. / A aten??o b?sica ? o primeiro n?vel de aten??o e estrutura o Sistema ?nico de Sa?de. Entretanto, o trabalho nos servi?os de aten??o b?sica apresenta demandas crescentes, repetitividade das tarefas, rapidez no atendimento e perda da autonomia. Tais caracter?sticas podem ser agrupadas segundo aspectos psicossociais do modelo demanda-controle. O modelo demanda-controle tem sido usado para avaliar a rela??o entre estresse ocupacional e agravos ? sa?de, entre os quais transtornos mentais. Logo, este estudo avaliou a associa??o entre aspectos psicossociais do trabalho e transtornos mentais comuns em trabalhadores da aten??o b?sica de Belo Horizonte. Trata-se de uma investiga??o com delineamento transversal. A amostra foi aleat?ria, estratificada por ?reas geogr?ficas, setor de atua??o e grupos ocupacionais. A amostra totalizou 1.808 indiv?duos, dos quais 1.072 eram trabalhadores da aten??o b?sica. Os aspectos psicossociais foram avaliados por meio das categorias do modelo demanda-controle, enquanto transtornos mentais comuns (TMC) foram avaliados pelo Self-Reporting Questionnaire (SRQ-20). Adotou-se o ponto de corte 6/7 para mulheres e 5/6 para homens no SRQ-20. Os pontos de corte dos indicadores do JCQ foram as m?dias. As medidas de associa??es foram raz?es de preval?ncias intervalos de 95% de confian?a e valores de p. A an?lise ajustada envolveu a constru??o de um modelo de regress?o log?stica. A preval?ncia de TMC foi de 27,9%. Houve associa??o entre transtornos mentais e os aspectos de demandas (p?0,001), controle (p=0,008) e suporte social (p?0,001). A categoria de alta exig?ncia apresentou forte associa??o com TMC ap?s ajuste por confundidores (RP=2,52, IC95%=1,55-4,08). Neste estudo, demandas psicol?gicas e controle tiveram influ?ncias semelhantes sobre a sa?de mental. Sugerem-se mudan?as no processo de trabalho na aten??o b?sica e execu??o das pol?ticas de sa?de do trabalhador da sa?de.
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Reanima??o neonatal: capacita??o de profissionais de sa?de com base na aprendizagem baseada em problemasMedeiros, Jane Cristina 11 May 2015 (has links)
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Previous issue date: 2015-05-11 / Em todo o mundo, incluindo no Brasil, h? uma falta de profissionais habilitados na
pr?tica de reanima??o neonatal pela falta de acesso ao treinamento ou mesmo ao
treinamento inadequado destes profissionais. Este trabalho relata a constru??o e
aplica??o de um curso em reanima??o neonatal voltado a profissionais de sa?de
com pouco ou nenhum conhecimento em reanima??o neonatal, utilizando a
metodologia da aprendizagem baseada em problemas (ABP). O curso foi realizado
em dois encontros, um para a realiza??o da sess?o tutorial, e um para treinamento
pr?tico nas habilidades relacionadas. Os participantes foram divididos em grupos de
oito profissionais sob a supervis?o de dois tutores com experi?ncia no emprego da
metodologia ABP. A experi?ncia foi considerada como bem sucedida, pois promoveu
o envolvimento dos participantes e motiva??o para o aprendizado. Alguns aspectos
foram refor?ados para o aprimoramento do curso, como o rigor no emprego correto
da metodologia ABP e a constru??o de material did?tico personalizado voltado para
as necessidades de aprendizagem dos alunos. Sugere-se que a proposta de curso
desenvolvida ? adequada tamb?m para estudantes de gradua??o de Medicina e
Enfermagem, ou outros cursos. / In whole world, including in Brazil, there is an absence of professionals who are able
to be present at the moment of birth and give to the newborn the cares that they
need to because either an absence of opportunity or inappropriate training to those
professionals. This master?s thesis describes a construction and application of a
neonatal resuscitation course that uses the problem based learning (PBL)
methodology. The course has done in two meetings, one for the tutorial session, and
another for practice session. The students were divided in groups of eight students
each, under supervision of two teachers with experience in PBL methodology. The
experience was considered successfully because there were students involvement
and motivation. Some course aspects were rebuilt for its upgrading, like the correct
use of methodology and building of custom educational material for students learning
necessity. It suggests that the course can be used by the medical and nursing
schools and perhaps other kind of health courses.
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