Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-12-12T17:33:31Z No. of bitstreams: 1 JulianaMotaFerreira_TESE.pdf: 2586511 bytes, checksum: 541ae9e7da732f4f7939f6e4b0f4b8d4 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-12-13T17:02:34Z (GMT) No. of bitstreams: 1 JulianaMotaFerreira_TESE.pdf: 2586511 bytes, checksum: 541ae9e7da732f4f7939f6e4b0f4b8d4 (MD5) / Made available in DSpace on 2017-12-13T17:02:34Z (GMT). No. of bitstreams: 1 JulianaMotaFerreira_TESE.pdf: 2586511 bytes, checksum: 541ae9e7da732f4f7939f6e4b0f4b8d4 (MD5) Previous issue date: 2017-09-15 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / A Aten??o Prim?ria ? Sa?de (APS) possui quatro atributos essenciais: acesso de primeiro contato, continuidade e integralidade da aten??o, e coordena??o da assist?ncia; e mais tr?s atributos derivados: aten??o centrada na fam?lia, orienta??o comunit?ria e compet?ncia cultural. A identifica??o da presen?a e extens?o desses atributos ? importante para definir um servi?o como orientado para a APS, e permite verificar a associa??o entre estes e os resultados da aten??o sobre a sa?de da popula??o. Todavia, avaliar o servi?o de sa?de consiste apenas na fase inicial do processo de qualifica??o, devendo ser seguido pelo desenvolvimento de estrat?gias para a melhoria da qualidade da APS. Dentro desse contexto, o presente estudo teve como objetivo avaliar os atributos da APS em um munic?pio do Nordeste do Brasil, e descrever estrat?gias utilizadas em ?mbito nacional e internacional para melhoria dos servi?os. Foi realizado um estudo transversal descritivo para avaliar a presen?a e extens?o dos atributos da APS, por meio da aplica??o do instrumento PCATool-Brasil, sendo classificados como alto escore os atributos que obtinham valores iguais ou maiores que 6,6. A an?lise final mostrou pontua??o total m?dia de 6,88 ? 0,91. A pontua??o m?dia para o atributo essencial foi 6,61 ? 0,91 e para o atributo derivado foi 7,80 ? 1,30. O componente de primeiro contato-acesso mostrou m?dia baixa (3,76 ? 1,11), enquanto que o sistema de coordena??o de informa??es apresentou a maior pontua??o m?dia (8,06 ? 1,60). Em um segundo momento, foram realizadas duas revis?es da literatura, buscando descrever experi?ncias internacionais relacionadas a melhorias na APS, e estrat?gias utilizadas no Brasil para ampliar a qualidade dos resultados. A maioria dos estudos internacionais estavam relacionados ? coordena??o do cuidado, programas ou modelos para gerenciar as pr?ticas, e ferramentas de tecnologia. As estrat?gias descritas no Brasil foram, em sua maioria, direcionadas para promo??o da sa?de e preven??o de agravos, utilizando educa??o em sa?de, orienta??o farmac?utica e nutricional e recursos tecnol?gicos. Concluiu-se que a avalia??o dos atributos mostrou forte orienta??o para APS, considerando a acessibilidade como um grande desafio no Brasil. A revis?o das experi?ncias para melhoria da APS mostrou ser um mecanismo relevante na identifica??o de poss?veis solu??es para superar obst?culos e alcan?ar melhores resultados em sa?de. / Primary Health Care (PHC) has four essential attributes: first contact access, ongoing care, comprehensiveness and coordination of care, and three derivative attributes: family centeredness, community orientation, and cultural competence. The identification of the presence and extension of these attributes is important in defining a service as oriented to PHC, and allows for the verification of the association between these and the results of the delivered care on the targeted population?s health. However, to evaluate the health service consists of the initial phase of the qualification process, and must be followed by the development of strategies aimed at improving PHC quality. Within this context, the present study aims to evaluate the attributes of APS in a municipality in the Northeast of Brazil, and to describe strategies used at the national and international level to improve services. A cross-sectional and descriptive study was carried out to evaluate the presence and extent of attributes of APS, through the PCATool-Brazil instrument, being classified as high score the attributes that obtained values equal or greater than 6.6. The final analysis showed the total average score of 6.88?0.91. The average score for essential attribute was 6.61?0.91, and for the derived attribute was 7.80 ? 1.30. The first contact-access component showed low average (3.76 ? 1.11), while the coordination-information system showed the highest average score (8.06 ? 1.60). Second, two reviews of the literature were carried out, that sought to describe international experiences related to improvements in PHC, and strategies used in Brazil to increase the quality of outcomes. The majority of the international studies were related to the coordination of care, programs or models to manage the practices, and technological tools. The strategies described in Brazil were mostly directed at health promotion and disease prevention, using health education, pharmaceutical and nutritional guidance, and technological resources. It was concluded that the evaluation showed strong orientation to primary health care, considering accessibility as a great challenge in Brazil. The review of experiences to improve PHC has proven to be a relevant mechanism to identify possible solutions to overcome obstacles and achieve better health outcomes.

Made available in DSpace on 2014-12-17T14:46:36Z (GMT). No. of bitstreams: 1 LucilaCP.pdf: 784288 bytes, checksum: 4004c3c28db8291809b6fa8c957d99e3 (MD5) Previous issue date: 2008-04-28 / The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient. / As ?lceras de press?o (UP), denominadas tamb?m ?lcera de dec?bito, s?o definidas como les?es causadas pela constante press?o exercida sobre um determinado ponto do corpo, ocasionando comprometimento do aporte sangu?neo com diminui??o ou interrup??o da irriga??o tissular, ocasionando oclus?o de vasos e capilares, isquemia e morte celular. Trata-se de um estudo descritivo com delineamento longitudinal, tipo painel, com abordagem quantitativa que objetivou analisar a associa??o existente entre condi??es predisponentes (CP), fatores intr?nsecos (FI) e fatores extr?nsecos (FE) com a ocorr?ncia de UP, em pacientes internados em Unidade de Terapia Intensiva (UTI), enfermarias de cl?nicas m?dica, cir?rgica e neurologia de um hospital universit?rio. A popula??o do estudo foi composta por todos os pacientes que estiveram acamados durante o per?odo de dezembro de 2007 a fevereiro de 2008. O estudo foi aprovado pelo Comit? de ?tica do HUOL/UFRN (no 135/07). A coleta de dados realizou-se por meio de um formul?rio estruturado de observa??o, dados dos prontu?rios e exame f?sico da pele dos pacientes. Os resultados foram organizados no programa SPSS 15.0, tabulados, categorizados e analisados por meio de estat?stica descritiva e inferencial. Dos 30 pacientes pesquisados, 43,3% encontravam-se internados na enfermaria de cl?nica m?dica e cl?nica cir?rgica, 20,0% na UTI, 20,0% na UTI/enfermaria e 16,7% na neurologia, sendo o tempo de interna??o nessas unidades de 7 a 18 dias (63,3%) e de 19 a 30 dias (36,7%), com predomin?ncia do sexo feminino e faixa et?ria ≥ 60 anos (60,0%). Foram diagnosticadas 19 UP em 43,3% dos pacientes acompanhados, 38,5% com uma UP entre 7 a 18 dias e 46,2% com duas ou mais entre 19 a 30 dias de interna??o, mostrando rela??o significativa (ρ-valor = 0,029) entre tempo de interna??o e o n?mero de UP. Verificou-se associa??o de 35,7% das CP (cardio-respirat?rias, hematol?gicas, metab?licas e psicog?nicas), FI (faixa et?ria, edema, altera??o na umidade da pele e altera??o da temperatura corporal) e FE (tipo de colch?o e for?a de press?o do corpo) no conjunto dos pacientes pesquisados, estatisticamente significante (ρ-valor = 0,001), entre as m?dias dos escores nos pacientes com e sem UP, com raz?o de chance de 12,0 de desenvolvimento de UP e exist?ncia de moderada correla??o (r = 0,618) na presen?a dessa associa??o. Os resultados denotam a influ?ncia da multiplicidade de fatores e condi??es na ocorr?ncia de UP, o que nos remete a refletir acerca da assist?ncia voltada para preven??o e diminui??o dessas les?es o que ir? favorecer a redu??o do tempo de internamento, sofrimento f?sico e psicol?gico, bem como a possibilidade de melhora do estado cl?nico do paciente.

Made available in DSpace on 2014-12-17T14:46:38Z (GMT). No. of bitstreams: 1 MaisaAS.pdf: 2002111 bytes, checksum: 3639909687907c825b2fac2980223c4c (MD5) Previous issue date: 2008-12-23 / Prospective descriptive study with quantitative approach, which aimed to analyze the relationship of the knowledge of Nurses and conduct assistance during the process of transfusion, to patients in the ICU of a university hospital in Natal-RN. The sample consisted of 27 professionals from the nursing staff (5 nurses and 22 nursing technicians), climbing in the ICU during the period of data collection. Data collection was through a questionnaire and structured form of observation, in addition to consulting the diary. The results were organized in SPSS 15.0, tabulated, cathegorized and analyzed by descriptive and inferential statistics. The results show a young population, aged between 21 and 32 years (63.0%), female (85.2%). Among those surveyed were the main type of stock, mostly technical, nursing (ρ= 0006), which have little time to experience - up to 2 years (ρ= 0008), did not know the DRC in 153 (ρ= 0019), held greater number of pipelines care in blood (ρ= 0018), the non-participation in training and feel informed about the process of transfusion, showed no significant differences. As for officials, highlighted only the time to experience more than 2 years, carrying out fewer procedures and feel informed about the blood. As for the pipes during the transfusion process, I found that the majority of pipes observed in both the stock and the staff were inadequate, with predominance in the first, both in the pursuit of conduct regarding the shortfall. The averages of inappropriate conduct, predominantly developed by stock, were higher in all stages for appropriate conduct. Analyzing the knowledge about the disease process, the stock market were those who had lower scores of knowledge in three stages. As the relationship between the pipes care and knowledge, we see that at all stages of the process of transfusion inadequate knowledge of the averages were higher, taking a significant difference in the stages pre-transfusion (ρ= 0012). When analyzing the average of pipes behind, we see that in inappropriate conduct were significantly higher (ρ= 0031), who had searched in inadequate knowledge. As for the frequency of total procedures performed, we found a significant predominance (ρ= 0049) of inappropriate conduct (88.9%) of which 81.5% were developed by professionals who had inadequate knowledge, showing moderate correlation (r = 0,516) and odds ratio of 2,750 times the development of inappropriate conduct in trade with inadequate knowledge. We conclude that the professionals surveyed, especially the technicians of nursing stock, showed serious deficiencies with regard to the development of pipelines and knowledge of the transfusion process, showing the inadequacy to develop this therapy. Facing the foregoing, we accept the alternative hypothesis proposed in the study, because we show that the inadequacy of knowledge about the process of transfusion influence in inappropriate conduct implemented by the nursing staff in ICU. / Estudo descritivo prospectivo, com abordagem quantitativa, que objetivou analisar a rela??o entre o conhecimento dos profissionais de enfermagem e as condutas assistenciais prestadas, durante o processo transfusional, aos pacientes na UTI de um hospital universit?rio em Natal-RN. A amostra foi composta por 27 profissionais da equipe de enfermagem (5 enfermeiros e 22 t?cnicos de enfermagem), escalados para a UTI durante o per?odo da coleta de dados, coleta esta realizada por meio de question?rio e formul?rio de observa??o estruturados, al?m da consulta ao prontu?rio. Esses resultados foram organizados no programa SPSS 15.0, tabulados, categorizados e analisados por meio de estat?stica descritiva e inferencial. Os resultados mostram uma popula??o jovem, na faixa et?ria entre 21 e 32 anos (63,0%), do sexo feminino (85,2%). Dentre os pesquisados houve predomin?ncia de bolsistas, em sua maioria t?cnicos de enfermagem (ρ= 0,006), os quais possuem pouco tempo de experi?ncia, at? 2 anos (ρ= 0,008), n?o conhecem a RDC no 153 (ρ= 0,019), realizaram o maior n?mero de condutas assistenciais na hemotransfus?o (ρ= 0,018), a n?o participa??o de treinamentos e a falta de informa??o sobre o processo transfusional n?o resultaram em diferen?as significativas. Quanto aos funcion?rios, destacaram-se apenas o tempo de experi?ncia superior a 2 anos, a realiza??o de menor n?mero de procedimentos e se sentirem informados sobre a hemotransfus?o. Em rela??o ?s condutas durante o processo transfusional, constatamos que, na maioria, as condutas observadas, tanto dos bolsistas como dos funcion?rios foram inadequados, com predomin?ncia nos primeiros, tanto na realiza??o das condutas quanto na inadequa??o. As m?dias das condutas inadequadas, predominantemente desenvolvidas pelos bolsistas, foram maiores em todas as etapas em rela??o ?s condutas adequadas. Analisando o conhecimento sobre o processo transfusional, os bolsistas foram os que apresentaram os menores escores de conhecimento nas tr?s etapas. Quanto ? rela??o existente entre as condutas assistenciais e o conhecimento, verificamos que em todas as etapas do processo transfusional as m?dias de conhecimentos inadequados foram superiores, tendo diferen?a significativa nas etapas pr?-transfusional (ρ= 0,012). Ao analisarmos a m?dia de condutas desenvolvidas, verificamos que nas condutas inadequadas foram significativamente maiores (ρ= 0,031) nos pesquisados que apresentaram conhecimentos inadequados. Quanto ? frequ?ncia total de procedimentos realizados, verificamos uma predomin?ncia significativa (ρ= 0,049) de condutas inadequadas (88,9%), das quais 81,5% foram desenvolvidas por profissionais que tiveram conhecimento inadequado, apresentando moderada correla??o (r = 0,516) e raz?o de chance de 2,750 vezes de desenvolvimento de condutas inadequadas nos profissionais com conhecimentos inadequados. Conclu?mos que os profissionais pesquisados, principalmente os t?cnicos de enfermagem bolsistas, apresentaram defici?ncias graves no tocante ao desenvolvimento das condutas e conhecimento sobre o processo transfusional, denotando a inadequa??o para desenvolver essa terap?utica. Diante do exposto, aceitamos a hip?tese alternativa proposta no estudo, pois evidenciamos que a adequa??o do conhecimento sobre o processo transfusional influenciou nas condutas adequadas implementadas pela equipe de enfermagem na UTI.

Made available in DSpace on 2014-12-17T14:46:39Z (GMT). No. of bitstreams: 1 ParticiaCBF_DISSERT.pdf: 926078 bytes, checksum: 9ea88765b5e731681c2629ed4e7288ec (MD5) Previous issue date: 2009-09-29 / A descriptive, quantitative approach and non-participant observation study, which was aimed at analyzing the association between knowledge and practice of inclusion and maintenance of urinary catheter by nursing professionals in the occurrence of urinary tract infection, performed in the ICU of Onofre Lopes University Hospital in Natal / RN. The original sample was composed of 42 nursing staff professional, five (5) nurses and 37 nursing technicians, 27 of them were outsourced (FUNPEC and IEL fellows) and 10 servers UFRN. Data collection was performed using two instruments, the first observation procedures used in the insertion and manipulation of indwelling urinary catheter (IUC) and the second with a questionnaire that addressed the characterization data of respondents, knowledge and conduct the insertion and manipulation of the IUC. The results were tabulated in Microsoft Excel and analyzed using SPSS software, version 15.0. We found the prevalence of institutional staff members on outsourcing - IEL and FUNPEC - (64.3%) were female (69.0%), aged 21 to 35 years (59.5%) and with mid-level education (88.1%). As to knowledge, we found that the nurses had levels of good to excellent and the nursing technicians, to regulate the poor. The nurses made a mistake when choosing IUC (40.0%) and washing hands (30.0%) and technicians on hand washing (74.4%) and the contents of the tray (34.7%). In relation to the conduct of insertion of IUC, the nurses made a mistake when choosing SVD (66.7%) and washing hands (57.1%). Regarding the handling of IUC/drainage system, the technicians were wrong more about washing their hands (56.0%). Analyzing the misconduct to the categorization of knowledge, we saw that the nursing staff who had missed more had inadequate knowledge (ρ = 0.001). At the end we found the risk of a patient to acquire UTI is higher in two and a half times when there is a large number of mismatches, patient spends more time using the IUC and hospitalized in the ICU. As regards the study hypotheses, we accept the alternative hypothesis and reject the null hypothesis proposed at the start of this research, where the number of gaps in knowledge and behavior increases the incidence of urinary tract infection. / Estudo descritivo, de abordagem quantitativa e observacional n?o participante, que teve como objetivo geral analisar a associa??o do conhecimento e conduta de inser??o e manuten??o da sonda vesical de demora pelos profissionais de enfermagem na ocorr?ncia de infec??o do trato urin?rio, realizado na UTI do Hospital Universit?rio Onofre Lopes em Natal/RN. A amostra pesquisada foi composta por 42 profissionais da equipe de enfermagem, sendo cinco (5) enfermeiros e 37 t?cnicos de enfermagem, deles 27 eram terceirizados (FUNPEC e bolsistas do IEL) e 10 servidores da UFRN. A coleta de dados foi realizada atrav?s de dois instrumentos, o primeiro utilizado na observa??o procedimentos de inser??o e de manipula??o da Sonda Vesical de Demora (SVD) e o segundo, com a aplica??o de um question?rio que abordou dados de caracteriza??o dos pesquisados, conhecimentos e conduta na inser??o e manipula??o da SVD. Os resultados foram tabulados no Excel e analisados atrav?s do programa estat?stico SPSS, vers?o 15.0. Encontramos a predomin?ncia de funcion?rios com v?nculo institucional terceirizado IEL e FUNPEC - (64,3%), do sexo feminino (69,0%), na faixa et?ria de 21 a 35 anos (59,5%) e com n?vel m?dio de escolaridade (88,1%). Quanto aos conhecimentos, verificamos que os enfermeiros apresentaram n?vel de bom a ?timo e os t?cnicos de enfermagem, de regular a ruim. Os enfermeiros erraram mais na escolha da SVD (40,0%) e na lavagem das m?os (30,0%) e os t?cnicos, na lavagem das m?os (74,4%) e no conte?do da bandeja (34,7%). Em rela??o ?s condutas de inser??o da SVD, os enfermeiros erraram mais na escolha da SVD (66,7%) e na lavagem das m?os (57,1%). Em rela??o ? manipula??o da SVD/sistema de drenagem, os t?cnicos erraram mais ao lavar as m?os (56,0%). Ao analisarmos as condutas inadequadas com a categoriza??o do conhecimento, vimos que os t?cnicos de enfermagem que erraram mais apresentaram conhecimentos inadequados (ρ = 0,001). Ao final, vimos que o risco de um paciente adquirir ITU est? maior em duas vezes e meia quando ocorre um n?mero grande de inadequa??es, paciente passa mais tempo usando a SVD e internado na UTI. Quanto ?s hip?teses do estudo, aceitamos a Hip?tese alternativa e rejeitamos a hip?tese nula proposta no in?cio desta pesquisa, onde a quantidade de inadequa??es no conhecimento e conduta aumenta a ocorr?ncia de infec??o do trato urin?rio.

Made available in DSpace on 2014-12-17T14:46:41Z (GMT). No. of bitstreams: 1 RodrigoAND_DISSERT.pdf: 4123762 bytes, checksum: 769cd7b343d86a0d219577a0a3bf4575 (MD5) Previous issue date: 2009-10-30 / Exploratory descriptive study, with a quantitative approach and prospective data, performed in Pronto Socorro Cl?vis Sarinho (PSCS), in Natal/RN, aiming to analyze care given by the nursing and medical staff to victims of violence attended to in an emergency hospital in Natal/RN; to identify care given by the nursing and medical staff as viewed by the victims; to compare data observed during the process of care with the victim s view on the care given by the nursing and medical staff; to identify the existing knowledge on violence and the process of caring for victims and its relation with prejudice; to identify obstacles and perspectives for prevention during the process of caring for victims in the emergency services. The population consisted of 97 physicians, 16 nurses, 75 nursing technicians and assistants and 365 victims of violence, with data collected from April to May 2009. Out of 188 professionals, 52.1% are female; 32% were aged 41 to 50; 99.5% had given care to a victim of violence; 90.4% reported to have given care to patients under custody; among these, 17.3% felt prejudice; 55.3% stated they don t provide different care for assaulted victims and assailants, however 44.7% stated they do; 86.7% feel their workplace is unsafe; 61.7% denied the existence of any obstacle and 38.3% reported the existence of obstacles; among these, 26.1% referred to inadequate facilities; 37.8% believe reinforcing security and professional training are the main solutions. Among the 365 researched violence victims, 82.2% were assaulted; male (69.6%); aged 18 to 24 (24.9%); hailing from the Greater Natal area (89.9%); on 19.7% the event happened on Saturday; during the night (48.8%); victim of physical assault (61.4%); produced by body force (27.7%); 24.4% were injured in the head and neck. 57% had used some drug, among which alcohol was predominant (75.5%). On 621 observations performed during the victim care process, when compared to the report of assaulted victims, there was a statistical difference, at 5% significance level, regarding reception, resistance from the professionals, questioning about the violent event, providing of guidance, interaction with the patient and the understanding of receiving proper care, and care resolution. In comparisons involving the observed and the assailant victims reports, there was a statistical difference regarding the resence of resistance from the professionals, performance of necessary procedures and the nteraction with the patient and the understanding of receiving proper care and 58.1% reported the nursing team was the one that provided the best care. We conclude that professionals had lready given care to assailant patients, acknowledge the importance of knowing how the vent took place and acquired this preparation during their practice. The most often referred bstacles that hinder assistance were: inadequate facilities, material deficit and lack of rofessional preparation. As solutions for these problems, they cited the reinforcement of ecurity and professional training / Estudo explorat?rio descritivo, com abordagem quantitativa e dados prospectivos, realizado no Pronto Socorro Cl?vis Sarinho (PSCS), em Natal/RN, com vistas a analisar o cuidado prestado pela equipe de enfermagem e m?dica, ?s v?timas de viol?ncia atendidas em um hospital de urg?ncia em Natal/RN; identificar na vis?o das v?timas o cuidado prestado pela equipe de enfermagem e m?dica; comparar os dados observados durante o processo de cuidar com a vis?o da v?tima sobre o cuidado prestado pela equipe de enfermagem e m?dica; identificar o conhecimento existente sobre viol?ncia e o processo de cuidar ?s v?timas e sua rela??o com o preconceito; identificar os obst?culos e as perspectivas de preven??o durante o processo de cuidar ?s v?timas nos servi?os de urg?ncia. A popula??o constou de 97 m?dicos, 16 enfermeiros, 75 t?cnicos e auxiliares de enfermagem e 365 v?timas de viol?ncia, com dados coletados de abril a maio de 2009. Dos 188 profissionais, 52,1% s?o do sexo feminino; 32% tinham entre 41 e 50 anos; 99,5% haviam cuidado de alguma v?tima de viol?ncia; 90,4% afirmaram j? ter cuidado de paciente custodiado; dentre estes, 17,3% sentiram preconceito; 55,3% afirmaram que n?o cuidam de uma v?tima agredida diferente de uma agressora, por?m 44,7% afirmaram que sim; 86,7% acham seu local de trabalho inseguro; 61,7% negaram a exist?ncia de algum obst?culo e 38,3% afirmaram a exist?ncia de obst?culo; dentre estes, 26,1% referiram-se ao espa?o f?sico inadequado; 37,8% acham que o refor?o na seguran?a e a capacita??o dos profissionais, s?o as principais solu??es. Das 365 v?timas de viol?ncia pesquisadas, 82,2% foram agredidas; do sexo masculino (69,6%); tinham entre 18 a 24 anos de idade (24,9%); procedentes da Grande Natal (89,9%); em 19,7% o evento ocorreu no s?bado; no hor?rio noturno (48,8%); v?tima de agress?o f?sica (61,4%); produzida por for?a corporal (27,7%); 24,4% sofreram les?es na cabe?a e pesco?o; 57% haviam usado alguma droga, destes, predominando o ?lcool (75%). Das 621 observa??es feitas durante o processo de cuidar das v?timas, quando comparadas ao relato das v?timas agredidas, houve diferen?a estat?stica, ao n?vel de signific?ncia de 5%, em rela??o ao acolhimento, presen?a de resist?ncia por parte dos profissionais, questionamento sobre o evento violento, fornecimento de orienta??es, intera??o com o paciente e entendimento de ser bem atendido, e resolutividade do atendimento. Nas compara??es entre o observado e o relato das v?timas agressoras, houve diferen?a estat?stica, quanto ? presen?a de resist?ncia por parte dos profissionais, realiza??o dos procedimentos necess?rios e quanto a intera??o com o paciente e entendimento de ser bem atendido e 58,1% das v?timas relataram que a equipe de enfermagem foi a que melhor atendeu. Conclu?mos que os profissionais j? haviam cuidado de pacientes agressores, reconhecem a import?ncia de conhecer como se deu o evento e adquiriram esse preparo em suas pr?ticas. O cuidado durante as observa??es e no relato das v?timas, este sofre interfer?ncia dos sentimentos de medo ou preconceito em rela??o as v?timas agressoras e isto foi percebido por elas. Os obst?culos mais referidos que dificultam a assist?ncia, foram: o espa?o f?sico inadequado, o d?ficit de materiais e o despreparo dos profissionais. Como solu??es desses problemas, citaram o refor?o na seguran?a e capacita??o dos profissionais

Made available in DSpace on 2014-12-17T14:46:45Z (GMT). No. of bitstreams: 1 MariliaFGS_DISSERT.pdf: 1695269 bytes, checksum: 7ad7b75ff5b630455afa1f8a0124e664 (MD5) Previous issue date: 2010-12-03 / The incessant search if nurse for qualify nursing care makes the Nursing Assistance Systematization, a current topic of discussion throughout the country, not only in order to comply the legal requirements of their practice, but especially by the expected benefits of its application. In this meaning, this research had a qualitative approach, developed for a way of research-action. The general purpose was to analyze the change in the nursing practices in a pediatric teaching hospital, based on construction and implementation of Nursing Assistance Systematization by the nursing team. The results had the thematic analysis of Paulo Freire and were shown in the form of reports. To achieve these purposes, it began by steps pre-trial, to review the charts of the institution and an approach with the managers. In the situational diagnosis of nursing practices without the systematization followed by applying a questionnaire with a nursing team and a focal group with nurses. These ways supported the implementation stage of the Nursing Assistance Systematization which developed actions associate such as focal group with the nurses about the nursing history, capacity with the nursing team about the Nursing Assistance Systematization, development, application and reworking of printed, and discussions in the small groups. The evaluations of the changes after the actions of the research occurred through individual interview with the nurses, to check the results. The charts review confirmed the deficit in the records performed by the nurse on the chart, which reinforced the need for implementation of Nursing Assistance Systematization, an argument used on the meeting with the managers, who promptly agree with the search. The questionnaire and the focal group with the nurses reveal a process of nursing work without systematization, showing gaps in practices, but also obtained relate of expectations of improvements in quality of care as of Nursing Assistance Systematization, furnishing data to the development of ways following-up. The prints were gradually used and modified as the team understood the Nursing Assistance Systematization and its purposes through capacity course. The final evaluation pointed to the partial implementation of the stages of Nursing Assistance Systematization had been institutionalized at the history and the development of nursing, beyond difficulties with diagnosis and prescription of nursing, in later representing a paradigm shift. This search collaborated to change the view about the Nursing Assistance Systematization by nursing team at the institution had been revealed through introduction of new practices in the process of nursing work, as examination of physical exam of the patient, the interview in the admission of customers on service and the daily monitoring by nursing through development of nursing. Before addition, it was noted which the purposes of this search were achieved, since were analyzed the changes in the nursing practices with the systematization. The research-action achieved proposes of the involvement of nursing team in changing their practices. This search contributed to the implementation of the Nursing Assistance Systematization in a pediatric teaching hospital and showed which is possible to seek resolution of problems when the objective is of the group and gave access for further searches within this theme / A busca incessante do enfermeiro por qualificar a assist?ncia de enfermagem faz da Sistematiza??o da Assist?ncia de Enfermagem (SAE) um tema atual de discuss?o em todo o pa?s, n?o apenas no intuito de atender ?s exig?ncias legais de sua pr?tica, mas especialmente pelos benef?cios esperados com sua aplica??o. Nesse sentido, este estudo teve uma abordagem qualitativa, desenvolvida por meio da pesquisa-a??o. O objetivo geral foi analisar a mudan?a nas pr?ticas de enfermagem em um hospital pedi?trico de ensino, a partir da constru??o e implementa??o da SAE pela equipe de enfermagem. Os resultados tiveram a an?lise tem?tica de Paulo Freire e foram divulgados na forma de relat?rios. Para atingir tais objetivos, iniciou-se por passos pr?-pesquisa, com a revis?o nos prontu?rios da institui??o e uma abordagem com os gestores. No diagn?stico situacional das pr?ticas de enfermagem sem a sistematiza??o, seguiu-se com a aplica??o de um question?rio com a equipe de enfermagem e um grupo focal com os enfermeiros. Esses passos subsidiaram a etapa de implementa??o da SAE, na qual se desenvolveram a??es concomitantes, tais como o grupo focal com os enfermeiros sobre o hist?rico de enfermagem, capacita??o com a equipe de enfermagem sobre a SAE, elabora??o, aplica??o e reelabora??o de impressos, e discuss?es em pequenos grupos. A avalia??o das mudan?as ocorridas ap?s as a??es da pesquisa ocorreu por meio de uma entrevista individual com os enfermeiros, para verificar os resultados obtidos. A revis?o de prontu?rios confirmou o d?ficit nos registros realizados pelo enfermeiro no prontu?rio, o que refor?ou a necessidade de implementa??o da SAE, argumento apresentado na reuni?o com os gestores, que prontamente acataram o estudo. Os question?rios e o grupo focal com os enfermeiros revelaram um processo de trabalho de enfermagem sem sistematiza??o, demonstrando lacunas nas pr?ticas, mas tamb?m se obteve relatos das expectativas de melhorias na qualidade da assist?ncia a partir da SAE, fornecendo-se dados para a elabora??o dos passos seguintes. Os impressos foram gradativamente utilizados e modificados, ? medida que a equipe compreendeu a SAE e seus objetivos por meio de uma capacita??o. A avalia??o final apontou para a implementa??o parcial das etapas da SAE, tendo sido institucionalizados o hist?rico e a evolu??o de enfermagem, al?m de relatadas dificuldades com o diagn?stico e a prescri??o de enfermagem, representando esta ?ltima em uma quebra de paradigma. Este estudo contribuiu para mudan?a na concep??o da SAE pela equipe de enfermeiros na institui??o, tendo sido revelada por meio da introdu??o de novas pr?ticas no processo de trabalho de enfermagem, como a realiza??o do exame f?sico do paciente, a entrevista na admiss?o do cliente ao servi?o e o acompanhamento di?rio pelo enfermeiro por meio da evolu??o de enfermagem. Diante disso, percebeu-se que os objetivos deste estudo foram atingidos, uma vez que se analisaram as mudan?as na pr?tica de enfermagem com a sistematiza??o. A pesquisa-a??o atingiu a proposta do envolvimento da equipe de enfermagem nas mudan?as de sua pr?tica. Este estudo contribuiu com a implementa??o da SAE em um hospital pedi?trico de ensino e mostrou que ? poss?vel buscar a resolu??o de problemas quando o objetivo ? do grupo, bem como abriu um leque de possibilidades para novos estudos dentro desta tem?tica

Made available in DSpace on 2014-12-17T14:46:49Z (GMT). No. of bitstreams: 1 IsabelKFC_DISSERT.pdf: 2842147 bytes, checksum: 5940c197670eef58d4b127c85880497a (MD5) Previous issue date: 2011-12-02 / Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service. / Estudo explorat?rio, descritivo, quantitativo e dados prospectivos, realizado no Servi?o de Atendimento M?vel de Urg?ncia da Regi?o Metropolitana de Natal/RN, com vistas a identificar o conhecimento da equipe multiprofissional acerca das normas de precau??es padr?o e seguran?a do trabalhador; identificar os riscos ocupacionais peculiares ?s atividades desenvolvidas nesse servi?o; caracterizar os acidentes de trabalho (AT) e conhecer os procedimentos adotados ap?s cada AT. A popula??o constou de 162 profissionais e os dados foram coletados entre os meses de novembro e dezembro de 2010. Quanto ? caracteriza??o pessoal e profissional, dos 162 profissionais, 12,96% eram m?dicos; 6,79%, enfermeiros; 33,95%, t?cnicos de enfermagem; 46,29%, condutores; 74,70% do sexo masculino; 43,21% tinham entre 31 e 40 anos; 69,33% residiam em Natal/RN; 50,00% possu?am o ensino m?dio completo; 58,64% casados; 69,75% tinham filhos; 46,91% tinham entre 1 e 4 anos de forma??o; 61,73% possu?am cursos de atualiza??o; 59,25% estavam com 3 a 4 anos de servi?o; 54,32%, com 1 a 4 anos de experi?ncia na urg?ncia; 44,44% recebiam de 1 a 2 sal?rios; 78,40% recebiam insalubridade; 67,28% atuavam na USB; 83,95% tinham jornada no SAMU Metropolitano de 31 a 40 horas semanais; 52,47% possu?am outro v?nculo empregat?cio. Quanto ao conhecimento sobre normas de precau??es padr?o, seguran?a e riscos ocupacionais, 99,38% sabiam o que era AT; 62,96% deram respostas incompletas; 74,07% conheciam as normas de AT; 46,67% adquiriram esse conhecimento em palestras; 53,09% conheciam os EPIs; 71,60% deram respostas incorretas sobre a import?ncia das PPs; 45,06% nunca receberam interven??o educativa sobre essa tem?tica; 89,51% disseram serem muito importante as interven??es educativas na preven??o de ATs; 90,12%, apontaram como muito importante este tema no ambiente de trabalho; 27,00% sugeriram a orienta??o sobre o tema no pr?prio local de trabalho; dentre os riscos f?sicos, 34,57% consideraram os ru?dos como o mais importante; dos riscos qu?micos, 78,40% referiram os gases e fuma?a; dos riscos biol?gicos, 48,77% citaram o contato com o sangue; dos riscos mec?nicos, 80,86% disseram que eram os acidentes de transporte; dos riscos ergon?micos, 40,12% afirmaram ser a tens?o/estresse no atendimento aos pacientes graves, psiqui?tricos e agressivos; e houve uma m?dia de 4,5 para o sentimento de seguran?a no ambiente de trabalho. Em rela??o aos dados sobre os ATs ocorridos, 31,48% sofreram pelo menos um evento acident?rio; 72,55% n?o notificaram; 60,98% responderam que n?o existia rotina para notifica??o; 56,86% estavam realizando o transporte de pacientes; 49,02% se acidentaram na USB/UR; 60,78% aconteceram durante o dia; 96,08% dos profissionais estavam em escala de trabalho normal (plant?o 24hs); 31,37% sofreram contus?o; 58,82% les?es nos membros/cintura p?lvica; 43,14% foram acidentes de transporte. Quanto ? evolu??o do AT, 62,75% n?o precisaram de afastamento do trabalho; 76,47% n?o tiveram sequelas; 88,24% n?o precisaram de reabilita??o; nenhum profissional precisou mudar de ocupa??o. E, por meio da regress?o log?stica univariada, evidenciou-se que os enfermeiros e o sexo masculino eram fatores de risco para a ocorr?ncia de AT. Conclu?mos que havia lacunas no conhecimento da equipe no que concerne aos AT, enfatizando-se a necessidade da educa??o permanente em biosseguran?a no servi?o.

Made available in DSpace on 2014-12-17T14:46:58Z (GMT). No. of bitstreams: 1 GrayceLTC_DISSERT.pdf: 1835806 bytes, checksum: f4f84109098e5cafa4fd9ac77f73ad99 (MD5) Previous issue date: 2013-02-07 / The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death / A aten??o com a seguran?a dos pacientes ? importante na qualidade da assist?ncia de enfermagem e dos cuidados de sa?de. No atendimento pr?-hospitalar, estes cuidados s?o essenciais no local do evento, com prop?sito de minimizar poss?veis consequ?ncias ao indiv?duo, garantindo um atendimento precoce e adequado, com melhoria da morbidade e diminui??o da mortalidade. Estes atendimentos igualmente associam-se a riscos significativos de eventos adversos e erros graves, que podem ser diminu?dos com a conscientiza??o dos profissionais, organiza??o e qualidade da gest?o. Trata-se de estudo descritivo, transversal, de abordagem quantitativa, com o objetivo de identificar os riscos para a seguran?a do paciente no atendimento pr?-hospitalar m?vel sob a ?tica dos enfermeiros, em uma cidade do Nordeste Brasileiro. A amostra da pesquisa foi formada por 23 enfermeiros. Os crit?rios de inclus?o foram: ter no m?nimo dois anos de experi?ncia e aceitarem participar da pesquisa. A coleta de dados foi realizada em duas etapas: primeiramente coleta de fotos atrav?s do m?todo adaptado de an?lise fotogr?fica, e a segunda com a aplica??o de question?rio, dividido em duas partes: dados s?cio-profissionais e instrumento de pontua??o de fotografia digital sobre a seguran?a do paciente. Encontrou-se a predomin?ncia de enfermeiros com tempo m?dio de trabalho no atendimento pr?-hospitalar m?vel de seis anos e seis meses, na faixa et?ria de 38 a 53 anos (69,56%) e com especializa??o Lato sensu (73,91%), sendo (29,41%) em urg?ncia e emerg?ncia e (29,41%) em terapia intensiva. Possuem o Advanced Cardicologic Life Support (ACLS) (74%) e o Pre Hospital Trauma Life Support (PHTLS) (100%); conhecem a tem?tica seguran?a do paciente (91,30%). Nas fotos observou-se uma maior variabilidade de categorias (riscos) onde 44% de vari?ncia emergiu na foto 01 do estudo. As fotografias 4 e 9, com m?dias abaixo de 5, foram classificadas como muito inseguras, enquanto que as fotos 7 e 3 com m?dias acima de 7, muito seguras. Dos resultados de riscos observados para a seguran?a do paciente no atendimento pr?-hospitalar m?vel emergiram cinco categorias: organiza??o e acondicionamento de equipamentos e materiais, rotinas e especificidades no atendimento pr?-hospitalar m?vel, riscos para a administra??o de medicamentos, para traumas e para infec??o. Partindo da an?lise desses riscos foram propostos dez passos para a seguran?a do paciente no atendimento pr?-hospitalar m?vel: 1- Identificar o paciente; 2- Seguran?a relacionada ? preven??o de infec??o; 3- Seguran?a na administra??o de medicamentos; 4- Seguran?a e padroniza??o do acondicionamento de equipamentos e materiais; 5- Aten??o para as especificidades do atendimento pr?-hospitalar m?vel; 6- Incentivar e valorizar a participa??o do paciente e fam?lia; 7- Promover a comunica??o com a central de regula??o; 8- Preven??o de traumas e quedas; 9- Proteger a pele de les?es adicionais; 10- Compreender o benef?cio de todos os equipamentos da ambul?ncia. Os m?ltiplos riscos e suas combina??es emergidas no estudo indicam a multifatoriedade de a??es a serem desenvolvidas e estimuladas, como a utiliza??o de passos para a seguran?a do paciente no atendimento pr?-hospitalar m?vel que contribui como subs?dio no gerenciamento de riscos, diminui??o de erros, incapacidades e morte

Made available in DSpace on 2014-12-17T14:47:00Z (GMT). No. of bitstreams: 1 ElianeSantosC.pdf: 383211 bytes, checksum: 9084c4210107f08d95090f4afcc07f34 (MD5) Previous issue date: 2003-12-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The great demand of accidents resulting in victims with rachi-medullar traumatism (RMT) and the need for indetifying how they are being assisted, led us to proceed with this investigation. It had as its goal to identify and analyze the knowledge of nurses and nurse assistents regarding the nursing assistance to these patients. It consists of a descriptive exploratory study, with a quantitative method and prospective data. For its execution, 193 subjects were interviewed, 37 of them nurses and 157 nurse assistents in 02 hospitals of the metropolitan zone of Natal. The results reveal that the subjects are not coherent when questioned whether they are prepared to assist victim of RMT and the content described by order of piority regarding the steps followed in the assistance of these victims, both in the pre-hospital and hospital care. Thus, we observe that only 06 nurses and 07 assistents, described correctly all the steps necessary to pre-hospital care and only 01 nurse and 02 assistents registered all the steps in the correct sequence regarding the hospital care. We conclude that, in face of the obtained results, we can urgently modify this reality, improving the nursing staff and giving them better work conditions / A grande demanda de acidentes produtores de v?timas com traumatismo raquimedular (TRM) e a necessidade de identificar como est?o sendo assistidas, levaram-nos a fazer esta investiga??o. Teve como objetivo identificar e analisar o conhecimento dos enfermeiros e os auxiliares de enfermagem acerca da assist?ncia de enfermagem a estes acientes.Trata-se de um estudo explorat?rio descritivo, com abordagem quantitativa e dados prospectivos. Para a sua realiza??o, foram entrevistados 193 sujeitos sendo 37 enfermeiros e 157 auxiliares de enfermagem de 02 hospitais da grande Natal. Os resultados revelam que os sujeitos n?o s?o coerentes quando questionados se est?o preparados para assistir ?s v?timas de TRM e o conte?do descrito por ordem de prioridade em rela??o aos passos utilizados na assist?ncia, tanto no atendimento pr?-hospitalar como hospitalar. Assim sendo, observamos que apenas 06 enfermeiros e 07 auxiliares descreveram corretamente todos os passos necess?rios ao atendimento pr?-hospitalar e somente 01 enfermeiro e 02 auxiliares registraram todos os passos na seq??ncia correta, no que se refere ao atendimento hospitalar. Conclu?mos que diante dos resultados obtidos, faz-se necess?rio modificar esta realidade, aperfei?oando a equipe de enfermagem e dando-lhe melhores condi??es de trabalho

Made available in DSpace on 2014-12-17T14:47:07Z (GMT). No. of bitstreams: 1 JussaraPN.pdf: 862677 bytes, checksum: 1ea45865c41e2e534902a9bd38c2853e (MD5) Previous issue date: 2006-12-04 / Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square &#967;2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state / Pesquisa descritiva que objetivou avaliar a assist?ncia prestada aos portadores de ?lceras venosas, em membros inferiores, atendidos pelas equipes do Programa Sa?de da Fam?lia (PSF), do munic?pio de Natal/RN. A popula??o alvo foi composta por 74 portadores de ?lceras venosas (UV), atendidos pelas equipes do PSF nas 31 USFs. O estudo obteve parecer favor?vel do Comit? de ?tica da Universidade Federal do Rio Grande do Norte (Protocolo n.55/05). A coleta de dados foi realizada domiciliarmente e nas USFs, por meio de entrevista estruturada e exame f?sico dos portadores de UV e observa??o n?o participante durante a troca de curativos nessas Unidades e domic?lios dos usu?rios. Os dados foram organizados em planilha eletr?nica Excel e transportados para o Programa SPSS 14,0, para an?lises descritiva em tabelas de conting?ncias 2x2 e inferencial (Qui-Quadrado -&#967;2, Correla??o de Spearmam, Teste de Propor??o Binomial e p-valor < 0,05). A preval?ncia de UV (0,36/1000) na popula??o alvo (a partir de 20 anos) foi maior que na popula??o cadastrada no PSF (0,25/1000). Detectamos uma preval?ncia maior na faixa et?ria a partir de 60 anos (2,22/1000), sendo 2,98/1000 no sexo feminino e 1,3/1000 no masculino (p-valor= 0,008). As caracter?sticas sociodemogr?ficas e de sa?de dos portadores de UV revelaram predomin?ncia do sexo feminino (74,5%), idosos a partir de 60 anos (67,6%), ensino fundamental (74,3%), renda familiar at? 2 SMs (68,9%), aposentados (90,5%), posi??o ortost?tica (23,0%), sono inadequado (59,5%), presen?a de IVC (100,0%), hipertens?o (44,6%) e diabetes (25,7%). Quanto ao tempo de exist?ncia da UV, 64,9% tinham mais de 1 ano, e 35,1% menos de 1 ano, com predomin?ncia de uma les?o (67,6%). A troca de curativos, em sua maioria, ? domiciliar, realizada de forma inadequada, destacando-se a t?cnica incorreta de limpeza, uso e associa??es tamb?m incorretas de produtos e subst?ncias, e pouca participa??o da equipe do PSF na avalia??o, realiza??o do curativo e escolhas de produtos e subst?ncias. A terapia compressiva n?o faz parte das condutas terap?uticas de tratamento de UV nas USFs. Quanto ? avalia??o da assist?ncia aos portadores de UV, 90,5% estavam inadequadas e apenas 9,5% adequadas. Os principais fatores de inadequa??o foram aus?ncia de: diagn?stico (47,3%), consulta com angiologista (63,5%), tratamento compressivo (100,0%), terapia t?pica adequada (98,62%), quite curativo adequado (70,3%), treinamento para troca de curativo (67,6%), acompanhamento pela equipe do PSF (51,4%) e exames realizados (55,4%). Conclu?mos que os portadores de UV, em sua maioria, apresentam baixo n?vel socioecon?mico e com doen?as cr?nicas associadas. Considerando que a assist?ncia prestada pelo PSF ? assistem?tica, fragmentada, sem diagn?stico, planejamento, avalia??o e evolu??o cont?nua, qualificamos a assist?ncia desenvolvida como inadequada e com pouco n?vel de resolutividade interferindo diretamente na manuten??o da cronicidade das UVs