Made available in DSpace on 2014-06-11T19:22:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T18:08:24Z : No. of bitstreams: 1 casafus_kcu_me_botfm.pdf: 1142337 bytes, checksum: 0c42640b1ea115174e65e30f65b45728 (MD5) / Secretaria de Saúde do Estado de São Paulo / Trata-se de uma pesquisa qualitativa, com os objetivos de: compreender o processo interacional planejamento-implementação da Sistematização da Assistência de Enfermagem (SAE), na perspectiva de dois grupos amostrais: Enfermeiros e Técnicos/Auxiliares de Enfermagem de um hospital universitário de grande porte, do interior paulista e desenvolver uma síntese dos modelos teóricos representativos dessas experiências. A saturação teórica se configurou, mediante a análise de 24 entrevistas, sendo de: 12 enfermeiros e 12 Técnicos/Auxiliares, lotados em unidades de internação clínicas e cirúrgicas. A entrevista não diretiva foi a técnica de coleta de dados, tendo como questão norteadora: — Como tem sido a sua experiência com a SAE? As entrevistas foram gravadas e transcritas na íntegra e analisadas, segundo os passos da Teoria Fundamentada em Dados, denominada internacionalmente por Grounded Theory. Desta análise emergiu dois modelos teóricos, referentes às experiências que deram origem a um terceiro, resultado da síntese. O primeiro refere-se à experiência interacional do enfermeiro, a qual reúne dois fenômenos: idealizando operacionalizar a SAE na sua plenitude, vislumbrando o reconhecimento social da profissão e frustrando-se com a falta de apoio da instituição no processo de trabalho da equipe de enfermagem. Da interrelação dos seus componentes (temas, categorias, subcategorias e elementos), configurou-se a categoria central — entre a idealização e a frustração no processo de trabalho do enfermeiro: recursos humanos como componente interveniente para operacionalização da SAE e visibilidade da profissão. O segundo modelo retrata a experiência de Técnicos/Auxiliares, composta de dois fenômenos: legitimando a SAE e não legitimando a SAE, dos quais emergiu a categoria central... / This is a qualitative study developed according to the comprehensive approach. It was approved by the Research Ethics Committee with the purpose to understand the planning-implementation interactional process of Nursing Care Systematization (SAE) at a university hospital in the perspective of two sample groups, namely nurses and nursing technicians/auxiliaries, in order to develop a synthesis of the theoretical models that are representative of the experiences lived. Theoretical saturation occurred through the analysis of 24 interviews with 12 nurses and 12 technicians/auxiliaries stationed in the clinical and surgical inpatient units of a large university hospital in inner São Paulo state. Non-directive interviews were used for data collection with the following guiding question: - What has your experience with SAE been like? The interviews were taped, fully transcribed and analyzed according to the steps the Grounded Theory. From such analysis, two theoretical models emerged with reference to the experiences. They originated a third model which was the result of the synthesis. The first refers to nurses’ interactional experience, which gathers two phenomena: idealizing SAE operationalization in its fullness, expecting the social recognition of the profession and becoming frustrated with the lack of support from the institution in the nursing team’s work process. From the inter-relation of its components (themes, categories, sub-categories and elements), the core category was formed - between idealization and frustration in nurses’ work process: human resources as an intervenient component for SAE operationalization and the profession’s visibility. The second model depicted technicians/auxiliaries’ experience, which consisted of two phenomena: legitimating SAE and not legitimating SAE, from which the core category emerged... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:23:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-05Bitstream added on 2014-06-13T19:50:54Z : No. of bitstreams: 1 castro_mam_me_araca.pdf: 341426 bytes, checksum: 1805ce782d7bea8fd9262abedf14c5dd (MD5) / As lesões traumáticas envolvem função e estética que resultam de mínimas perdas de superfície do esmalte a fraturas complexas envolvendo polpa e até perda da coroa. O conhecimento técnico e a experiência clínica são fundamentais para a obtenção de um diagnóstico correto e para realizar uma terapia racional. É objetivo deste trabalho analisar o conhecimento dos especialistas em Dentística, titulados pela Faculdade de Odontologia de Araçatuba - UNESP, sobre fraturas coronárias e corono-radiculares. Para tanto, a partir de um questionário descritivo, foram abordadas questões referentes ao perfil dos profissionais entrevistados e procedimentos empregados na conduta frente a fraturas coronárias e corono-radiculares. Cento e cinqüenta e quatro questionários foram devidamente preenchidos, e os dados obtidos foram submetidos à análise descritiva, enquanto o teste estatístico foi aplicado para demonstrar freqüência e o nível de significância entre variáveis (teste qui-quadrado). Muito embora os entrevistados tivessem formação de especialista em Dentística, grandes dificuldades foram encontradas nos planos de tratamento propostos. Dos entrevistados, 42,8% foram incapazes de tratar todos os casos de traumatismo dentário. As fraturas de esmalte, dentina e cemento, com e sem envolvimento pulpar, foram as que apresentaram maiores dificuldades de resolução, pois necessitam de conceitos e práticas multidisciplinares para favorecer o tratamento e o prognóstico dos casos. / Traumatic lesions involve function and aesthetics that result from a minimal loss of the surface of enamel up to complex fractures involving pulp and even the loss of a crown. Technical knowledge and clinical experience are fundamentally necessary to obtain the correct diagnostic and to perform a rational therapy. The goal of this study is to analyse the knowledge about crown and crown-root fractures obtained by specialists in Dentistry, titled from Dentistry School at UNESP - Araçatuba. For that, starting from a descriptive questionnaire, some questions regarding the profile of inquired professionals and procedures used in the performance of treatment of crown and crow-root fractures. 154 questionnaires were answered and the obtained data was submitted to a descriptive analysis, while a statistical test was applied to show the frequency and the level of the significance among variables (square test). Despite the inquired professionals having background in Dentistry, a lot of difficulties were found in the planning of the treatments. 42.8% of the interviewed professionals were unable to treat all cases of dental traumatism. Crown-root fractures, involving pulp or not, were the ones that presented major difficulties being necessary some concepts and multidisciplinary approach that favor planning and treatment.

Orientador: Edison Iglesias de Oliveira Vidal / Resumo: No Brasil atual a maior parte dos profissionais e instituições de saúde ainda se encontram longe de constituírem uma rotina de discussão sobre preferências de cuidados no fim da vida junto a pacientes com prognóstico reservado. Esta corresponde a uma grande lacuna na atenção à saúde em nosso país, a qual frequentemente se associa a sofrimento evitável de pacientes e familiares. Em 1991 nos EUA foi iniciado um programa de discussão de preferências de cuidados no fim da vida denominado POLST (Physician Orders for Life-Sustaining Treatment). Trata-se de um sistema coordenado para evocar, documentar e comunicar as preferências de pacientes/familiares quanto a tratamentos prolongadores da vida para enfermos com expectativa de vida reduzida. Atualmente o POLST representa uma das melhor sucedidas estratégias para a elicitação e documentação de preferências de cuidados no fim da vida naquele país. O objetivo dessa pesquisa foi realizar a Adaptação Transcultural (ATC) do formulário POLST para o contexto brasileiro. A metodologia de ATC baseou-se nas recomendações da International Society for Pharmacoeconomics and Outcomes Research. Foram realizadas 3 traduções diretas e independentes do instrumento fonte para o português, as quais passaram por uma reunião de reconciliação de forma a gerar uma versão síntese. Essa versão foi submetida a duas traduções reversas para o inglês e posteriormente foi realizado um teste piloto do formulário com 20 médicos e 10 pacientes. Versões do instrument... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In Brazil most health care professionals and institutions still have not included discussions about preferences of care at the end of life with patients with decreased life expectancy as part of their daily routine. This represents a major gap for the care at the close of life in Brazil that is frequently associated with avoidable suffering of patients and their loved ones. In 1991 the Physician Orders for Life-Sustaining Treatment (POLST) program was started in the USA. It embodies a coordinated system to elicit, record and communicate patients’ and families’ preferences about life-prolonging treatments for individuals with decreased life expectancy across a variety of health care settings. The POLST paradigm has spread across the USA and currently represents one of the most successful strategies to elicit and record preferences of care at the end of life in that country. The present research aimed to conduct the Cross-Cultural Adaptation (CCA) of the POLST form to the Brazilian context. The cross-cultural adaptation methodology was based on the principles of good practice for the translation and cultural adaptation process recommended by the International Society for Pharmacoeconomics and Outcomes Research. Three independent direct translations of the source instrument to Portuguese were performed. Those translations were synthesized into a single version after a reconciliation meeting. Two independent native English speakers performed 2 back translations of that version in... (Complete abstract click electronic access below) / Mestre

As diretivas antecipadas de vontade para o fim da vida são documentos que expressam os desejos da pessoa relacionados aos procedimentos que podem ser aplicados a ela em uma situação de assistência médica no fim da vida. Nesse sentido, as diretivas são úteis para informar as equipes de assistência médica a respeito dos tipos específicos de tratamento que o paciente permite, ou não permite, quando não estiver apto a manifestar suas vontades em uma hipotética situação futura de incapacidade. Este tipo de documento foi elaborado nos Estados Unidos na década de 1970, e foi introduzido no ordenamento ético brasileiro pela Resolução 1995/2012 do Conselho Federal de Medicina. O objetivo desta dissertação é estudar essa norma ética sob o enfoque do direito penal, uma vez que as diretivas antecipadas de vontade para o fim da vida possuem uma íntima relação com a ortotanásia e a eutanásia, que são passíveis de sanção penal no Brasil. Assim, é fundamental analisar as diretivas antecipadas utilizando as ferramentas da doutrina penal, e princípios como os da dignidade humana e razoabilidade. O objetivo é pesquisar as qualidades, imperfeições e limites das diretivas antecipadas sob o ordenamento jurídico nacional, e também compreender as bases legais das diretivas antecipadas, que são os institutos da autonomia e do consentimento. Concluímos que, ainda que as diretivas antecipadas de vontade sejam uma norma ética bem-vinda, demandam algumas melhorias e refinamentos, que poderiam ser representados pelos planejamentos antecipados de tratamentos, um tipo de documento direcionado aos valores de vida das pessoas. Além disso, uma mudança de paradigma relacionada à eutanásia, particularmente a eutanásia passiva e a ortotanásia, no sentido de descriminalizá-las, seria importante para que as diretivas antecipadas tenham eficácia no Brasil. / Advance directives for dying patients are documents which express personal desires related to procedures that may be applied to people in a situation of medical assistance in the end of life. In this sense, they are useful to make health assistance teams know about what kind of specific treatment the patients permit, or do not permit, when they are not able to communicate their wishes in a hypothetical and future situation of disability. This kind of document was created in the United States in the seventies, and entered Brazilian ethical law by Resolution 1995/2012 of the Federal Council of Medicine. The aim of this dissertation is to study this ethical rule by means of the criminal law, because advance directives have a close relation to euthanasia and ortothanasia, which are prone to criminal sanction in Brazil. Therefore, it is paramount to analyze the advance directives using the doctrinal tools of criminal law and principles like human dignity and reasonability. The goal is surveying the qualities, inadequacies and limits of advance directives under Brazilian law, and also to understand the legal basis of the advance directives, which are the institutes of autonomy and consent. We concluded that, although advance directives for dying patients are a welcome ethical law, it demands some improvement and refinement, which could be represented by the advance care planning, a kind of document that is focused on the life values of people. Furthermore, a change of paradigm related to euthanasia, particularly passive euthanasia and ortothanasia, in the direction of making them apart of criminalization, would be vital to promote the adequate efficacy of the advance directives in Brazil.

Communication concerning the care one wishes to receive at the end of life (EOL) is central to ensuring that wishes are honored. Many studies have examined doctor-patient or doctor-family EOL communication. However, relatively few studies have focused on the occurrence of EOL care discussions among family members. This is an important topic, as research suggests that advance directives (ADs) are ineffective if patients have not involved surrogate decision-makers, most of whom are family members. This study examined EOL care discussions among family members. It used quantitative and qualitative data from a diverse sample of older adults from West Central Florida collected for the purpose of this examination. The quantitative and qualitative data were analyzed separately and together. This study employed the Transtheoretical Model, which proposes that individuals are in varying behavioral “stages of change” and that bringing about a behavioral change requires understanding their particular stage and adapting interventions appropriately. Statistical analysis of the quantitative data (N=364) using multinomial logistic regression showed that participants were in distinct stages that were associated with several factors, including family involvement with health care decision-making and communications with doctors. Racial and ethnic differences were not found in controlled analysis, though Hispanics were less likely to be in more advanced EOL care discussion stages in unadjusted analyses. Several themes were found in qualitative analysis of focus groups (n=36) drawn from the larger sample. Findings suggested that those who engaged in family EOL care discussions were more careful planners overall, more accepting of death, and able to manage complex family dynamics. They also had greater knowledge of EOL matters, largely related to knowledge of loved ones EOL wishes. The quantitative-qualitative (mixed-methods) study reinforced the role of family relationships in general in whether EOL care discussions occurred. It also highlighted the role of being proactive and having EOL care knowledge. All three studies – the quantitative, qualitative, and mixed methods showed the potential for doctors and other health professionals to help families with EOL care discussions and ACP overall.

This experimental study was designed to evaluate the effect of planned teaching on the self-medication practices of ambulatory cardiac patients. The sample was composed of forty male and female cardiac patients who were over the age of forty-five years, who lived at home and were of low socio-economic status. They all lived in a large urban centre and attended an outpatient clinic for medical attention. All were taking digoxin and thirty-six, 18 from each group, were also taking a diuretic. They were randomly assigned to two groups, experimental and control, when they visited the outpatient clinic. The twenty patients in the control group were given the usual routine factual information during their clinic visit. The twenty patients in the experimental group received additional planned teaching over a thirty-minute period by the researcher. The data were gathered by means of a twenty-item questionnaire designed to elicit information regarding the self-medication behavior of the study population. The questionnaire was administered in the homes of the patients ten to fourteen days following their visit to the outpatient clinic. Three hypotheses were tested in the study. Analysis of the data in relation to Hypothesis I indicated a statistically significant difference in the number of self-medication errors in digoxin and diuretics made in a twenty-four-hour period by patients in the experimental group as compared with the control group. The experimental group made significantly fewer errors. Although patients in the experimental group made fewer errors of the four types of errors studied with regard to Hypothesis II, there was not a statistically significant difference in errors related to time, dosage and non-prescribed medications made in a twenty-four-hour period by patients in the experimental group as compared with the control group. There was, however, a statistically significant difference in the fourth type of error--that of omission. The testing of Hypothesis III showed a statistically significant difference in the level of knowledge of the two groups of patients. The experimental group had a higher level of knowledge of their medications. The study concludes with consideration of implications for nursing practice and research. / Applied Science, Faculty of / Nursing, School of / Graduate

This exploratory study examined the phenomenon of loss as expressed by the spouses of myocardial infarction patients. The purpose of the study was to describe the thoughts, feelings, actions and observable behaviours of the spouses from the initial impact of illness to six weeks post myocardial infarction and to develop a framework, based on the literature, which related the concept of loss to the experience of spouses of M.I. patients. The study was conducted with a convenience sample of 12 spouses, ten women and two men, whose partners had experienced their first myocardial infarction. Using a semi-structured interview guide with open-ended questions, the investigator interviewed each subject four times over a six week period; from the initial impact of illness to approximately six weeks post myocardial infarction. Each interview covered three content areas: thoughts, feelings and actions. Broad open-ended questions were used to elicit data on the spouses thoughts, feelings and actions. During the interview the investigator observed the verbal (type, quality, characteristics of speech, focus of conversation) and non-verbal (activity, eye contact, body language, appearance) behaviours of the spouses. An empirical inductive approach was used as the methodology for this study. Data coding and analysis were approached using the constant comparative method, an inductive method of discovering grounded theory developed by Glaser and Strauss (1967). The findings revealed that the spouses experienced behaviours in response to loss that were common and formed a pattern through time. Three distinct phases were identified: Phase I The Event and Initial Spousal Response; Phase II Reaction to the Event; Phase III Impact of the Event. The phases were described further in light of the constructs formulated from the literature review: (1) Reactions to Loss; (2) The Elements of Loss; (3) The Meaning of Loss. This study was designed to provide insight into understanding the event of a myocardial infarction within the context of the phenomenon of loss. The findings supported the use of a loss framework for assessing the reactions of spouses who are threatened with the death of their partner. Nurses are in a critical position to assist spouses experiencing loss. Implications and recommendations for nursing education, practice and research were delineated in light of the conclusions of the present study. / Applied Science, Faculty of / Nursing, School of / Graduate

The aim of this diploma work is to search the answer to question: What are the causes for little use of advanced directives in real life from expert's point of view? Text is separated into theoretical part, methodological and analytical. In theoretical part, the autor is conceptualising basic terms from main research question and is leading the revers into the context. Methodological part is revealing the background of the research, which was carried out by qualitative research strategy through half-structured interviews with chosen experts in problems with advanced directives. In analytical part are presented results of research, which the autor is comparing to theoretical roots. Particiapnts of the research are seeing the causes of little use in advanced directives in little information about its existence, in legal format and its rising concerns from possible legal punishment and last but not least it can be caused by ethical and personal background. Keywords Advanced directives, illness, autonomy, causes, practise.

The aim of this diploma work is to search the answer to question: What are the causes for little use of advanced directives in real life from expert's point of view? Text is separated into theoretical part, methodological and analytical. In theoretical part, the autor is conceptualising basic terms from main research question and is leading the revers into the context. Methodological part is revealing the background of the research, which was carried out by qualitative research strategy through half-structured interviews with chosen experts in problems with advanced directives. In analytical part are presented results of research, which the autor is comparing to theoretical roots. Particiapnts of the research are seeing the causes of little use in advanced directives in little information about its existence, in legal format and its rising concerns from possible legal punishment and last but not least it can be caused by ethical and personal background. Keywords Advanced directives, illness, autonomy, causes, practise.

Approximately 49 million Americans are 65 years and older, 80% of whom have ≥1 chronic condition, while nearly 70% of Medicare beneficiaries have ≥2 such conditions. Moreover, avoidance of medical care is frequently seen among older adults; a national survey reported that over 33% of participants avoided seeking care even when they suspected that they should go to the doctor. Healthcare avoidance, especially by older adults, can result in adverse health and economic outcomes including higher use of emergency department (ED), longer inpatient stays, and poorer health status, alongside emotional burden. Studies have shown that perceived satisfaction of care and the need to seek care as a result of presence of illness are associated with care seeking behaviors. Thus, this study aimed to examine the extent to which these enabling and need factors translate to care seeking behaviors among Medicare beneficiaries. This is a cross-sectional study that includes 13,441 Medicare beneficiaries who responded to the 2018 Medicare Current Beneficiary Survey (MCBS). MCBS provides information on the beneficiaries’ medical conditions including healthcare utilization, healthcare access, and satisfaction with care. Multivariate logistic regression analyses were conducted to test the association between satisfaction of available care by specialists; satisfaction with the quality of medical care received the year before; presence of chronic illness like cardiovascular diseases (CVD), diabetes, arthritis, lung disease (chronic obstructive pulmonary disease (COPD), asthma, etc.) and depression, with care seeking behavior among Medicare beneficiaries. Care seeking behavior, which is the outcome of interest, was defined using three measures: not doing anything to avoid going to the doctor, not keeping sickness to self, and going to the doctor as soon as one feels sick. Of the total respondents, only about 29% showed care seeking behavior. Being male, being Hispanic, and having more than high school education were significantly associated with higher care seeking behavior. Lower likelihood of care seeking behavior was seen among beneficiaries who were dissatisfied with ease getting to doctor from home [adjusted odd’s ratio (aOR)=0.635; p