Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-11-18T14:26:17Z No. of bitstreams: 1 Ariele Priebe Reisdorfer_.pdf: 1985228 bytes, checksum: 076794974edc775959e935820eee2c49 (MD5) / Made available in DSpace on 2016-11-18T14:26:17Z (GMT). No. of bitstreams: 1 Ariele Priebe Reisdorfer_.pdf: 1985228 bytes, checksum: 076794974edc775959e935820eee2c49 (MD5) Previous issue date: 2016-10-14 / Nenhuma / A cirurgia cardíaca é indicada como tratamento para doenças cardiovasculares. A realização desse procedimento é complexa e exige que todo o cuidado do pós-operatório imediato e parte do mediato sejam realizados na Unidade de Terapia Intensiva (UTI). Nesse sentido, o serviço prestado pela equipe de enfermagem contribui para garantir a recuperação do indivíduo submetido à cirurgia cardíaca. O objetivo desta pesquisa é elaborar um programa de Educação Permanente em Saúde para a equipe de enfermagem da UTI Adulto do Hospital Geral de Caxias do Sul/RS acerca do cuidado ao paciente no pós-operatório de cirurgia cardíaca. Esta pesquisa, de caráter qualitativo, contou com a participação de vinte e sete integrantes da equipe de enfermagem (enfermeiros e técnicos) que prestam cuidado ao paciente no pós-operatório do hospital em estudo. A coleta de dados ocorreu por meio de uma entrevista semiestruturada. Para o tratamento dos dados, foi utilizada a análise temática, da qual emergiram quatro categorias: desafios da equipe em relação aos cuidados específicos ao paciente no pós-operatório de cirurgia cardíaca; o medo da admissão na UTI de paciente no pós-operatório de cirurgia cardíaca; relações multiprofissionais; e necessidade de educação permanente em saúde. Os resultados apontaram que os profissionais que iniciaram suas atividades nesse cenário há pouco tempo sentem dificuldade na prestação de cuidados ao paciente, enquanto os mais antigos percebem a fragilidade dos novos colegas e relembram das suas quando iniciaram. Além disso, todos sentem a necessidade de qualificar a prática profissional. Nesse contexto, as propostas de intervenção deste estudo foram a elaboração do Programa de Educação Permanente em Saúde, uma cartilha de orientação sobre os cuidados no pós-operatório de cirurgia cardíaca e um checklist para guiar a passagem do plantão do bloco cirúrgico para a UTI. / The cardiac surgery is indicated as a treatment for cardiovascular diseases. This procedure is complex and its recuperation on the immediate postoperative and a part of the mediate postoperative is realized on the Intensive Care Unit (ICU). The nursing assistance contributes for the patient recovery after cardiac surgery. The objective of this search is to prepare a Health Permanent Education Program for the nursing team that work at the ICU Adult of this hospital, about the assistance to the patient that realized cardiac surgery. The study is qualitative and twenty-seven people from the nursing team that care of this patient participated of the search. It was utilized a semi structured interview to collect data. The analysis of the data were realized through the thematic analysis. Four categories emerged from the study: team challenges for specifically providing care on the postoperative of cardiac surgery; the fear of the patient admission on the ICU; multi professional relationships and necessity of health permanent education. This study indicated that the new professionals face difficulties to care of the patient that realized this surgery. The professionals that work for longer at this place observe the fragilities on the new coworkers and also remember their difficulties when they started to work. All of them related that is necessary to qualify their professional practice. Therefore, the proposal of this study were the elaboration of the Health Permanent Education Program; a guidance booklet about the care on the postoperative of cardiac surgery; and a checklist to guide the shift change from the surgical ward to the ICU.

Dental caries is the most common chronic disease in children, and prevalence rates are disproportionately higher in American Indian/Alaska Native (AI/AN) populations. The Association of State and Territorial Dental Directors (ASTDD) recommends annual oral health screening for children in Head Start programs using the Basic Screening Survey (BSS). The 2014 study was a follow-up to a 2010 national survey of AI/AN children ages five and under that assessed oral health outcomes such as untreated decay, decay experience, urgent need for treatment, presence of sealants and decayed, missing and filled deciduous teeth (dmft) scores, and investigated the changes in Early Childhood Caries (ECC) prevalence from 2010 to 2014 in the Indian Health Service (IHS) Nashville Area. A gap analysis was completed comparing current recommended practices among dental clinics that participated in the IHS ECC Collaborative ASTDD Framework to Prevent and Control Childhood Tooth Decay (ASTDD Framework). Due to historical mistreatment of AI/AN populations in research, and out of respect for the sovereignty of the Tribal Nations that participated in the study, there limited data was made available for this study. In 2010, 579 children were screened in the Nashville Area; 1231 children participated in 2014. While there was a statistically significant, yet clinically small 9.36% reduction of untreated decay from 2010 (30.33%) to 2014 (27.49%), the ECC Collaborative did not reach their objective of a 25% reduction. There was also a significant increase in urgent need for treatment (3.17% in 2010 to 4.35% in 2014), and in presence of sealants (4.54% in 2010 to 10.01% in 2014). Gaps in best practices identified were related to need for increased risk assessments and enhancing policy development. Based on study findings and the limited access to data on Tribal and Area levels, development of culturally appropriate policies that are unique to individual Tribal needs, and focus on perinatal care, is recommended. Individual Tribal programs also need to be evaluated and surveillance needs to be continued to establish trend data. All program evaluations and research should be conducted in an ethical manner that is community-based and considerate of the needs of the Tribe.

The purpose of this study was to determine the awareness and attitudes of dental hygienists in Ohio regarding the Advanced Dental Hygiene Practitioner (ADHP) as an occupation proposed by the American Dental Hygienists’ Association and to determine whether the ADHP could be a viable career option for Ohio dental hygienists. I developed a survey to assess dental hygienists’ awareness, attitudes, and their views regarding the new mid-level dental provider. The study was limited to licensed dental hygienists in Ohio. The study included a simple random sample of 400 of the 4100 dental hygienists in Ohio obtained by a systematic approach, a random start and selection of subjects at a constant interval. The method of data collection was electronic surveys. Fifty-four dental hygienists (13% of the sample) participated in the study. The results show that most of those responding were aware of the ADHP. Also, their attitude regarding the new mid-level dental provider was positive. Attitudes varied more when the respondents provided data on the adoption of legislation for the new provider. There was no consensus among respondents regarding the ADHP as a viable career option. More robust research is needed on the viability of the ADHP in Ohio.

The increased use of technology has affected almost every aspect of how data are collected, stored, retrieved, and analyzed across the health care system. The health information management (HIM) workforce in the United States is predominantly composed of women. With HIM employment rising by 2020, additional education of the current workforce is a necessity. This qualitative phenomenological study evaluated women working with HIM associate degrees and RHIT certifications to determine their perceived need for advanced education for career advancement. This study used the social cognitive career theory (SCCT) to determine how women in HIM perceive needs based on self-efficacy, expected outcomes, and goals. The research questions evaluated education type, subject matters, and ability to advance. The study recruitment process included the use of HIM online research forums resulting and narrative inquiry data collection from 22 personal interviews across 19 states in the Unites States. Colaizzi's data analysis strategy demonstrated themes of HIM education access, barriers, preparedness, and role interests. The data gathered showed need and interest in further education directly correlated to time remaining in career and role aspirations. Recommendations for further research include evaluation of advanced HIM education needs in a male population or individuals with post-graduate education. To affect positive change, dissemination of this study's findings to HIM leaders may create awareness and rationale for women to obtain technology and data related advanced education. In addition, this study may influence educational institutions to promote HIM as a field of study and fill the anticipated gap in HIM field expertise in the coming decade.

Using critical feminist theories and methodologies, my research investigates the power relations and influences at play within the field of children's environmental health. I begin with the research question of how a parent's everyday purchase of a toy or other children's product is "hooked into" extra-local governance (agenda-setting, rule-making and monitoring). Focusing on Bisphenol A and phthalates as an example, in-depth interviews were conducted with six government officials (three federal and three municipal), three non-governmental organization (NGO) representatives, a politician, six higher education faculty members and a parent, as well as two focus groups of 23 parents. Legislation and other relevant documents from governments, NGOs, industry and media were analyzed together with reports of their activities and attitudes to theorize "how things work" in the identification and management of toxic substances in products for sale, with a special interest in how this affects children's environmental health. My research revealed the influence of neo-liberalism, corporate power and over-reliance on strictly evidence-based biomedical reductionism in slowing down assessment and regulation of chemicals while many health professionals and grassroots activists have called for swifter responses based on the precautionary principle, as favoured by European governments. That is, politics and bureaucracy, with the approval of industry, over the past two decades, have clung to reductionist science as the only paradigm for understanding toxicity, thus slowing down regulatory processes. Although the historical and epistemological power relations mapped in my research work together to legitimize scientific certainty rather than the precautionary principle, I argue that the resulting regulatory logjam has been and could be addressed by reference to European examples, knowledge produced by collectives and the establishment of upstream and equity-based public health strategies with public input into the process.

Using critical feminist theories and methodologies, my research investigates the power relations and influences at play within the field of children's environmental health. I begin with the research question of how a parent's everyday purchase of a toy or other children's product is "hooked into" extra-local governance (agenda-setting, rule-making and monitoring). Focusing on Bisphenol A and phthalates as an example, in-depth interviews were conducted with six government officials (three federal and three municipal), three non-governmental organization (NGO) representatives, a politician, six higher education faculty members and a parent, as well as two focus groups of 23 parents. Legislation and other relevant documents from governments, NGOs, industry and media were analyzed together with reports of their activities and attitudes to theorize "how things work" in the identification and management of toxic substances in products for sale, with a special interest in how this affects children's environmental health. My research revealed the influence of neo-liberalism, corporate power and over-reliance on strictly evidence-based biomedical reductionism in slowing down assessment and regulation of chemicals while many health professionals and grassroots activists have called for swifter responses based on the precautionary principle, as favoured by European governments. That is, politics and bureaucracy, with the approval of industry, over the past two decades, have clung to reductionist science as the only paradigm for understanding toxicity, thus slowing down regulatory processes. Although the historical and epistemological power relations mapped in my research work together to legitimize scientific certainty rather than the precautionary principle, I argue that the resulting regulatory logjam has been and could be addressed by reference to European examples, knowledge produced by collectives and the establishment of upstream and equity-based public health strategies with public input into the process.

Prologue is a health information system developed for underserved communities in Bihar, India. It is aimed at helping people living in poverty and with low literacy to take the right steps to manage their and their family’s health. Bihar suffers from one of the worst healthcare records in the country. This is as much due to the lack of access to the right information as it is due to the economic condition of the region. The inaccessibility of information is aggravated by the complex social set up in these communities, for e.g. women aren’t allowed to leave their homes and community has the strongest influence on an individual’s decision making. To make sure that right information permeates even to the most inaccessible user groups, especially women and to uplift community’s awareness as a whole, two different communication channels were designed-an interactive radio show and a public installation.

School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure. / text

INTRODUCTION : Le raisonnement clinique est au coeur de l’exercice professionnel. Cependant, nous manquons d'instruments pour identifier et objectiver les difficultés de raisonnement clinique, et il existe relativement peu de descriptions de méthodes de remédiation définies. Un important travail reste donc à faire, pour mieux comprendre comment les difficultés se manifestent dans le raisonnement clinique des étudiants en formation, mais également pour rendre ces concepts plus accessibles aux enseignants; ceci permettra alors d’améliorer la qualité de la démarche d’identification des difficultés, et d’envisager des remédiations ciblées et efficaces. OBJECTIFS : Cette recherche s’articule d’une part, autour de l’objectivation et la compréhension des pratiques actuelles des cliniciens enseignants en médecine, d’autre part, autour de la construction et l’implantation d’outils et de processus susceptibles de faciliter la démarche de diagnostic et de remédiation des difficultés de raisonnement clinique. MÉTHODOLOGIE : Une recherche de type qualitative, utilisant les méthodes de la recherche action participative s’est révélée pertinente pour atteindre nos objectifs. La recherche est composée de quatre étapes : 1. Une étude exploratoire. 2. La construction et de l’implantation d’un premier outil dans trois milieux cliniques en médecine familiale. 3. L’élaboration d’une taxonomie des difficultés de raisonnement clinique ainsi que la construction d’un nouvel outil. 4. Le développement d’une approche globale pour soutenir et former les cliniciens enseignants. RÉSULTATS : Les enseignants ont une perception rapide, mais qui demeure globale et intuitive, des potentielles difficultés de raisonnement clinique des résidents. Cette perception ne se traduit pas forcément en termes pédagogiques. Nous avons pu observer l’absence de processus pédagogiques organisés et structurés pour la gestion de ces difficultés. Ceci semble projeter les cliniciens enseignants dans une zone d’inconfort, en les confrontant à un manque de maîtrise et à l’incertitude au sujet de leurs actions pédagogiques. La catégorisation des difficultés de raisonnement clinique que nous avons construite permet d’identifier les difficultés telles qu’elles se manifestent dans le quotidien des supervisions cliniques. Cet outil a cependant besoin d’être intégré dans un processus plus global. CONCLUSION : Une approche globale qui comprenne le développement de processus implantés par le Département, l’implantation d’outils, la vulgarisation de la théorie, et la formation des enseignants est déterminante. / CONTEXT: Clinical reasoning is central to medical practice. However, we lack tools to identify and objectify the difficulties of clinical reasoning, and there are relatively few descriptions of remediation methods defined. Much work remains to be done to better understand how the problems manifest themselves in the clinical reasoning of students in training, but also to make these concepts more accessible to teachers.Then this will improve the quality of the identification process difficulties, and allow considering targeted and effective remediations.PURPOSE: This research is based on the one hand, around the objectification and understanding of current practices of clinical teachers, on the other hand, around the construction and implementation of tools and processes to facilitate the process of diagnosis and remediation of difficulties in clinical reasoning. METHODOLOGY: A qualitative research, mainly using the methods of participatory action research has been relevant to achieving our goals. The research consists of four steps: 1. An exploratory study 2. The construction and implementation of a first tool in three clinical settings 3. The development of a taxonomy of difficulties in clinical reasoning and the construction of a new tool. 4. The development of a comprehensive approach to support and train clinical teachers RESULTS: Teachers have a quick perception, but still global and intuitive, of the potential difficulties of clinical reasoning residents. This perception does not necessarily move into pedagogical terms. We observed the absence of organized and structured pedagogical processes to manage these difficulties. This seems to project the clinical teachers in a zone of discomfort, by confronting them with a lack of control and uncertainty about their educational activities. The categorization of clinical reasoning difficulties that we have built allows identifying the problems as they occur in everyday clinical supervision. This tool, however, needs to be integrated into a larger process. CONCLUSION: It is necessary to develop a comprehensive approach that includes faculty development process, implementation tools, vulgarization of the theory, and teacher training.

Thesis (M.A.)--Indiana University, 2010. / Title from screen (viewed on June 4, 2010). Department of History, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): William H. Schneider, Robert G. Barrows, Stephen J. Jay. Includes vitae. Includes bibliographical references (leaves 107-112).