Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-12-05T13:29:31Z No. of bitstreams: 1 RUY_DE_ALMEIDA_BARCELLOS.pdf: 2171813 bytes, checksum: d242fe874538146ea8081420b788cadb (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-12-06T18:13:57Z (GMT) No. of bitstreams: 1 RUY_DE_ALMEIDA_BARCELLOS.pdf: 2171813 bytes, checksum: d242fe874538146ea8081420b788cadb (MD5) / Made available in DSpace on 2018-12-06T18:20:07Z (GMT). No. of bitstreams: 1 RUY_DE_ALMEIDA_BARCELLOS.pdf: 2171813 bytes, checksum: d242fe874538146ea8081420b788cadb (MD5) Previous issue date: 2018-09-24 / Objective: To evaluate the impact of the implantation of a checklist during multidisciplinary daily round in the period of using invasive mechanical ventilation (MV) and permanence in the ICU. Methods: In a non-randomized clinical trial with historical controls, 466 patients submitted to MV were evaluated in a Hospital in Caxias do Sul (RS). Of this total, 235 and 231 were evaluated in the pre-intervention and post-intervention phases, respectively. The outcomes studied were SAPS-3, SOFA, frequency of infections, ICU stay, days of MV, reintubations, rehospitalizations, deaths in the ICU and hospital. Results: There was a significant reduction after the routine use of the checklist in the lenght of permanence in 37.5% (p <0.001) and 60% (p <0.001) in the time of mechanical ventilation. The frequency of pulmonary focus infection was reduced by 11.9% (p = 0.030). Conclusions: The multidisciplinarity structured through the use of checklists has an impact on the reduction of the days of use of mechanical ventilation and stay in the ICU. / Objetivo: Avaliar o impacto da implanta??o de uma lista de verifica??o durante round di?rio multiprofissional nos tempos de ventila??o mec?nica invasiva (VM) e perman?ncia na UTI. M?todos: Em um ensaio cl?nico n?o randomizado com controles hist?ricos, foram avaliados 466 pacientes submetidos ? VM em um hospital em Caxias do Sul (RS). Foram avaliados 235 e 231 pacientes nas fases pr?-interven??o e p?s-interven??o respectivamente. As vari?veis estudadas foram: Simplified Acute Physiology Score (SAPS-3), Sequential Organ Failure Assessment (SOFA), frequ?ncia de infec??es, perman?ncia na UTI, dias de VM, reintuba??es, reinterna??es, ?bitos na UTI e hospitalar. Resultados: Houve redu??o significativa ap?s a implanta??o da lista de verifica??o no tempo de perman?ncia em 37,5% (p<0,001) e de 60% (p<0,001) no tempo de ventila??o mec?nica. A frequ?ncia de infec??o de foco pulmonar teve redu??o 11,9% (p=0,030). Conclus?es: A multidisciplinaridade estruturada atrav?s da utiliza??o da lista de verifica??o teve impacto na redu??o dos dias de utiliza??o de ventila??o mec?nica e perman?ncia na UTI.

Com a atual transição demográfica refletida no envelhecimento populacional, as doenças crônicas transmissíveis foram substituídas pelas doenças crônicas não transmissíveis (DCNT), que ocasionam implicações no processo do envelhecimento saudável, para o idoso e para as famílias, havendo a necessidade da procura por Instituições de Longa Permanência para Idosos (ILPI). Nesse contexto, o objetivo desse trabalho foi descrever o perfil de saúde de idosos residentes em instituições de longa permanência públicas do município de Bauru/SP, possibilitando o tratamento e monitoramento para melhor qualidade de vida dessa população. Trata-se de um estudo transversal descritivo analítico, realizado entre os anos 2015 e 2017, com amostra constituída por 146 idosos residentes das duas únicas ILPI públicas do município de Bauru/Sp. Foram realizados exames de hemograma, glicemia de jejum, e perfil lipídico para avaliar respectivamente anemia, diabetes e dislipidemia nessa população. Foram utilizados dados sóciodemográficos dos prontuários médicos dos residentes e utilizado o IMC dos idosos para avaliação nutricional. Os resultados obtidos destacam que 72 (49%) idosos eram do sexo masculino e 74 (51%) do sexo feminino, com prevalência de indivíduos com idade entre 60 e 69 anos (40%) com pele branca (68,5%). Quanto ao hemograma, 33 (22,6%) idosos estavam com valores indicativos de anemia, 54 (37%) resultados abaixo do aceitável de HDL-colesterol, 44 (30,1%) idosos com resultados elevados de LDL-colesterol, característicos de dislipidemias. 77% dos idosos apresentaram peso normal, indicando boa condição nutricional. As mulheres foram as mais acometidas (17,6%) pelo baixo peso na faixa etária entre 60 e 69 anos em associação com os casos de anemia. Concluímos que as condições de saúde da maioria dos idosos residentes em ILPI públicas no município de Bauru foram consideradas de boa qualidade frente aos desafios diários, fragilidades individuais e a complexidade de fatores envolvidos nesta avaliação. A prática de exercícios físicos para o controle das dislipidemias é de extrema importância durante o envelhecimento, porém nas instituições os exercícios são realizados com moderação respeitando as individualidades. Ressalta-se a importância dos cuidados multiprofissionais adequados e aos exames de sangue periódicos para que haja integração do conhecimento sobre o perfil de saúde e monitoramento das doenças crônicas, promovendo a melhor qualidade de vida dos idosos, especialmente os institucionalizados. / With the current demographic transition reflected in population aging, chronic communicable diseases have been replaced by chronic noncommunicable diseases (NCDs), which have implications for the aging process for the elderly and for families. Long Stay for the Elderly people (ILPI). In this context, the objective of this study was to describe the health profile of elderly people living in long-term public institutions in the city of Bauru/SP, allowing treatment and monitoring to improve the quality of life of this population. This is a descriptive cross-sectional analytical study, carried out between 2015 and 2017, with a sample of 146 elderly residents of the only two public ILPI in the city of Bauru/SP. Hemogram, fasting glycemia, and lipid profile tests were performed to assess anemia, diabetes and dyslipidemia in this population, respectively. Data from medical records and BMI of the elderly were used for nutritional evaluation. The results showed that 72 (49%) of the elderly were male and 74 (51%) were female, with a prevalence of individuals aged between 60 and 69 years (40%) and white skin (68.5%). Regarding the CBC, 33 (22.6%) elderly patients had values indicative of anemia, 54 (37%) below-acceptable HDL-cholesterol, 44 (30.1%) elderly patients with high LDL-cholesterol Of dyslipidemias. 77% of the elderly presented normal weight, indicating an excellent nutritional condition. The women were the most affected (17.6%) due to the low weight in the age group between 60 and 69 years, all of them being associated with anemia. We conclude that the health conditions of the majority of the elderly people living in public ILPI in the city of Bauru were considered of good quality in face of daily challenges, individual fragilities and the complexity of factors involved in this evaluation. The practice of physical exercises for the control of dyslipidemias is extremely important during aging, but in institutions the exercises are performed with moderation respecting the individualities. The importance of appropriate multiprofessional care and periodic blood exams is important in order to integrate knowledge about the health profile and monitoring of chronic diseases, promoting the better quality of life of the elderly, especially the institutionalized ones.

Diante da necessidade de mudança do paradigma do sistema de saúde e uma maior coerência entre o serviço ofertado e as condições de saúde da população, vários países tem buscado a reconfiguração de seus sistemas e/ou novos modelos de organização da gestão. No Brasil, vem sendo instituídas as Redes de Atenção à Saúde (RAS) e como referencial teórico operacional de gestão nesta nova organização se destacam a Gestão da Clínica e a Clínica Ampliada. A Continuidade do Cuidado é um dos elementos principais desse novo paradigma, assim, novos modelos assistenciais surgem em resposta. Os Cuidados Continuados Integrados (CCI) é uma experiência internacional exitosa, de um novo modelo assistencial que se situa nos desenhos de atenção entre o hospital geral e a atenção primária. Está sendo implantado no Brasil, aonde assume a denominação de Cuidados Prolongados e se insere na Rede de Atenção às Urgências e Emergências. OBJETIVO: O presente trabalho tem por objetivo estudar a Unidade de Cuidados Prolongados (UCP), como uma estratégia de atenção no Sistema Único de Saúde (SUS), identificando o processo de trabalho de unidades de um projeto piloto, sob as referências da Gestão da Clínica e da Clínica Ampliada. MÉTODOS: Trata-se de estudo transversal, qualitativo quanto a abordagem, descritivo e exploratório quanto aos objetivos. O trabalho foi elaborado em três etapas complementares, sendo observação (etapa 1), análise de documentos (etapa 2) e aplicação de questionário estruturado composto de 82 assertivas, dividido em 6 blocos temáticos (trabalho em equipe, fluxo do usuário, prática clínica, estrutura / ambiente / materiais, gestão da qualidade e satisfação profissional). O instrumento foi aplicado aos trabalhadores da UCP de dois municípios do Estado de São Paulo (passo 3), que concordaram em participar da pesquisa (N de 26 participantes, 13 de cada unidade em estudo). A análise de dados foi realizada para compreender a organização do fluxo de trabalho e a percepção de trabalhadores e funcionários sobre a instituição, o processo e sua satisfação. A análise das respostas foi realizada calculando a escala média (RM) para a escala de Likert, medindo o grau de concordância dos participantes, em relação ao assertivo. Atribuiuse um valor de 1 (total discordância) a 5 (total concordância) correlacionando as variáveis estudadas intra e interunidades, buscando significação nas variações. RESULTADOS E DISCUSSÃO: foram identificados o desenho assistencial desenvolvido por ambas unidades, desde o referenciamento do usuário de acordo com o modelo de atenção estudado, até seu contra-referenciamento para a atenção básica, além do processo de trabalho e organização da equipe. Através da aplicação do questionário, identificou-se que os profissionais têm a tendencia à satisfação em ii relação aos 6 blocos temáticos (3,1 a 4,3), entretanto com variações significativas em assertivas individuais, em todos os blocos. CONCLUSÃO: O modelo de atenção estudado apresenta evidências de resultados positivos que estão em alinhamento com a literatura estudada, apresentando um design funcional dentro dos princípios do SUS. A articulação deste modelo na RAS ainda é um ponto a ser melhorado. De acordo com as percepções dos profissionais que compõem o trabalho em equipe, devem ser alcançadas melhorias em todos os tópicos estudados, a fim de preencher toda a operação com as propostas de gestão clínica e a clínica ampliada. / Several countries have sought the reconfiguration of their systems and/or new management organization models when faced with the need to change the paradigm of the health system and greater coherence between the delivered services and the health conditions of the population. In Brazil, the establishing of Health Care Networks (RAS) are in course. Clinical Management and the Extended Clinic are the highlights of the theoretical concepts for the operational management of this new arrangement. Continuity of Care is one of the main elements of this new paradigm, so innovative care models emerge in response. Integrated Continuing Care (CCI) is a successful international experience of a novel care model located in the design of care between the general hospital and primary care. It has been implemented in Brazil, denominated by the name of Extended Care and it is part of the Care Network for Urgencies and Emergencies. OBJECTIVE: The aim of this work is to study the Extended Care Unit (UCP), as a care strategy in the Unified Healthcare System (SUS), identifying the workflow of pilot UCP healthcare units, under the references of Clinical Management and Extended Clinic. METHODS: This is a cross-sectional study, with qualitative approach, descriptive and exploratory regarding the objectives. The work was elaborated in three complementary stages, being observation (step 1), analysis of documents (step 2) and application of structured questionnaire composed of 82 assertions, divided into 6 thematic blocks (teamwork, users\' flow, clinical practice, structure / environment / materials, quality management and professional satisfaction). The instrument was applied to UCP workers of two municipalities of the State of São Paulo (step 3), which have agreed to participate of the research (N of 26 participants, 13 of each unit under study). The data analysis was performed in order to understand the organization of the workflow and the perception of workers and staff about the institution, the process, and their satisfaction. Analysis of the responses was performed by calculating the Mean Ranking (RM) for Likert scale, measuring the degree of agreement of the participants, in relation to the assertive. It was assigned values of 1 (total disagreement) to 5 (total concordance) correlating the intra and inter-unit variables studied, seeking significance in the variations. RESULTS AND DISCUSSION: The design of patient assistance carried out by both units were identified, from user referral according to the model of care studied, until their counter-referral for primary care, as well as the workflow process and the team organization. Based on the application of the questionnaire, it was identified that professionals have the tendency to satisfaction in relation to the 6 thematic blocks (3,1 to 4,3), however with significant variations in individual assertives, in each block. iv CONCLUSION: The care model studied presents evidence of positive outcomes that are in alignement with the literature studied, presenting a functional design inside the SUS principles. The articulation of this model in RAS is still a point to be improved. According to the perceptions of the professionals that compose the teamwork, improvements must be achieved in every topic studied, in order to fill the whole operation with the proposals of the clinical management and the extended clinic.

Background. Shortage of nurses is an alarming problem in Sweden and the world as a whole. To be able to solve this problem it important to identify those factors that according to the nurses can contribute to make their work attractive. Aims. The aim of this study was to describe factors that make work attractive and how these differ from the actual work situation among nurses who work in orthopedic departments. Methods. It was a cross-sectional survey with descriptive and comparative design. Data were collected in orthopedic departments in sex different hospitals in the middle of Sweden using questionnaires. A total of 95 nurses responded. Correlation and regression analyses was used to analyze the data. Main Results. According to the nurses’ factors that were most important for a job to be attractive were leadership, salaries, collaboration (teamwork) and job status. Nurses appreciated their current work situation lower than the attractive work. To feel valuable was the best in the current work situation, while the salary was worst. Comparison of the current work with the attractive work shows significant difference with significant level &lt;0.05 when comparing all factors. The most significant was salary because it had the biggest discrepancy between the current work and the attractive work while the journey to and from work had the least discrepancy. Conclusions. According to the results of the analyses good leadership, high salaries, good collaboration (teamwork) and good job status are of great importance when considering strategies to retain nurses. Nurses appreciated their current work situation lower than the attractive work with salaries being worst. This implies that one strategy that could improve the current working situation may be an increase in salaries. / Sammanfattning Bakgrund. Brist på sjuksköterskor är ett alarmerande problem i Sverige och i världen. För att kunna lösa problemet är det viktigt att identifiera de faktorer som enligt sjuksköterskor kan bidra till att göra deras arbete attraktivt. Syfte. Syftet med studien var beskriva faktorer som gör ett arbete attraktivt och hur detta skiljer sig mot den faktiska arbetssituationen bland sjuksköterskor som arbetar på ortopediska vårdavdelningar i mellan Sverige. Metod. Det är en tvärsnitt studie med beskrivande och jämförande design. Datainsamling skedde på ortopediska vårdavdelningar på sex olika sjukhus i mellan Sverige med hjälp av enkäter. Totalt 95 sjuksköterskor svarade. Korrelations- och regressionsanalys användes för att analysera data. Huvudresultat. De faktorer som enligt sjuksköterskor var mest betydelsefulla för att ett arbete ska vara attraktivt var ledarskap, lön, samarbete och arbetsstatus. Sjuksköterskor skattade sin nuvarande arbetssituation lägre än det attraktiva arbetet. Att känna sig värdefull skattades högst i den nuvarande arbetssituationen medan lönen var sämst. Jämförelse av nuvarande arbete med attraktivt arbete visade signifikant skillnader vid jämförelsen av alla faktorer. Lönen hade störst diskrepans mellan det nuvarande arbetet och det attraktiva arbetet medan resan till och från arbete hade minst diskrepans. Slutsatser. Enligt analys av resultatet har ledarskap, lön samarbete och arbetsstatus stor betydelse vid övervägande av strategier för att behålla sjuksköterskor. Sjuksköterskor skattade sin nuvarande arbetssituation lägre än det attraktiva arbetet och lönen lägst. Detta innebär att en strategi som skulle kunna förbättra den nuvarande arbetssituationen på något sätt kan vara löneökning.

Developmental delays related to feeding dysfunction in premature infants can lead to lengthy hospitalizations and increased healthcare costs initially and throughout the first year of the child's life. The purpose of this project was to use readiness-to-feed assessments to evaluate the impact of an infant-driven feeding protocol on length of stay. The project compared the length of stay of 2 groups of infants: a demand fed according to a readiness-to-feed protocol (protocol group, n = 14) and a traditionally fed according to scheduled, volume-driven feedings (traditional group, n = 15). The logic model served as the change management framework and synactive theory of infant development provided the theoretical framework. According to Als' synactive theory, a shortened hospital stay for premature infants may reduce adverse effects related to neurosensory development, delayed bonding, and a distant parenting experience. A quantitative research design was used, and data were collected through a retrospective chart review of the 2 groups. Descriptive statistics and analysis of variance were completed. The findings indicated that the length of stay in the protocol group was less than the length of stay in the traditionally fed group and that the difference was statistically significant (p = 0.03). Social change benefits related to the project include improved family bonding, improved neurosensory development of infants, and a reduction in healthcare costs as a result of a shortened length of stay. The findings of this project demonstrated that by using the readiness-to-feed protocol, neonatal intensive care nurses can decrease lengths of stay and costs of hospitalization while reducing adverse effects of traditional care on infant development and bonding.

An F-1 academic visa is required for foreign students studying at academic institutions in the United States. While requirements for acquiring the F-1 visa are a matter of federal policy, some of the principles regulating orientations, host families, and home-stays do not align with best practices found at the university level, which include quality student orientations and thorough trainings with a vetting process for host families and home-stays. This lack of regulation may place visiting students at risk in terms of personal safety and wellbeing and have negative impacts for program credibility and lost revenue. Using Stone's regime theory as the foundation, the purpose of this multiple case study of orientations and home-stay experiences of F-1 visa students under the Student and Exchange Visitor Program, was to explore from the perspective of program participants, ways to increase safety and quality assurance of these programs. Data were collected through in-depth interviews with six former student participants. These data were inductively coded and subjected to a thematic analysis procedure. A key theme of this study is that participants perceived that additional training to host families including vetting and monitoring processes and student orientations in acculturation and communication would enhance the experiences of F-1 visa holders. The implications for positive social change include recommendations to schools and study abroad organizations to implement policy changes regarding the requirements for students and host families, sponsors, and home-stay monitoring and orientation components for students and host families to promote more effective and safer home-stays for F-1 high school students.

Retention of nursing directors is important to the viability and success of the healthcare industry because they have a large impact on nursing job satisfaction, overall retention of nurses in an institution, productivity, and patient outcomes. Factors that retain nurse directors, such as autonomy and empowerment, appear to be important to job satisfaction, but there is little in the current research to corroborate these findings. The purpose of this quantitative study was to determine what factors impact nursing directors' intent to stay in their current role and what effect role autonomy and empowerment have on their intent to stay as compared to traditional job satisfiers. Kanter's empowerment theory was used to evaluate the key factors that influence job satisfaction and retention, namely, empowerment and autonomy. The key variables were measured with Attitude toward Professional Autonomy Scale for Nurses, Conditions for Work Effectiveness Questionnaire-II, Intention to Stay Scale, and Minnesota Satisfaction Questionnaire. Nursing directors were recruited American Organization of Nurse Executives and LinkedIn. Seventy-six participants answered 4 survey tools on the key. Data were analyzed using Pearson's r, multiple and logistic regression. Results revealed that empowerment had a significant relationship to nursing directors' intent to stay and that traditional job satisfiers were significantly related to predicting intent to stay. The results could affect positive social change because increasing job satisfaction of nursing directors would lead to their desire to remain in their position and would stabilize overall retention of nurses, productivity, and patient outcomes. Future research is needed to devise, and test interventions designed to enhance empowerment and positively affect intent to stay.

Longer-term immigrants residing in the United States exhibit physical health decline related to higher body mass index (BMI). Theories on immigrant acculturation have been used to examine health patterns by length of stay in the United States. The purpose of this cross-sectional study, guided by the Schwartz model of acculturation, was to examine the effect of acculturation and length of stay in the United States on BMI in a sample of Haitian immigrants living in the Northeast Metropolitan area. The research question was used to examine the effects of acculturation and length of stay on BMI in the convenience sample of 116 Haitian men and women, aged 18 years and older, who had relocated to the United States for 3 years or more. Data were collected using a demographic questionnaire and medical records from a participating health clinic and then analyzed by conducting a multiple linear regression. According to study results, acculturation, length of stay, age, gender, and physical activity were not significant predictors of BMI change. An ancillary analysis using the subscales of acculturation revealed similar results. This study may provide positive social change by enabling health providers to understand the beliefs, values, and practices of Haitian immigrant groups and the acculturation pattern of individuals when providing care for this population.

<p>Syftet med studien var att undersöka kvinnors attityder till fängelsevistelsen. Forskning kring kvinnors kriminalitet och fängelsevistelse är mycket bristfällig både internationellt och nationellt. Tidigare forskning utgår främst ifrån män och deras kriminalitet, vilket blivit normgivande för synen på brottslingar och kriminalvårdens uppbyggnad. Studien inriktades på kvinnliga interners attityd till fängelsemiljö, kommunikation och upplevelse av stämpling under fängelsevistelsen. 256 interner var vid tillfället placerade på olika anstalter i Sverige. Alla erbjöds delta enligt etiska rådets principer. Enkäter med frågor och påståenden på en 5-gradig ordinalskala skickades till samtliga anstalter, varav 76 ifyllda enkäter returnerades. Svaren skiljde sig åt beroende på anstalt och om man befann sig på en öppen eller sluten avdelning. Slutresultaten visade att flertalet hade en relativt positiv attityd till fängelsevistelsen.</p> / <p>The aim of this study was to examine women’s attitudes to their stay in prison. Research about women and crime is insufficient, both nationally and internationally. Previous research concentrates on men and their crimes, and this has created the standard within the correctional system. The current study concentrates on women’s attitudes to the prison environment, communication and the experiences of conspiracies. 256 Swedish female inmates were in prison at the time the study was in progress. Each of them was invited to participate in accordance with the guidelines of the Ethical Council. Questionnaires with statements and questions using a five-point ordinal-scale were sent out to all prisons resulting in the return of 76 questionnaires. The results differed depending on the institution where the prison sentences were served and whether or not it was a high- or low security prison. The final result revealed that women in Swedish penal institutions have a relatively positive attitude to their imprisonment.</p>

Syftet med studien var att undersöka kvinnors attityder till fängelsevistelsen. Forskning kring kvinnors kriminalitet och fängelsevistelse är mycket bristfällig både internationellt och nationellt. Tidigare forskning utgår främst ifrån män och deras kriminalitet, vilket blivit normgivande för synen på brottslingar och kriminalvårdens uppbyggnad. Studien inriktades på kvinnliga interners attityd till fängelsemiljö, kommunikation och upplevelse av stämpling under fängelsevistelsen. 256 interner var vid tillfället placerade på olika anstalter i Sverige. Alla erbjöds delta enligt etiska rådets principer. Enkäter med frågor och påståenden på en 5-gradig ordinalskala skickades till samtliga anstalter, varav 76 ifyllda enkäter returnerades. Svaren skiljde sig åt beroende på anstalt och om man befann sig på en öppen eller sluten avdelning. Slutresultaten visade att flertalet hade en relativt positiv attityd till fängelsevistelsen. / The aim of this study was to examine women’s attitudes to their stay in prison. Research about women and crime is insufficient, both nationally and internationally. Previous research concentrates on men and their crimes, and this has created the standard within the correctional system. The current study concentrates on women’s attitudes to the prison environment, communication and the experiences of conspiracies. 256 Swedish female inmates were in prison at the time the study was in progress. Each of them was invited to participate in accordance with the guidelines of the Ethical Council. Questionnaires with statements and questions using a five-point ordinal-scale were sent out to all prisons resulting in the return of 76 questionnaires. The results differed depending on the institution where the prison sentences were served and whether or not it was a high- or low security prison. The final result revealed that women in Swedish penal institutions have a relatively positive attitude to their imprisonment.