Construir mudanças é imprescindível no sistema de saúde atual e, mais especificamente, no contexto da terapia intensiva, na busca de contemplar a humanização do cuidado, envolvendo, dentre outros aspectos, o reconhecimento dos usuários como cidadãos, em sua integralidade e subjetividade. O objetivo deste estudo é apreender o que significa, para os profissionais da equipe de saúde que atua na terapia intensiva, a humanização do cuidado, ou seja, compreender sua percepção e experiências acerca do que seja, para cada um, no contexto do Centro de Terapia Intensiva (CTI), ações humanizadoras. Aproximando-me de algumas idéias do referencial da fenomenologia, foram realizadas entrevistas com profissionais das várias categorias que atuam no CTI de um hospital escola da cidade de Ribeirão Preto, no período de setembro de 2007 a janeiro de 2008, partindo da seguinte questão norteadora: \"considerando seu trabalho no dia a dia, conte-me sobre as experiências que tem vivido neste CTI, em relação a situações que você considera \"humanizadoras\" e aquelas que considera \"desumanizantes\". Da análise das entrevistas, emergiram as seguintes temáticas: \"Humanização implica reconhecer o paciente em sua singularidade e integralidade\", \"Fazer técnico X humanização no cotidiano do CTI\", \"As condições de trabalho e suas implicações na humanização do cuidado em UTI\", \"O preparo da equipe para construir um cuidado humanizado\". Algumas situações que consideram o paciente em sua integralidade e singularidade no CTI nem sempre são compreendidas e valorizadas pela equipe, havendo dificuldades em reconhecer as diferenças entre as necessidades das pessoas internadas. Ainda se faz significativamente presente no CTI, principalmente para a equipe de enfermagem, a dicotomia \"fazer técnico/humanização\", como pólos distintos e difíceis de serem conciliados no ato complexo de cuidar. Quanto às condições de trabalho, a equipe de saúde aponta aspectos relacionados ao número insuficiente de profissionais, sobrecarga de atividades, o lidar cotidiano com situações de sofrimento humano, a estrutura física do CTI e a gestão tradicional do trabalho, principalmente no que concerne ao serviço de enfermagem, como aspectos que dificultam a construção da humanização do cuidado, uma vez que o profissional com desgaste físico e psicológico, em sofrimento, não tem abertura para o acolhimento do outro. O preparo da equipe para o cuidado humanizado foi pouco enfatizado, mas mostra-se com limites, sendo o processo formativo, seja na formação inicial como continuada, estratégia significativa para a reflexão e recriação cotidianas do cuidar. Nesse contexto, algumas sugestões são feitas para o cenário em foco, no sentido de promover a reflexão e a construção de novos modos de conceber e agir no que se refere à humanização na terapia intensiva. / Building up changes is essential in the current health system, and more specifically in the intensive care context, with a view to care humanization. This involves, among other aspects, acknowledging users as citizens, in their integrality and subjectivity. This study aims to apprehend what care humanization means to health team professionals working in intensive care, that is, to understand their perception and experiences about what humanizing actions are for each of them in the context of the Intensive Care Unit (ICU). Approaching some ideas from the phenomenological reference framework, interviews were held with professionals from the different categories working at the ICU of a teaching hospital in Ribeirão Preto, Brazil, between September 2007 and January 2008, based on the following guiding question: \"considering your daily work, tell me about your experiences at this ICU, with respect to situations you consider \"humanizing\" and others you consider \"dehumanizing\". The following themes emerged from the analysis of the interviews: \"Humanization implies acknowledging the patient in his/her singularity and integrality\", \"Technical practice X humanization in daily reality at the ICU\", \"Work conditions and their implications in the humanization of care at the ICU\", \"The team\'s preparation to build up humanized care\". Some situations that consider patients in their integrality and singularity at the ICU are not always understood and valued by the team, facing difficulties to acknowledge differences between the needs of hospitalized patients. Moreover, the dichotomy \"technical practice/humanization\" is significantly present at the ICU, mainly for the nursing team, as distinct poles that are hard to conciliate in the complex care act. As to the work conditions, the health team appoints aspects related to the insufficient number of professionals, activity overload, daily handling of situations marked by human suffering, physical structure at the ICU and traditional work management, mainly what the nursing service is concerned, as factors that make the construction of care humanization more difficult, as physically and mentally exhausted professionals, who are suffering, are not open to welcome the other. The team\'s preparation for humanized care received little emphasis, but reveals to be limited. The training process, either initial or permanent, is a significant strategy for daily reflection and recreation of care delivery. In this context, some suggestions are presented for the research scenario, so as to promote reflection and the construction of new ways of conception and action with respect to humanization in intensive care.

Introduction: Short-term medical missions (STMMs) are international service trips of short duration and typically involve teams traveling to provide medical service to low- and middle-income countries. The phenomenon of STMMs is neither well understood nor well defined in the literature. To date, the only published reviews of STMMs focus exclusively on the academic literature. However, these reviews do not capture the characteristics of medical missions conducted by visiting medical teams (VMTs) with no impetus to publish. YouTube, a video sharing platform which launched in 2005, is a novel information source for studying health-related issues. The goal of the present study is to understand the scope of STMMs. Specifically, we aim to characterize the STMMs described in publications listed in PubMed and videos posted to YouTube. We aim to subsequently compare findings from the literature and video review. Methods: We followed PRISMA guidelines to conduct a two pronged search of PubMed-indexed articles and videos posted to YouTube. We created a data extraction form to collect information about short-term medical mission characteristics, including sending and recipient country, sending organization, size of VMT, duration of medical mission, student involvement, and links to the local health system. Additional YouTube video-specific information was extracted including number of views, perspective, quality, operating location of the team, and distribution of medicines and vitamins. The free-text observations of the videos were thematically analyzed. Results: The majority of STMMs described in both PubMed (72%) and YouTube (93%) originate from the USA. The countries receiving the highest number of STMMs identified through literature publications were Haiti, Guatemala, Ethiopia and Peru; among videos, the countries with the highest number of STMMs were Philippines, Haiti, Honduras, and the Dominican Republic. Analysis based on income grouping shows the majority of missions go to lower-middle income countries. Analysis of recipient country based on health workforce density shows that most STMMs go to countries with a health workforce shortage, but this relationship is not linear. The majority of STMMs described in the literature (46%) were organized by secular non-profit organizations whereas the majority of STMMs described in the videos (45%) were organized by faith-based organizations. Out of 49% of articles that specified size, the median was eight members. In comparison, out of 33% videos that specified size, the median was 19 members. Whereas the median size of STMM reported in the literature was 9.5 days, the median duration in videos was 7 days. Student involvement was mentioned in 39% of articles and 18% videos. The majority (87.3%) of articles described a link to the local health system, whereas only 49.8% of videos described any link to the local health system. The median number of views of the videos was 315. Almost all videos (98.6%) were taken from the perspective of the VMT, and 82.2% were of amateur quality (non-professional). Although patients’ faces were shown in 96.1% of videos, only 0.7% of these videos stated that patient consent was obtained. Among the videos that specified the operating location of the STMM, 52.2% took place in a local healthcare facility, 21.5% in a school classroom, and 20.5% in a church. Over half (59%) of the videos portrayed the distribution of medications or vitamins. Of the videos that specified the type of service provided, 80% described STMMs that delivered medical (non-surgical) services. The provision of dental (36%), surgical (29%), and optometric (18%) services was also commonly described. Themes that emerged from the videos included patient privacy issues and long wait times. Discussion/Conclusion: The identified recipient countries of STMMs, when analyzed by income grouping and health workforce density, suggest inadequate distribution of STMMs. Furthermore, the videos highlight aspects of STMMs that have not been clearly explored in the literature including patient privacy, long wait times, and the distribution of medications and vitamins. Additionally, we found considerable variation between STMMs described in the academic literature and in grey data sources, specifically with respect to recipient country, sending organization, size of VMT, duration of STMM, and student involvement. Thus, we recommend caution in using only the academic literature to characterize the scope of medical missions. Future programmatic and policy directions should include improved pre-departure VMT training, rigorous evaluation of STMMs and the creation of a global registry.

Background Failures in non-technical skills (NTS) contribute to adverse events in healthcare. Previous research has explored the assessment and training of these skills, and yet there is a lack of evidence for their impact on clinical outcomes. Gastrointestinal endoscopy is a high-pressure specialty, but to date there is little on the role of NTS in this area, or a method for their assessment. This MD project aims to measure NTS in endoscopy, explore their relationship with clinical outcomes, and identify those specific to this area of healthcare. Methods An observational study of endoscopy teams in real time, using the Oxford NOTECHS II assessment tool. Comparison of NTS performance with procedure outcomes and patient satisfaction. A qualitative interview study with staff members to establish the NTS specifically relevant to working in gastrointestinal endoscopy. Results Reliability of the Oxford NOTECHS II tool by a single rater in this environment was good. Positive relationships were found between NTS scores and polyp detection, scope withdrawal time and completion of items on a safety checklist. However, relationships with other outcomes, including patient satisfaction were weak, or inconclusive. The themes identified relating to NTS in gastrointestinal endoscopy were leadership, working together as a team, situation awareness, making decisions, the patient and communication. Conclusions Although few conclusive relationships were found between NTS performance and procedure outcomes, those positive associations found seem logical as they are likely to reflect increased care and vigilance. This may have been affected by a lack of variation in scores. The NTS relevant to this area are similar to other areas of healthcare. However, the interaction with and around the awake patient is unique to endoscopy and an important influence on the NTS that staff must possess. There is scope to develop a more specific tool for the assessment of NTS in endoscopy.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O princÃpio da interprofissionalidade à critÃrio fundamental que orienta equipes multiprofissionais na EstratÃgia SaÃde da FamÃlia. A aÃÃo profissional, no entanto, parece ser marcada por uma lÃgica caracterizada pela delimitaÃÃo estreita de territÃrios de cada categoria, conformando um quadro de disputa entre as lÃgicas contraditÃrias da profissionalizaÃÃo e da interprofissionalidade. Esta à compreendida como a sÃntese de um processo de integraÃÃo de saberes e de colaboraÃÃo interprofissional, processos estes mediados pelos afetos. Considerando haver obstÃculos diversos para a efetivaÃÃo da interprofissionalidade, a pesquisa objetiva compreender a dinÃmica das relaÃÃes interprofissionais na produÃÃo do cuidado na EstratÃgia SaÃde da FamÃla, explorando a existÃncia de condiÃÃes de possibilidade para a construÃÃo da interprofissionalidade na AtenÃÃo PrimÃria à SaÃde no Brasil. Trata-se de estudo de caso, de natureza qualitativa, inspirado na HermenÃutica. O cenÃrio de estudo à um Centro de SaÃde da FamÃlia, numa capital brasileira. A recolha das informaÃÃes foi procedida no perÃodo de marÃo a agosto de 2011, com realizaÃÃo de entrevistas abertas, observaÃÃo das atividades desenvolvidas pelas equipes e realizaÃÃo de oficinas de produÃÃo de conhecimento, envolvendo 23 profissionais da ESF, NÃcleos de Apoio à SaÃde da Familia e residentes de Medicina e de SaÃde da FamÃlia e Comunidade. Foram identificadas condiÃÃes de possibilidades da interprofissionalidade na ESF, sintetizadas em trÃs dimensÃes: organizacional, coletiva e subjetiva. Incluem-se na dimensÃo organizacional dispositivos e arranjos institucionais, suportes para as atividades interprofissionais, quais sejam: a estruturaÃÃo de uma âRede de SaÃde â Escolaâ, transformando todas as unidades de saÃde de um municÃpio em espaÃos de ensino, pesquisa e assistÃncia; a âEducaÃÃo Permanente Interprofissionalâ que contribua para ultrapassar a lÃgica da profissionalizaÃÃo ainda hegemÃnica na formaÃÃo dos trabalhadores da saÃde; bem como a âAbordagem Centrada na FamÃliaâ, em contraposiÃÃo à tendÃncia de organizar os serviÃos de saÃde com base em interesses corporativos. A segunda dimensÃo enfoca aspectos relacionados à organizaÃÃo dos profissionais como grupo de trabalho, ou seja, a organizaÃÃo do coletivo em comunidade de prÃtica, caracterizada pela pactuaÃÃo de um projeto em comum, engajamento mÃtuo e repertÃrios compartilhados. Mesmo tendo sido os profissionais da saÃde formados hegemonicamente para a lÃgica da profissionalizaÃÃo, envolvendo luta por status e reserva de mercado de trabalho, a participaÃÃo numa equipe da ESF, constituida como comunidade de prÃtica, possibilita a aprendizagem de outros valores, favorecendo a integraÃÃo de saberes e a colaboraÃÃo interprofissional, embora nÃo livre de conflitos. A terceira dimensÃo privilegia aspectos subjetivos, como a identificaÃÃo dos profissionais com o modelo assistencial da ESF, saber lidar com frustraÃÃes e a afetividade. Consideramos ser possÃvel a interprofissionalidade, desde que sejam disponibilizadas condiÃÃes organizacionais e coletivas, mobilizadoras de aspectos subjetivos dos profissionais. A oferta das condiÃÃes de possibilidade, no plano organizacional, à indispensÃvel, mas nÃo suficiente para a integraÃÃo de saberes e a colaboraÃÃo interprofissional. Sem a mobilizaÃÃo dos afetos, dos desejos e dos micropoderes de cada sujeito, nÃo hà interprofissionalidade possÃvel. / The principle of interprofessional learning and practice is a fundamental criterion that guides multidisciplinary teams in the Family Health Strategy (FHS).The professional action however, seems to be marked by a logic characterized by the narrow boundaries of the territories of each category as a scene of contention between the contradictory logics of professionalization and interprofessional practice. This is understood as the synthesis of a process of integration of knowledge and interprofessional collaboration (COLET, 2002). These processes are mediated by affects. Considering that there are several obstacles to the realization of the interprofessional learning and practice, the research aims to understand the dynamics of inter-relationships in the production of care in the familyÂs health strategy, exploiting the existence of conditions of possibility for the construction of interprofessional learning and practice. This is a qualitative case study inspired by hermeneutics. The scenario is a study of the Family Health Center, in a Brazilian capital. The gathering of the information was provided from March to August 20122, with open interviews, observation of activities in the FHS and workshops for knowledge production, involving 23 professionals. Conditions were identified in the possibilities of interprofessional FHS, combined in the following groups: Organizational, collective, and subjective. Included in the organizational dimension are devices and institutional arrangements, cross-media activities for the structuring of a âHealth-Education systemsâ, transforming all health facilities of a municipality into areas of teaching, research, and assistance. The âinterprofessional continuing educationâ helps to overcome the hegemonic logic of professionalism, sill found in the training of healthcare workers and user-centered approach, in contrast to the trend of organizing health service base on corporate interests. The second dimension focuses on aspects related to the organization of professionals working as a group, or the organizations of the collective community practice, characterized by agreeing on a common project, mutual engagement and shared repertoire. Even though health professionals trained to the hegemonic logic of professionalization, involving a struggle to preserve status and labor market participation in the ESF team, the way they are formed as a community of practice, enables the learning of other values, knowledge and practice, favoring the integration of interprofessional collaboration and knowledge, though not free of conflict. The third dimension includes subjective aspects such as the identification of professionals of the ESF health care model, dealing with frustration and affection. We consider that the interprofessional learning and practice is possible, if subjected to the organizational and collective conditions, mobilizing subjective aspects of professionals. The offering conditions of possibility in the organizational level are essential but not sufficient for integration of knowledge and interprofessional collaboration. Without the mobilization of emotions, desires and micro powers of each subject, inter-professional learning and practice is not possible.

Sverige och det har visat sig att många vårdskador uppstår i den perioperativa vården. Bristande kommunikation har visat sig vara en vanlig orsak till vårdskador. Tidigare forskning visar på att införandet av kommunikationshjälpmedel främjar kommunikationen och ökar patientsäkerheten, men trots införandet fortsätter vårdskadorna att öka. Syfte: Syftet är att belysa faktorer som främjar och säkerställer god kommunikation inom det intraoperativa teamet för att öka patientsäkerheten. Metod: En systematisk litteraturstudie med kvantitativ ansats användes för att svara på syftet. Sökningar gjordes i två vetenskapliga databaser, CINAHL och PubMed. Totalt 16 vetenskapliga primärartiklar inkluderades, data extraherades och analyserades i enlighet med Bettany-Saltikov och McSherry (2016). Resultat: Resultatet är en konklusion av två kategorier; faktorer som främjar kommunikation och faktorer som säkerställer kommunikation. Resultatet visar att införandet av exempelvis WHO:s checklista främjar kommunikationen och ökar patientsäkerheten.  Slutsats: Kommunikationen främjas och patientsäkerheten ökar genom införandet av kommunikationshjälpmedel men för att kommunikationen ska säkerställas behövs det strategtiska lösningar för att de ska användas korrekt.

In response to increasing demands placed on public education, professional learning communities (PLC) have emerged as a means of providing teachers with opportunities to collaborate together. Collaboration has been shown to improve teaching practices and lead to better student outcomes. Many collaborative teams, however, struggle to reach their collaborative potential. Trust has been shown to be an important factor contributing to the success of collaborative efforts. Few studies exist that empirically assess the relationship between team functionality and team trust. This study examines the relationship between these two constructs. A measurement tool was developed by the author to measure PLC team functionality based on five domains of functionality. Team trust was measured by a preexisting tool developed by Costa & Anderson (2010) based on four dimensions of trust. Multiple regression analyses were performed to assess the strength of the relationship between PLC team functionality and team trust. Control factors such as team stability, years of teaching, and principal support were included in the analysis. Findings showed a positive, significant relationship between the five domains of PLC team functionality and the four dimensions of team trust. While individual relationships between domains of functionality and dimensions of trust varied, between 46%-60% of variability in team functionality was explained by team trust. This study demonstrates the importance of trust in collaborative efforts of PLC teams as well as highlights a more complex relationship between the two constructs than previously understood in the literature.

Agile development is a software development methodology that originated in 2001 (Beck, et al.). It has since gained wide recognition and use in the software industry, and is characterized by iterative development cycles. Organizations outside of the software industry are also finding ways to adapt Agile development to their contexts. BYU Independent Study (BYUIS) is an online education program at Brigham Young University that provides online courses at the high school and university levels. In April 2016, BYUIS implemented the Agile development process to the design and development of online courses. This thesis is a case study that looks specifically at the adoption of Agile at BYUIS, from its implementation in April 2016 to the time of this study in summer of 2017. The question this qualitative study seeks to answer is as follows: how and why did the adoption of the Agile development methodology to instructional design practices at BYUIS reflect or differ from the 12 principles of Agile development? To answer this research question, the researcher used multiple data sources: semi-structured interviews with three administrators, two production team managers, and three instructional designers; surveys for BYUIS student employees (i.e., scrum team members) after each week of observation; and field note observations of three Agile scrum teams for two weeks each. The data from each of these sources was analyzed through a descriptive coding process and then organized into a thematic network analysis. The Results section analyzes evidence from the interviews, surveys, and observations that reflect or differ from each of the 12 principles of Agile. The Discussion addresses three main issues of implementing Agile at BYUIS: how to accommodate for part-time schedules, the complexity of working on different projects, and how to facilitate communication in scrum teams if co-location is not possible. It also looks at how these three issues could be manifest in other organizations and introduces potential solutions. The researcher then presents suggestions for future research on Agile in instructional design or other contexts.

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No description available.

Team norms are one of the most frequently used explanations of how teams as a collective entity can influence individual member’s behaviors (Hackman & Walton, 1986; Bettenhausen & Murnighan, 1991; Feldman, 1984). Despite such importance, current theoretical and empirical development of team norms is relatively inadequate. In this dissertation, I view norm strength and norm enforcement as two central pillars of team norms, and specifically examine team norm enforcement from a social network perspective. I first develop a typology based on the existing literature and specify the behavior content of three types of norm enforcement mechanisms: sanction, recognition and learning. Second, I examine the impact of the structural and configural properties on team performance. This model was tested on 799 employees nested in 101 work teams from China. Results from the data analysis have offered partial support that the structural characteristics of norm enforcement network had impacts on team performance above and beyond norm strength.