Made available in DSpace on 2017-06-01T18:18:03Z (GMT). No. of bitstreams: 1 dissertacao_eliezer_queiroz.pdf: 704795 bytes, checksum: 177fdbf42a3a16772ffce78671b4130d (MD5) Previous issue date: 2011-01-28 / In this dissertation, we sought to demonstrate that, despite the new procedural techniques exist, trying to become more effective by courts there, then, as a social need to give speed to the demands faced by the Brazilian judiciary. In this sense, it was observed that the principles become a potent weapon in the hands of judges and may give them a quicker exit procedure for cases that are presented to the Judiciary. And as a consecration of the principles are the values of justice, are a source of law and are applied by judges, can be perfectly used in the resolution of the dispute, upon the occurrence of gaps in the law. Was studied because, as it applies to fungibility between the urgency protections and what it can mean for the judiciary patriotism. Worked up an explanation of the urgency protections, making the need to see the exhibition of the debate the question of replacement of the injunction restraining and vice versa, considering that despite that, this last fact has not been well accepted by the doctrine. But it appeared that in accordance with Article 273, § 7 of the Code of Civil Procedure, it becomes possible to perform the exchange of a request for early relief done irregularly, for a precautionary measure, say, incidentally, the process of knowledge. And he came to the conclusion that denying the effect of commingling would somehow defy the current law stand, and the principle of diligence and reasonable duration of proceedings / Nesta dissertação, buscou-se demonstrar que, a despeito de existirem novas técnicas processuais, procurando tornar mais efetiva a prestação da tutela jurisdicional haverá, então, uma necessidade social quanto a se dar celeridade às demandas que se colocam ao judiciário brasileiro. Nesse sentido, observou-se que os princípios se tornam arma potente nas mãos dos julgadores, podendo proporcionar-lhes uma saída processual mais ágil para os casos que são apresentados ao Poder Judiciário. E como os princípios são consagrações de valores de justiça, são fonte do direito e são aplicados pelos magistrados, podem ser perfeitamente usados na resolução da lide, quando da ocorrência das lacunas da lei. Estudou-se, pois, como se aplica a fungibilidade entre as tutelas de urgência e o que isso pode representar para o sistema judiciário pátrio. Trabalhou-se a explicação das tutelas de urgência, fazendo-se ver a necessidade da exposição do debate da questão da substituição da tutela antecipada pela medida cautelar e vice-versa, considerando-se que, apesar disso, este fato último não tem sido bem aceito pela doutrina. Mas se verificou que de acordo com o artigo 273, § 7º, do Código de Processo Civil, torna-se possível a realização da troca de um pedido de antecipação de tutela feito, de forma irregular, por uma medida cautelar, digamos, incidentalmente, no processo de conhecimento. E chegou-se à conclusão de que negar o efeito da fungibilidade seria, de alguma forma, afrontar o atual direito posto, bem como ao princípio da celeridade e duração razoável do processo

Bakgrund: Att ha ett trycksår innebär att huden och underliggande vävnad drabbas av en lokal skada, orsakad av syrebrist. Riskfaktorer för att drabbas av trycksår är bland annat nedsatt allmäntillstånd och begränsad rörlighet. Smärtan som ett trycksår medför kan upplevas på olika sätt, allt från att det tar över hela livet till att patienter döljer den. Syfte: Att beskriva sjuksköterskors erfarenheter av trycksårsförebyggande arbete, vid arbete på vårdavdelningar. Metod: En kvalitativ systematisk litteraturstudie, baserat på tolv vetenskapliga artiklar, som analyserats enligt en analysmetod. Resultat: Analysen presenteras i två teman: “Vikten av kunskap” och “Vikten av omgivande resurser”, som resulterade i totalt fem sub-teman: “Behov av utbildning för ökad förståelse”, “Tidigare erfarenheter av att behandla trycksår”, “Patienters roll”, “Vårdpersonalens betydelse” samt “Organisationens förutsättningar”. Slutsatser: Förebyggande av trycksår kräver en viss kunskap och kompetens hos sjuksköterskor för att effektivisera detta arbete. Sjuksköterskor beskrev även vikten av teamarbete och planering, vilket försvåras av tids- och personalbrist. Sjuksköterskor upplever en maktlöshet kring det trycksårsförebyggande arbetet, då de saknar vissa förutsättningar för att kunna optimera vården. Samtidigt kan det trycksårsförebyggande arbetet minska kostnaderna för sjukvården.

This study was to investigate the role played by traditional authorities in IDP policy implementation in local municipal councils in the Vhembe District located in Limpopo Province. The specific objectives of this study were to characterise the traditional authority serving in the municipal councils. Traditional leaders serving in municipal councils, the district mayor, local municipal mayors, managers, IDP managers, district and provincial representatives of the House of Traditional Leaders in Limpopo Province were interviewed using semi-structured sets of questionnaire to obtain the required data. The data were entered into an Excel Spreadsheet and subsequently exported into an SPSS for analysis. The results of the study revealed that traditional authority forms an integral part of IDP policy implementation in Vhembe District Municipality. The results further revealed that perceptions of stakeholders vary as to the role played by traditional authorities in the IDP policy implementation process. The results revealed that some traditional leaders agreed that participation in IDP policy implementation (45.5%), involvement (45.2%), the submission of views (41.2%); ward committee meetings (42.8), council IDP policy (90.0%), role (50.0%), submission of proposals (38.7%) and consultation by the municipality (93.2%), were all satisfactorily taking place in the municipality. Furthermore, the results indicated that traditional leaders serving in municipal councils were members of the ruling party (40.0%), aged on average 55.26 years, distributed between 35 and 75 years, and were from extended households of 11.3 members per household, distributed between 3 and 25 members ¯ with an average of 2.4 spouses per traditional leader, distributed between one and five spouses. The majority had attained secondary level education (40.0%), tertiary level education (33.3%) and primary education (26.7%). They showed high experience ranging between 2 to 35 years, and 17.46 years on average as traditional leaders – with a further 7.66 years of experience in the municipal council. The majority make their livelihood by way of compensation from council (73.3%), wages from government as traditional leaders (93.3%), or employment (6.7%). All the traditional leaders own vehicles. The study concluded that the demographic and endowment characteristics of these traditional leaders influence their role in municipal IDP policy implementation. / Thesis (PhD)--University of Pretoria, 2012. / School of Public Management and Administration (SPMA) / unrestricted

Bakgrunden till examensarbetet var att vårdpersonal ska arbeta för att främja amning och för detta arbete behövs tydliga riktlinjer. Syftet med examensarbetet var att beskriva och jämföra omvårdnad och amningsutfall hos ammande barn som inte gick upp i vikt under sina första levnadsveckor. Metoden för arbetet var en retrospektiv journalgranskningsstudie där ett extraktionsprotokoll användes för att komma fram till resultatet. I studien inkluderades totalt 144 barn som vårdats inneliggande på barn- eller neonatalavdelning under perioden juli 2016 till juli 2019. Resultatet från studien visade att de flesta barn tillmatades med bröstmjölk och modersmjölksersättning via antingen bröst eller ventrikelsond samt att andelen barn som helammade var låg. Vidare visade studien att faktorer som minskade oddsen för helamning i samband med utskrivning var tillmatning med nappflaska, användande av modersmjölksersättning eller om barnen om barnets kön var en pojke. Slutsatsen var att barnen i första hand bör tillmatas via ventrikelsond då behov av tillägg utöver amning finns och att bröstmjölk bör vara förstahandsval vid tillmatning eftersom det främjar den fortsatta amningen. Barnsjuksköterskans roll för att främja amningen är att ge en god omvårdnad av barnet och fngera som ett stöd för mamman.

MPM / Oliver Tambo Institute of Governance and Policy Studies

Team collaboration is a fundamental part of Quality Management (QM), and working together successfully is an important part of improving an organization. Team collaboration is also essential for achieving quality of care, patient safety and care continuity, especially when handling critically ill patients. Transferring a patient from an intensive care unit (ICU) to a general ward demands planning, communication, competence, a system view, and a quality culture. This patient transfer process, called ICU transitional care, extends across hospital boundaries, which have different organizational cultures, technologies, and knowledge. It is a challenge to manage these differences in order for team collaboration to meet the needs of patients, relatives and co-workers. To achieve this, further research is required to understand how care teams, both within hospital units and between organizational boundaries, can collaborate more successfully and efficiently to achieve quality of care in the ICU transitional care process. The overall purpose of this thesis is to contribute to a deeper understanding of how to improve team collaboration within ICU transitional care aiming to increase quality of care. To achieve this, four research questions were formulated and three case studies conducted. In the first case, a systematic literature review was performed to explore the extent to which Quality Management and Nursing Science can offer complementary perspectives to provide better quality of care by looking at Quality Management core concepts and tools. Findings from this study revealed, among other things, a need for further research on team collaboration in ICU transitional care. The purpose of the second study was to develop and test a questionnaire aiming to measure the perception of team collaboration in the patient transfer process from the ICU to the general ward. This study also aimed to analyze the results to see how the questionnaire could help improve team collaboration within ICU transitional care. Empirical data were collected from two ICUs at two hospitals. Participants at the ICUs answered the developed questionnaire, and the results showed that it could be used for measuring perceived team collaboration in this patient transfer process. The results from the questionnaire also gave insights that might be useful for improving team collaboration in this ICU transitional care process. The purposes of the third study were, first, to describe how co-workers’, within a team, perceived team collaboration in patient transfers from ICU to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration. Focus group discussions (FGDs) were conducted at two hospitals to answer the two questions. There were several findings from the study, and the results indicated that team collaboration has an important role when creating prerequisites for a holistic view of the process, and that there was a perceived need among the co-workers to improve team collaboration over organizational boundaries. Co-workers also expressed a need for more involving patients and relatives when improving team collaboration.   Four overarching conclusions can be drawn from this research. Firstly, Quality Management is used in ICU transitional care to improve the quality of care. Secondly, multi-professional team collaboration is perceived to be easier and better developed within hospital units than between them. Collaborating in teams between hospital units is challenging for several reasons. Some reasons are unclarity in routines for communication and decision-making, for example who decides what.  A third conclusion is the importance of how teams and team collaboration are defined and structured in ICU transitional care. This involves roles and responsibilities of teams. Teams have specific characteristics that are important for their performance. A fourth conclusion is an expressed need to involve patients and relatives more when it comes to improve team collaboration in ICU transitional care. The main findings from the three studies presented in this thesis have given insight and deeper understanding of how co-workers perceive team collaboration within ICU transitional care at two hospitals located in Sweden, and co-workers’ suggestions for how team collaboration can be improved aiming to increase quality of care. / <p>Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 3 (inskickat).</p><p>At the time of the defence the following paper was unpublished: paper 3 (submitted).</p>

Background: It has been under discussion in Sweden that the psychiatric inpatients ward is in the need of developing more content and structure. Earlier science shows that implementation of new conversations methods has been appreciated and developing for both nurses and patients. There is also obstacle for nurse`s to prioritize time for conversations with their patients. Aim: The aim was to explore nurse`s experiences of using a manual based CBT in conversations with patients in psychiatric inpatient ward. Method: Research design was interviews with qualitative approach and thematic analysis, inductive approach. Six nurses who worked in a psychiatric inpatients ward were interviewed. Results: The results of the study were summarized in to two main themes; Feelings in work as a nurse and the nurse in the professional role. Six under themes was conducted into the two mentioned main themes. Its presenting feelings connected to these conversations with CBT methodand about the professional working role. It was described useful in the daily work and agood support for the patient recovery, person-centered treatment and difficulties associated to the implementation of the new work. Conclusion: Cbt makes it possible to make in dept-care relationship, strengthens patients' recovery and provides structure for the conversation which also requires support and adaptation for making it useful in the daily work. / Bakgrund: Det har diskuterats i Sverige om att den psykiatrisk heldygnsvården är i behov av utveckling vad gäller innehåll och struktur. Tidigare forskning har visat att införandet av samtalsmetoder har varit uppskattat och utvecklande för både sjuksköterskor och patienter. Det finns också hinder för sjuksköterskor att prioritera tid för samtal med patienter. Syfte: Syftet med denna magisteruppsats var att utforska sjuksköterskors erfarenheter av att använda sig av manualbaserad KBT i samtalet med patienter i psykiatrisk heldygnsvård. Metod: Designen var intervjustudie med kvalitativ ansats och tematisk analys med induktiv approach. Sex sjuksköterskor intervjuades och de var yrkesverksamma på psykiatriska heldygnsvårdsavdelningar. Resultat: Resultatet presenteras i två huvudteman; Känslor i arbetet som sjuksköterska och sjuksköterskan i sin professionella roll. Sex undertemandelades in under de två huvudkategorierna. Det presenteras känslor kopplade till sjuksköterskans arbete med KBT metoden i samtalet likväl som det handlade om den professionella yrkesrollen. Det beskrevs som hjälpsamt för patienters återhämtning, personcentrerat bemötande samt vissa svårigheter kopplat till det nya arbetssättet. Slutsats: KBT möjliggör fördjupad vårdrelation, stärker patienters återhämtning och ger struktur för samtalet. Vilket ocksåbör backas upp med stöd omkring införandet och med viss anpassning för att det skall bli användbart i det dagliga arbetet.

Bakgrund: Anestesisjuksköterskan arbete består i att ge god anestesiologisk omvårdnad. Varje enskild situation ställer krav på färdigheter, kunskap och kompetens. (Gran Bruun, 2013). Att “identifiera svår luftväg”, “skapa en handlingsplan”, “bevara lugn och fokusera på uppgiften”, “tekniska färdigheter” samt “använda utrustningen” är faktorer som anestesisjuksköterskan upplevde som avgörande för att hantera en svår luftväg på ett framgångsrikt sätt (Dabija et al., 2019). För att hantera väntade och oväntade händelser upplevde anestesisjuksköterskor att klinisk erfarenhet var en avgörande förutsättning för hur praktiskt och mentalt förberedda de var för oväntade situationer. Motiv: Baserat på tidigare evidens faller det sig intressant att undersöka hur anestesisjuksköterskan upplever att hantera ofri luftväg utanför operationssalens givna kontext. Syfte: Att studera anestesisjuksköterskans erfarenhet av beslutsfattande vid luftvägshantering i samband med uppdrag utanför operationsavdelningen. Metod: Kvalitativ design användes för studien, insamling av data gjordes med semistrukturerade intervjuer. Åtta anestesisjuksköterskor inkluderades i studien varav ett internt bortfall. Resultat: Anestesisjuksköterskan grundar sina beslut i observationer och bedömningar kring flera parametrar när de hanterar ofri luftväg på uppdrag utanför operationsavdelningen. De bedömer patientens kliniska tecken men också omgivning och förutsättningar för uppdraget, för att kunna hantera olika typer av väntade och oväntade händelser. Anestesisjuksköterskan kan uppleva en del utmaningar i form av svårigheter och negativa känslor men också utmaningar i att skapa kontroll i olika situationer. Som nyutbildad anestesisjuksköterska upplevde de att de behövde stöd i sitt beslutsfattande samt att de upplevde en del prövningar i form av oro och att vara oförberedd. Konklusion: Att vara förberedd för alla möjliga väntade och oväntade händelser beskrivs som mycket viktig. Erfarenhet i yrket underlättar förberedelser, beslutsfattande och ger en ökad trygghet i dessa situationer. För att förstå hur den nyutbildade anestesisjuksköterskan uppfattar dessa situationer vore det intressant att studera anestesisjuksköterskors upplevelser i ämnet vidare för att om möjligt utveckla riktlinjer och på det sättet stödja dem i arbetet. / Background: The nurse anesthetists’ work consists of providing good anesthesiologic nursing. Each individual situation places demands on skills, knowledge, and competence (Gran Bruun, 2013). "Identifying a difficult airway", "creating an action plan", "maintaining calm and focusing on the task", "technical skills" and "using the equipment" are factors that the nurse anesthetist experienced as crucial to managing a difficult airway successfully (Dabija et al., 2019). To deal with expected and unexpected events, nurse anesthetist feels that clinical experience was a crucial prerequisite for how practical and mentally prepared they were for unexpected situations. Motive: Based on previous evidence, it is remarkable to investigate how the nurse anesthetist experiences handling obstructed airways outside the operating ward. Aim: to investigate the nurse anesthetists’ experiences regarding decision making in airway management during assignments outside the operating ward. Methods: Qualitative design was used for the study; data collection was done with semi-structured interviews. Eight nurse anesthetists ‘were included in the study, of which one internally exulted. Results:  Show that the nurse anesthetists’ base their decisions on observations and assessments on several parameters when handling obstructed airways on tasks outside the operating ward. The nurse anesthetist may experience some challenges including difficulties and negative emotions, but also challenges in establishing control in different situations. As a newly trained nurse anesthetist, they felt that they needed support in their decision-making and that they experienced some difficulties in the form of anxiety and being unprepared. Conclusion: Being prepared for all kinds of expected and unexpected events is described as very important. Experience in the profession favors preparation and decision-making and provides increased security in these situations. To understand how the newly trained nurse anesthetist perceives these situations, it would be interesting to study the nurse anesthetists ‘experiences in the subject further to develop guidelines if possible and in that way support them in their work.

Bakgrund: Postoperativ sårinfektion är den näst vanligaste vårdrelaterade infektionen i Sverige och många kan undvikas genom förebyggande arbetssätt. En viktig preventiv åtgärd är den preoperativa duschen. Sjuksköterskor upplever tidsbrist och stress vilket hindrar dem från att ge patienter tillräckligt med information och hjälp kring proceduren och patienter avviker från riktlinjer vid utförandet på grund av ofullständig information. Operationssjuksköterskan är ansvarig för hygien och aseptik i operationssalen och framhåller vikten av preoperativa hygieniska förberedelserna fördet slutgiltiga resultatet av huddesinfektionen.  Motiv: Genom att belysa vårdavdelningssjuksköterskors erfarenheter av preoperativa dusch kan kunskap skapas om eventuella utmaningar samt om hur dessa problem kan förebyggas vilket i sin tur kan öka möjligheter för att främja en patientsäker vård.  Syfte: Syftet var att beskriva avdelningssjuksköterskors erfarenhet av hygieniska preoperativa förberedelser av patient inför kirurgi. Metod: Semistrukturerade intervjuer i fokusgrupper genomfördes med sjuksköterskor som arbetar på kirurgvårdavdelningar. Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Resultatet presenterades i ett tema och de fyra kategorierna: “Kluvenhet kring betydelsen av preoperativ dusch”, “Behov av tydligare riktlinjer på avdelningen”, “Behov av tydligare arbetsledning” och “Acceptans kring att inte följa riktlinjer”. Konklusion: Sjuksköterskorna upplevde hinder som kunskapsbrist, personalbrist och tidsbrist vid de preoperativa hygienförberedelserna, vilket skapade känslor av osäkerhet, frustration och uppgivenhet. De beskrev en önskan om att ha rätt förutsättningar för att kunna följa nationella riktlinjer och ge omvårdnad av god kvalitet. / Background: Postoperative surgical site infection is the second most common cross infection in Sweden and many can be avoided by preventive measures. An important preventive measure is the preoperative shower. Nurses experiences lack of time and stress which prevents them from giving the patient sufficient information and assistance through the procedure and patients deviate from the guidelines due to lack of information. The operating room nurse is responsible for aseptic and hygiene in the operating room and emphasizes the importance of the preoperative shower for the final result of the skin disinfection.  Motive: By illustrate surgical ward nurses’ experiences of preoperative shower, knowledge can be created about possible challenges and how these problems can be prevented, which in turn can increase opportunities to promote a patient-safe care.  Aim: The aim of the study is to describe surgical ward nurses’ experiences of hygienic preoperative preparations of patient before surgery.  Methods: Semi-structured interviews in focus groups with nurses in a surgical ward were conducted. Collected data were analyzed with qualitative content analysis.  Result: The results were presented in one theme and four categories: “Hesitation of the importance of preoperative shower”, “Need of clearer guidelines in the surgical ward”, “Need of clearer leadership” and “Acceptance of not following guidelines”.  Conclusion: The nurses experienced obstacles such as lack of knowledge, lack of personnel and lack of time in the preoperative hygiene preparations, which created feelings of insecurity, frustration and abandonment. They described a desire to have the right conditions to be able to follow national guidelines and provide a good quality care.

SAMMANFATTNING Det senaste årtiondet har antalet utbildningsplatser på kandidatprogrammet i omvårdnadsvetenskap successivt ökat på landets högskolor och samtidigt har sjukhusen haft svår att tillsätta vakanta sjukskötersketjänsterna. Studentsalar har implementerats på utvalda vårdavdelningar med både pedagogiska avsikter och med avsikt att skapa platser för de sjuksköterskestuderande vid deras verksamhetsförlagda utbildning. Det var därför intressant att studera hur sjuksköterskor upplevde det fortfarande nya sättet att handleda på. Syftet var att beskriva sjuksköterskor upplevelser av att handleda sjuksköterskestudenter i studentsal på en akutvårdsavdelning. Som metod användes en kvalitativ induktiv intervjustudie. Ansats och design valdes utifrån studiens uppställda syfte. Studiens deltagare rekryterades från två olika kliniker på ett akutsjukhus i Mellansverige. Ett meningsfullt urval tillämpades. Datainsamlingen genomfördes via individuella intervjuer med sju legitimerade sjuksköterskor. All insamlad data transkriberades och meningsbärande enheter bröts ut ur texten för att vidare kondenseras, kodas och kategoriseras. Analysen genomfördes med en manifest innehållsanalys där fyra kategorier och tio subkategorier formulerades under analysprocessen. Resultatet visade att deltagarna hade både positiva och negativa upplevelser av att handleda på studentsal. De stora vinsterna som de handledande sjuksköterskorna poängterade var att handledningen efter införandet av studentsalar upplevdes mer professionell och att handledningsformen skapade en bättre struktur för både handledare och studenter. De negativa aspekterna som framkom handlade ofta om resursbrister i form av t.ex. bemanning och svårigheter att handleda flera studenter samtidigt. Det fanns en ambivalens hos deltagarna gällande handledningsmodellen som i sin tur inte alltid upplevdes som helt klar och tydlig enligt sjuksköterskorna. Handledning i studentsal kan vara en mycket fördelaktig form av handledning förutsatt att alla resurser som krävs för ett lyckat resultat tillhandahålls från verksamheten. Det förefaller vara av stor vikt att behovet av information, tid och resurser tillgodoses redan vid implementering av studentsal som handledningsmodell på en akutvårdsavdelning. / ABSTRACT During the last decade the number of training posts in the bachelor program in nurse education in Sweden has increased. At the same time the Swedish hospitals have had problems filling vacant posts among nursing staff. Student wards have been implemented at several wards on hospitals all around the country with both pedagogical intent and with the intent to create space for the nursing students in their clinical training. Therefore it was interesting to explore how the nurses experienced this new way of providing preceptorship for nursing students during clinical education. The aim was to describe nurses´ experiences of providing preceptorship on a student ward in an emergency care setting. A descriptive design and a qualitative approach was used. The participants were recruited from two clinics at an emergency hospital in a county situated in the middle of Sweden by a purposive sampling method. The data was collected through individual semi-structured interviews conducted with seven registered nurses. All data were transcribed and further analyzed using manifest qualitative content analysis. Four categories and ten sub-categories were identified during the process of analysis. The findings showed that the participants had both positive and negative experiences related to preceptorship in a student ward. The greatest gain of precepting nursing students in a student ward was that the supervision became more structured and felt more professional. Negative aspects that emerged were often referred to as lack of resources such as to few nurses on duty and the struggle of supervising more than one nursing student at the same time. There seemed to be ambivalence among the participants referring to the concept of peer-learning not being entirely explicit, according to the nurses preceptors. Preceptorship on a student ward might be a most beneficial model of supervision provided that all resources needed for a positive outcome are supplied by the hospital management. It seems to be of greate importance that all requirements such as information, time and resources are available for use at the early beginning of implementation.