[Ecosystemic and gerontotechnological actions in complex nursing care to the elderly with ostomy]

The goal was to identify the ecosystem and gerontogeriatric technological actions to be done in a complex nursing care for the elderly patients of ostomy. To do so, a qualitative and descriptive research was made on a Case Study. The data were collected through interviews. The elderly were classified due to the Functioning, Disability and Health. They also went through physical exams and systematic observation. Ten people from the Estomatherapy Service of the south of Brazil took part in the research along the period of June to August of 2012. A theoretical model was developed and the data were compared with a protocol. The ecosystem actions identified the construction of a therapeutic environment, the guaranty of physical access and environmental adaptation. The gerontogeriatric technological actions identified a health educative process, the routing to the support group and the material and necessary equipment distribution for self-care. Being the nursing care primordial for the elderly patients of ostomy, they are able to face their limitations, demystifying their deficiency/ disability /health.

Understanding the process of living as signified by myocardial revascularization surgery patients

OBJECTIVE

To understand the meanings for the process of living, for patients undergoing myocardial revascularization surgery, and to construct an explanatory theoretical model.

METHOD

Grounded Theory was used, with data collection undertaken between October 2010 and May 2012, in a health institution which specializes in cardiac surgery, located in the south of Brazil. Thirty-three subjects were interviewed (patients, health care professionals and family members), distributed in four sample groups.

RESULT

The explanatory theoretical model was comprised of 11 categories and the central phenomenon. The specialized service and the cardiac rehabilitation program formed the context, the discovery of the cardiac disease and the feelings experienced during the perioperative period were the cause and intervening conditions in the process of experiencing the myocardial revascularization surgery. The strategies were relying on the family's support, having faith and hope, and participating in the rehabilitation program. This process's main consequences were the confrontation of the changes and the resulting limitations, difficulties and adaptations to the new lifestyle after surgery.

CONCLUSION

The process of experiencing the myocardial revascularization surgery constitutes an opportunity for maintaining the patient's life associated with the needs for confronting the significant changes in lifestyle.

Weaving meanings from the deliberative process of collegiate management in nursing

OBJECTIVE

to understand the meanings of the collegiate deliberations attributed by its members on an undergraduate nursing course.

METHOD

Grounded Theory, interviews being held with 30 participants, making up 4 sample groups, between January and June 2012, in a public higher education institution.

RESULT

5 categories emerged, indicating the phenomenon and weaving the paradigmatic model: Understanding the experience of the complex relationships and interactions in the deliberations of collegiate management in nursing: intertwining divergences, convergences, dialogs, collectivities and diversities. This deliberative process presents various meanings involving discussion, and divergent, convergent and complementary positions, through dialog, commitment and negotiation.

CONCLUSION

the deliberations in the collegiate of nursing, intertwining dialogs, collectivities and diversities, mold the complex relational fabrics.

Representations about suicide of women with history of domestic violence and suicide attempt

Suicide attempt is characterized by complex and multifaceted phenomena with significance on global public health. The aim of this study was to grasp the structure of social representations of suicide of women with history of domestic violence and suicide attempt. The study was developed with a qualitative approach, based on the Theory of Social Representations. There were 30 women that responded the Free Word Association Test, all of them with history of domestic violence and suicide attempt by poisoning. Data were processed through the EVOC software and the results were grouped into three categories: core elements, intermediate elements and peripheral elements. The representation of women about suicide is related to life histories characterized by rejection and lack of love, which leads to disease, especially because of depression. The feeling of powerlessness in face of the need for change and release produce emotional problems that culminate in the decision of committing suicide.

[The family revealing itself as a being of rights during hospitalization of the child]

This is a descriptive study with a qualitative approach, carried out during the second half of 2011, in a Pediatric Unit in a city in the extreme South of Brazil. The study aimed to understand the situations in which families reveal themselves as beings of rights during the hospitalization of the child. Fifteen family caregivers participated, divided into three sample groups. Data collection was conducted through semi-structured interviews, and the data were analyzed using open, axial and selective analysis. The study had the Grounded Theory as methodological framework. It was found that the family revealed itself as a being of rights, when recognized as such, is called and fights for their rights; suggests improvements for the care and maintains its autonomy, even if it has to submit to the decisions of the team in the child favor. It was concluded that is essential to allow them to be families in the hospital, enabling the exercise of their rights and citizenship.

Conjugal violence in the perspective of "Family Health Strategy" professionals: a public health problem and the need to provide care for the women

OBJECTIVE

to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy.

METHODS

research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications.

RESULTS

the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care.

CONCLUSIONS

the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence.

Academic Master's courses in the field of nursing: an analysis of course load

OBJECTIVE

to identify, among the Academic Master's courses, run by Brazilian post-graduate nursing programs, analyzed in the three-yearly evaluation (2007-2009) of the Coordination for the Improvement of Higher Education Personnel (CAPES), the course load stated by the programs for training Master's degree students.

METHOD

a descriptive, quantitative, documental study, with data collected in July 2010, through consulting the above-mentioned Coordination's reports in the item "Programs' Proposals", in the Table of Indicators, available on the Internet.

RESULTS

discrepancies were found between the course loads of the 32 Academic Master's courses in the different regions of Brazil, with the smallest having a course load of 315 hours and the largest, 1530 hours.

CONCLUSIONS

greater discussion is needed about the course load necessary for training the competencies and skills for the profile desired for the students on graduating from the course. The study provides advances in nursing knowledge, as previous investigations on the same issue were not identified. It is hoped that Academic Master's courses in nursing may see themselves in this process and may review their pedagogical decisions in the light of the new models of training/qualification of nursing professionals, centered in science, technology and innovation in the area.

Governanca em enfermagem: revisao integrativa da literatura

O objetivo deste estudo foi identificar e caracterizar os tipos de governança em enfermagem, destacando seu impacto na prática dos enfermeiros e no cuidado em saúde. Trata-se de revisão integrativa a partir das bases de dados MEDLINE, CINAHL, LILACS e na biblioteca eletrônica SciELO, de 2007 a 2011, com os descritores Governança /Governance e Enfermagem/ Nursing, totalizando 25 artigos. Foram identificados três modelos de governança, estudados principalmente nos Estados Unidos e Inglaterra: governança compartilhada, governança clínica e governança pública. Entre os impactos desses modelos, destacam-se: melhoria da qualidade assistencial, maior autonomia profissional dos enfermeiros, melhoria da articulação entre os serviços de saúde e maior satisfação profissional entre enfermeiros. Pontua-se a necessidade da realização de estudos sobre a temática na América Latina, com o intuito de avaliar sua aplicabilidade em diferentes contextos.

Hearing loss in people with HIV/AIDS and associated factors: an integrative review

Abstract

The current scientific literature reports on the incidence of hearing impairments due to HIV/AIDS, and the hearing changes can occur due to damage to the outer, middle or inner ear. Thus, it is important to study how these changes occur, the hearing loss and their associations with the HIV/AIDS infection.

Objective

To identify the factors related to hearing loss in people with HIV/AIDS in the global scientific literature.

Method

Study carried out an Integrative Review of the Literature. The key words used were: hearing loss, hearing disorders and deafness, separately associated to the keyword HIV on PUBMED, ScIELO, LILACS and ISI databases. We used complete original papers, of free access, in English, Spanish, French and Portuguese. Thirteen quantitative studies from 1994-2010 were selected.

Conclusion

We did not find any strong direct association between anti-retroviral therapy and hearing loss; however, there are indications of hearing loss in the population studied, and their associations and causes need to be better investigated.

Pós-graduação Stricto Sensu em Enfermagem no Brasil: avanços e perspectivas

A Enfermagem é campo de conhecimento específico e prática social que se consolida e se fortalece como ciência. No Brasil, tem se desenvolvido em função do aumento e qualificação dos programas de pós-graduação stricto sensu. Este artigo tem como objetivo apresentar um resgate histórico da Pós-Graduação Stricto Sensu de Enfermagem no Brasil e refletir sobre sua evolução, avanços, desafios e perspectivas futuras. Explora-se a criação dos cursos de pós-graduação stricto sensu, destacando os movimentos para se construir a cultura da pós-graduação acadêmica e profissional na Enfermagem. Apresenta-se a trajetória histórica da sua consolidação, expansão, conquista da excelência e visibilidade internacional ao longo de quatro décadas e apontam-se os desafios e as perspectivas futuras. Constata-se que a pós-graduação na área vem contribuindo para o avanço e consolidação do conhecimento científico, tecnológico e de inovação em Enfermagem e saúde, tendo como filosofia, o respeito à diversidade e o livre debate de ideias, a elevação da qualidade de vida e saúde e a efetivação do exercício da cidadania.

Vacinação contra influenza: construção de um instrumento educativo para maior adesão dos profissionais de enfermagem

Este estudo objetivou construir um instrumento educativo, na modalidade de cartilha, com o intuito de sensibilizar e promover maior adesão dos profissionais de enfermagem à vacinação contra Influenza. Trata-se de uma pesquisa construtivista, com participação de profissionais de enfermagem de um hospital universitário, nas etapas de elaboração e validação dos conhecimentos. A cartilha impressa "Influenza/Gripe - O profissional da saúde precisa saber" foi disponibilizada no site www.hu.ufsc.br, por ocasião da campanha de vacinação 2011. Confirmou-se desinformação sobre o tema; ampla consulta ao site, pelo número de acessos e possíveis leituras; sua importância para a sensibilização dos profissionais de enfermagem; e contribuição para ações educativas na instituição. A Cartilha é um instrumento que pode permitir o alcance de níveis adequados de adesão à vacinação, proporcionando assistência segura ao paciente, e proteção da saúde do profissional, da família e da comunidade.

Do padrão nightingaleano de enfermagem ao sistema social luhmanniano: estudo teórico

O presente estudo, de caráter teórico, objetivou analisar e discutir um possível código binário para o sistema de Enfermagem, no sentido de identificar o seu próprio saber, na perspectiva dos pressupostos teóricos de Niklas Luhmann. Apostar em uma comunicação funcionalmente diferenciada e socialmente relevante para o sistema de enfermagem implica em transcender o tradicional código saúde-doença, predominante no sistema de saúde e cuja comunicação socialmente relevante é a doença. Implica, ainda, em investir proativamente na promoção e proteção do viver saudável de indivíduos, famílias e comunidades, para que a saúde seja o ponto central das discussões e intervenções.

[Representational structure of intensive care for professionals working in mobile intensive care units]

This qualitative study was performed based on the Social Representations Theory, using a structured approach. The objective was to analyze the social representations of intensive care for professionals who work in mobile intensive care units, given the determination of the central nucleus and the peripheral system. This study included the participation of 73 health care professionals from an Emergency Mobile Care Service. Data collection was performed through free association with the inducing term care for people in a life threatening situation, and analyzed using EVOC software. It is observed that a nucleus is structured in knowledge and responsibility, while contrasting elements present lexicons such as agility, care, stress, and humanization. The representational structure revealed by participants in this study refer particularly to the functionality of intensive care, distinguishing itself by the challenges and encouragements provided to anyone working in this area.

Nursing work at night in palliative oncology care

OBJECTIVE: to understand the meaning baccalaureate nurses and nursing technicians attribute to night work in the context of clinical palliative oncology nursing care services, as well as how nursing works to attend to clients and caregivers' needs in this period. METHOD: in this exploratory and qualitative study, grounded theory was used. Seven nurses and four nursing technicians were interviewed, who composed two sample groups. Nine categories were produced and, in their comparative content analysis, a knowledge emphasis was evidenced with implications for nighttime nursing work. In this study, these aspects were discussed in two of the categories, which are: to describe care practice in order to understand nursing care management and to point out the difficulties in care practice and nursing care management. RESULTS: The results evidence the complexity in the nighttime care context, considering the clients' clinical conditions and clients and caregivers' psychological demands, mainly because of the threat of death. CONCLUSION: The team attempts to respond to these needs through communication, but reveals a lack of assistential services and an overload. Interdisciplinarity is a palliative care premise, favoring holistic care delivery, and cannot be neglected at, which requires attention and investment to develop better practices.

[Meaning the process of living the coronary artery bypass graft surgery: changes in lifestyle]

The study aimed to understand how patients mean your experience process of living after surgical revascularization. Will be presented in this article, a category and seven subcategories that represent significant changes from that experience, that is, the "consequences" component of the paradigm model, according to Grounded Theory, method of study. Participated in data collection 23 subjects The interviews were semi-structured and took place from October 2010 to August 2011. Significant changes are related to aspects of social and sexual life, work diet physical activity and drug treatment. We conclude that surgical revascularization experience encourages the reflection and the (re) think the lifestyle, it has limitations and difficulties that challenge changes in daily habits of patients and families to live a healthier process.

Práticas de enfermeiros na gerência do cuidado em enfermagem e saúde: revisão integrativa

Estudo com objetivo de evidenciar e analisar as práticas dos enfermeiros na gerência do cuidado descritas na produção científica brasileira e internacional, por meio de uma revisão integrativa. Foram pesquisados artigos publicados entre 2005 e 2010, nas bases LILACS, SciELO, BDENF e CINAHL, a partir dos descritores Gerência e Administração, associados a Cuidado e Enfermagem, e os termos Nursing Management e Nursing Care, totalizando 27 publicações. A gerência do cuidado realizada pelo enfermeiro relaciona-se diretamente à busca pela qualidade assistencial e de melhores condições de trabalho, por meio de ações como: realização do cuidado, gerência de recursos humanos e materiais, liderança, planejamento da assistência, capacitação da equipe de enfermagem, coordenação da produção do cuidado e avaliação das ações de enfermagem.

Policies, Management and Innovation Research Groups for Nursing Excellence

Objetivo: apuntar presupuestos sobre políticas, gerencia e innovación de grupos de investigación (GPs, sigla en portugués) de excelencia en enfermería. Método: estudio interpretativo, de dialogicidad y reflexión, realizado con gestores/investigadores autores y actores de este proceso. Resultado: presupuestos para GPs de excelencia en enfermería: cuenta con políticas bien definidas altamente calificados; produce conocimientos avanzados con infra-estructura física, personal, financiera, organizacional y logística adecuadas; considera que la práctica de la producción de conocimientos es un proceso colectivo, dinámico, continuo y complementario; integra tecnologías de la información y comunicación en la producción, consumo y diseminación del conocimiento. Discusión: esos presupuestos pueden potencializar las estructuras organizativas y operacionales de los GPs objetivando una mayor productividad e impacto por la aplicación del conocimiento producido. Conclusiones: la excelencia del GP es fruto de políticas bien definidas, proceso gerencial competente, innovador, dinámico y efectivo, constituyéndose en referencia de emprendimiento e innovación en investigación.

La ética y la técnica contemporánea: Implicaciones en el Área de la Salud

Este artículo tiene el objetivo de propiciar, a partir de las ideas de algunos autores, una reflexión y discusión en los profesionales de la salud sobre las implicaciones en la práctica cotidiana de los avances de la técnica, así como sobre el papel de la ética como ente regulador de estos avances. También se propone analizar los cambios que se han generado en las relaciones entre los profesionales y las personas/clientes de los servicios de salud, a partir de la biotecnología. Se propone este análisis con la finalidad de incorporar en nuestra práctica cotidiana la ética por la vida, por la libertad de vivir mejor, respetando la naturaleza y la dignidad humana.

User embracement as a good practice in primary health care

The purpose of this study was to understand user embracement as a good practice for use in primary health care, according to the perceptions of administrators, health professionals and patients, considering the dimensions of dialogue, attitude and reorganization of health services. It consists of a descriptive-analytical investigation, of a qualitative nature. The Grounded Theory was used as the theoretical-methodological referential. Data were obtained through interviews performed with seven coordinators, ten professionals and twelve patients of the Health Centers of Florianópolis-SC. Under the perspective of good practices, user embracement becomes a point of intersection between different subjects and primary health care practices, unfolding the dimensions of embracement-dialogue, embracement-attitude and embracement-reorganization of services. User embracement triggers transformations in the working process, in the relationships established in the care spaces and in the organizational scope of the services. The interconnection of this triad reconfigures and changes the actions in primary health care and contributes to the consolidation of this health care model.

Prazer e sofrimento no exercício gerencial do enfermeiro no contexto hospitalar

Este estudo objetivou analisar os fatores de prazer e sofrimento no exercício gerencial do enfermeiro no contexto hospitalar. Trata-se de uma pesquisa exploratório-descritiva com abordagem qualitativa, que utilizou como técnica de coleta a entrevista semiestruturada. Foi realizada em um hospital universitário, e os dados foram analisados mediante análise temática. Os 19 enfermeiros que participaram do estudo revelaram que a gerência é fonte de prazer quando há crescimento pessoal e profissional, reconhecimento dos colegas e satisfação do paciente; e fonte de sofrimento em função das dificuldades de relacionamento com a equipe de trabalho e da sobrecarga de trabalho. Ressalta-se a necessidade de os enfermeiros gerentes compreenderem a dualidade sofrimento e prazer na busca de um trabalho mais construtivo e realizador, por meio de maior articulação da atividade gerencial, com a experiência de vida, além do respaldo institucional e apoio dos colegas de trabalho.

Secondary Health Care: best practices in the health services network

OBJECTIVE: to understand the organization of health practices, based on the interactions at the secondary care level, and to analyze how the actions and services at this level of care contribute to the development of best practice in health. METHOD: a qualitative approach, based in Grounded Theory. Data was obtained from individual interviews, with managers, health care professionals and health service users making up the sample group representing the secondary level of healthcare. The theoretical model was formulated based on four categories, analyzed based in the elements of the network modeling of health care theoretical framework. RESULTS: The organization of health practices at a secondary level is in the process of consolidation and is contributing to the development of best practices in the locale studied. CONCLUSION: The broadening of access to consultations and specialized procedures, and the articulation of the network's points, are aspects of this level of care which are considered essential for care which is effective and integral. This study contributes to the analysis of health practices from the perspective of network modeling, based on the interactions between secondary care and the health system's other health facilities, which are shown as going through a process of consolidation in the locale studied.

Pensamento Lean e cuidado do paciente em morte encefálica no processo de doação de órgãos

A doação de órgãos é um processo complexo que desafia os profissionais e gestores do sistema de saúde. Este estudo objetiva apresentar um modelo teórico de organização do cuidado ao paciente em morte encefálica e o processo de doação de órgãos, balizado pelas principais ideias do pensamento Lean que possibilitam a melhoria da produção a partir de ciclos de planejamentos e criação de um ambiente propício para o sucesso da sua implementação. O pensamento Lean pode tornar mais eficaz e eficiente o processo de doação de órgãos e contribuir com a sua melhoria, a partir da sistematização das informações e capacitação dos profissionais para a excelência do cuidado. O modelo apresentado configura-se como um referencial disponível para validação e aplicação pelos profissionais e gestores de saúde e enfermagem na prática da gestão do cuidado ao paciente potencial doador de órgãos em morte encefálica e respectiva demanda por transplante.