Oral hygiene prior to cardiac surgery to prevent infections: Randomized clinical trial

CONTEXT

It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates.

OBJECTIVE

We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery.

DESIGN, SETTING AND PARTICIPANTS

Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53).

INTERVENTION

a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning.

PRIMARY OUTCOME

the presence of infection.

RESULTS

The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days.

CONCLUSION

The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events.

CLINICAL TRIAL REGISTRATION

Site Ensaclinicos.gov.br number U1111-1214-2862.

DESCRIPTORS

Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.

Quality of child and adolescent care transitions considering the presence of chronic disease

OBJECTIVES

to analyze the quality of child and adolescent care transitions from hospital to home, considering the presence of chronic disease.

METHODS

quantitative, cross-sectional study, carried out from February to September 2019 in two hospitals in the south of Brazil. We used an instrument to characterize participants and the Care Transitions Measure (CTM-15) for the legal tutors of children and adolescents that were discharged from the institutions.

RESULTS

the general mean of the quality of transition of care was 87.9 (SD=13.4), in a scale from 0 to100). We found a significant difference in the quality of transition of care when comparing patients with and without chronic disease (90.0 and 84.3; p=0.001).

CONCLUSIONS

we found the quality of the transition of care to be satisfactory, with better results for patients with chronic disease. This can help understand the most impactful aspects in the transition of care, especially in regard to children health.

Tooth loss severity and core and non-core food consumption among older Brazilian adults

OBJECTIVE

To investigate the association between tooth loss severity and core and non-core food consumption in the older Brazilian population.

METHODS

We analysed data from 20 756 people aged 60 years or older who participated in the 2019 Brazilian National Health Survey. The average consumption days a week of core (8-item) and non-core (4-item) foods were the outcomes, measured using a Food Frequency Questionnaire. Tooth loss severity was the main exposure, using a four-category ordinal variable: mild (1-12 teeth missing), moderate (13-22), severe (23-31) and edentulous (all 32). Sociodemographic, tobacco smoking, use of dental prosthesis, difficulty in chewing and systemic conditions were among the covariates. Linear regression models estimated the association between tooth loss and food consumption.

RESULTS

Almost two-thirds of participants had moderate or worse levels of tooth loss. Older adults with more severe tooth loss reported an overall lower consumption of core and higher non-core foods than those with mild tooth loss. Worse tooth loss severity was associated with lower consumption of vegetables and/or legumes and fruits, and higher consumption of beans, artificial fruit juices and confectionery.

CONCLUSIONS

Older Brazilian adults with more severe tooth loss are consuming lower core and higher non-core foods. Our findings reinforce the importance of the common risk factor approach to tackle the adverse effects of tooth loss on diet.

Continuity of care for children with chronic conditions: mixed methods research

OBJECTIVE

To analyze the continuity of care for children with chronic conditions from the transition from hospital to home.

METHOD

Parallel-convergent mixed-methods research, with a cross-sectional study and Grounded Theory. A characterization instrument and the Care Transitons Measure were applied to 201 legal guardians of children with chronic conditions, and semi-structured interviews were conducted with 35 participants (among professionals and guardians). Data were combined by integration.

RESULTS

The efforts of the hospital team to promote continuity of care after discharge from the transition from hospital to home impact on the quality-of-care transition perceived by caregivers, with a mean of 89.5 (standard deviation = 12.5) points. However, the absence of formal mechanisms to guide the transition of care makes it difficult to achieve continuity of care in the health network.

CONCLUSION

Continuity of care for children is hindered by barriers, against which hospital care professionals seek individual strategies to overcome them. It is essential to establish institutional actions and public policies aiming at the transition of care to promote continuity of care.

Management Actions for Prevention and Control of Healthcare-associated Infections: A Grounded Theory approach

AIM

To understand the management actions for prevention and control of healthcare-associated infections performed by health professionals.

BACKGROUND

Prevention of nosocomial infections has evidence-based practice at its essence, but not all institutions are successful in implementing prevention methodology.

METHODS

Qualitative research with Grounded Theory methodological framework. The research was carried out in two southern Brazilian hospitals. Data collected was employed through open interviews with twenty-one health professionals and managers. This process occurred concurrently with the data analysis, through constant comparative analysis.

RESULTS

The understanding of the co-responsibility of managerial actions emerged as a central phenomenon of the theoretical model. Management actions for the prevention and control of healthcare-associated infections are a collective phenomenon, in which co-responsibility sustains the effectiveness of the offered assistance. The behaviors of health teams in the face of structural and human weaknesses influence the construction of a supportive relationship in the effectiveness of patient safety actions.

CONCLUSIONS

The sharing of responsibilities between professionals, and the actions of prevention and control of healthcare-associated infections arising from this conduct, positively influence the promotion of safer and improved quality care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should consider applying the tools to prevent and control HAIs and generate in-depth discussion to promote institution's cultural changes.

Quality of transitional care of children with chronic diseases: a cross-sectional study

Abstract Objective: To analyze which factors may be associated with the quality-of-care transition of children with chronic diseases from the hospital to their home. Method: A cross-sectional, quantitative study, carried out in two hospitals in Southern Brazil, from February to September 2019. Participants included 167 family members of children with chronic disease. Data collection took place through a demographic questionnaire, and the use of the Brazilian version of the Care Transitions Measure (CTM-15). Results: The average score for the quality of care transition was 90.1 (sd = 19.5) (0–100). Factor 1, “Health management preparation”, was the one with the highest self-perceived average, 92.3 (sd = 11.6), while Factor 4, “Care plan”, had the lowest average, 86.3 (sd = 21.3). The quality of care transition was higher for patients living in municipalities belonging to health regions other than the hospital’s. Conclusion: The quality of care transition for children with chronic diseases, perceived by the children’s family members, in the discharge process from the hospital to home, was considered high. Living in a health region other than the hospital’s region was associated with better perception of the quality of care transition.

Condições de higiene bucal de idosos residentes em instituições geriátricas de pequeno porte em Porto Alegre

Following the population-aging phenomenon, the number and the demands for nursing homes is increasing. Generally, oral health condition of institutionalized elderly people is poor and the maintenance of good patterns of oral hygiene is a problem. The aim of this study is to describe the oral hygiene conditions of elderly people who live in small (< 20) nursing homes of Porto Alegre-RS and to establish the relationship with independents variables: sex, age, time of institutionalization and level of dependence of the residents and number of care givers and price charged by the institutions. Oral hygiene conditions were verified through dental and denture plaque index. The mean obtained to teeth plaque scores was 2.24 (Sillnes and Löe index) and on dentures was 7.14 (Ambjornsen index). The poor oral hygiene condition is prevalent on the examined population when analyzed the independent variables sex, age, time of institutionalization, price, and number of caregivers because it was not demonstrated statistical significance related to the presence or the quantity of plaque on teeth and dentures (p>0,05). The level of dependence was the variable that presented statistical signficant (p=0,024). Independent elders showed lower means of dental plaque when compared to the moderate dependent or dependent elders. It is concluded that oral hygiene condition of this institutionalized elderly people is poor and need multidisciplinary and interinstitutional actions to revert this frame of continued neglect.

Managerial competences of researchers from Nursing research groups

Objective:

to analyze the managerial competences of researchers from research groups linked to a Graduate Program in Nursing.

Method:

a cross-sectional study with researchers from Nursing research groups, which analyzed the managerial competences by means of a Scale of Managerial Competences in Research Groups containing 50 items related to people management and research results (Factor 1) and resource provisioning and people management (Factor 2), with answers 4 and 5 considered as sufficient dexterity for each competence analyzed. For data analysis, logistic regression was used.

Results:

of the 219 participants evaluated, the prevalence was 48.86% of sufficient dexterity for factor 1 and 32.88% of sufficient dexterity for factor 2; with 41.21% of sufficient dexterity for Managerial Competences in research groups. A significant difference was identified in the proportions of the managerial competences for schooling, age group and performance in the group (p≤0.001). There were differences in mean age, time of experience with research and participation in the research group (p≤0.001), between the participants with sufficient and insufficient dexterity for the managerial competences.

Conclusion:

the results obtained in this study emphasize the potential of the research groups for the development of managerial competences of Nursing researchers, especially for people management.

Teledentistry System in Dental Health Public Services: A Mixed-Methods Intervention Study

INTRODUCTION

Health information and communication technologies, such as Teledentistry, can help expand access to dental health public services making it more effective.

OBJECTIVE

To analyze the factors that affect the implementation of a Teledentistry system in dental health public services.

METHODS

The study follows the Implementation Research methodological framework. A mixed-method approach was applied using a triangulation design-sequential model to collect, analyze, and interpret qualitative and quantitative data about the implementation of a Teledentistry system. A compulsory teleconsultation from the general dentist was planned to access periodontics specialized care. The study was developed in a South Brazilian capital city and the platform of the Santa Catarina Telehealth Center was used. Qualitative and quantitative data were collected sequentially to achieve a better understanding of implementation research issues.

RESULTS

In seven months, 68 teleconsulting was performed by 22% of the general dentists, prior to the referrals on periodontics. Only one reported not needing to refer the patient to the periodontist as a result of the teleconsulting guidance. Teledentistry system implementation and usage were influenced by the managers' political and administrative awareness to deploy and maintain the intervention. Lack of sufficient resource investment, lack of system integration, and internet failures were relevant limiting factors. The teleconsultant guidelines contributed to general dentistry's better decision-making regarding treatment, urgency of case management, and prioritization of referrals to the periodontists CONCLUSION: Identifying the factors that influence the implementation and finding solutions to overcome them, can prevent future failures and improve usage of the system.

Dental plaque control strategies for the elderly population: A scoping review

OBJECTIVE

To review the scientific literature and identify dental plaque control strategies focussed on elderly people that improve plaque indices.

DESIGN

Scoping review (Joanna Briggs protocol).

DATA SOURCES

Individual search strategies developed for six databases. The selection of the manuscripts in two phases: title and abstract review, and complete review.

ELIGIBILITY CRITERIA

Studies on interventions for plaque control in elderly people (60y+). Epidemiological studies and those focussed on caregivers, health professionals and periodontal maintenance therapies were excluded.

RESULTS

The initial search yielded 2803 studies, 26 were included. The results were classified into: exclusively chemical (10), educational (9), exclusively mechanical (6), and combined mechanical and chemical (1). The studies reported different types of interventions: sugarless chewing gum, chlorhexidine (CHX) in different preparations and concentrations, mouthwash based on essential oils, stannous/sodium fluoride dentifrice and lactoferrin/lactoperoxidase tablets. Additionally, conventional and alternative toothbrushes and professional brushing were tested. Educational interventions included oral hygiene guidance, verbal information, and demonstrations of dental and denture cleaning procedures, and lifestyle changes. Many studies have reported strategies that improve dental plaque indices but without statistical significance when compared to control groups. Promising results were found with the use of CHX, sugarless chewing gum, professional brushing and educational strategies with demonstration, but the results were not long-lasting.

CONCLUSION

The literature reports that mechanical, chemical and educational strategies have some efficacy in dental plaque control in the elderly population. The results should be viewed with caution, considering the type of intervention (isolated or combined) and the maintenance of the results obtained.

CARE MANAGEMENT IN PRIMARY HEALTH CARE: A CONSTRUCTIVIST GROUNDED THEORY

ABSTRACT Objective: to understand care management in Primary Health Care based on the meanings attributed by workers who work in this context and build a theoretical-explanatory model. Method: this is a qualitative research based on the Grounded Theory on Constructivist Data, developed in the Primary Health Care network of a municipality located in southern Brazil. Participants were selected inductively according to theoretical sampling, totaling 37 workers, divided into four sample groups. Data collection through semi-structured interviews, from January 2017 to November 2018. Data analysis took place in two phases: initial coding and focused coding. The initial codes were classified, synthesized and integrated for the development of the categories, which, articulated, gave rise to the model. To support the analysis, Nvivo®11 was used. Results: the central phenomenon “Managing care in Primary Health Care” was supported by four categories: “Organizing care management”, “Implementing care management in the care environment”, “Relating with other subjects for care management”; “Articulated socially and politically”. These categories composed the theoretical model supported by the constitution of four interdependent dimensions: organizational, relational, care and sociopolitical. Conclusion: care management, implemented in daily work, reveals itself in a variety of practices, conditions and situations that integrate the intertwined world of work and the lives of users and workers of healthcare services. The model helps those involved in care management in Primary Health Care to expand and strengthen care practices committed to users.

Oral health of homebound older adults followed by primary care: a cross sectional study

Abstract Objective to characterize the life, health, and oral health conditions of homebound older people registered in the primary care teams and oral homecare provided. Method cross-sectional, household based study with a convenience sample, in Florianópolis, southern Brazil. Data collection through a questionnaire and clinical oral examination which included sociodemographic variables, condition of teeth and mucosa, oral hygiene, access to dental care and dentist providing homecare. Absolute and relative frequency analysis and bivariate analysis (chi-square, CI=95%) were performed. Results 123 older people participated with mean age of 81.3 years, 62.6% were women. Living with a caregiver were 87%, 60% were domiciled for up to 5 years, and 89.4% were frail. Regarding the presence of teeth, 56.1% were edentulous and 40.5% had from 1 to 8 teeth. Root remains were observed in 12.8%, untreated caries lesions in 25.2%, visible biofilm in 69.9%, tooth mobility in 57.7% and mucosal lesions in 8.9% of the elders; 45.5% needed help with oral hygiene and 24.4% did not perform daily mouth cleaning. The difficulty in accessing dental care due to homeboundness was reported by 32.5% and home visits provided by the dentist occurred in only 16.3%. Conclusion the oral health of the older adults studied is poor due to the presence of oral problems that require intervention. There is dependence on third parties for oral care, which is not consistently guaranteed at home. The study points to the need for dental homecare provided by public health services.

[Obstacles to public governance and their influence on oral healthcare in the state of Santa Catarina, Brazil]

The study aimed to analyze public governance in the regionalized healthcare network in the state of Santa Catarina, Brazil, and its influence on decision-making in the organization of oral healthcare. This was an exploratory analytical study with a qualitative approach, with the methodology based on Grounded Theory. Thirty in-depth interviews were held with managers from the Regional Inter-Managers Commissions and Bipartite Commissions (CIR and CIB, respectively, in Portuguese), under the State Health Department, representatives from the State Health Councils, and administrators of specialized oral healthcare services, in two sample groups, in addition to non-participant observation in CIB meetings. After comparative data analysis, the theoretical model was formulated in which the central category was expressed in the title Influence of Failures in Governance on the Oral Healthcare Network: The Erratic Expansion of Services by Vertical Induction and Confirmation of the Peripheral Status Assigned to Oral Health. The governance practiced in the Santa Catarina State Health System displays well-established formal support structures, such as the consolidation of the CIR. However, weaknesses were identified that reveal problems in the governance systems' legitimacy. The situation perpetuates the peripheral status assigned to the structuring of oral healthcare in network format and the erratic expansion of services, characterized by vertical induction and without contextualized recognition of oral health problems as guidance for planning the services. There is a need for greater public awareness and the inclusion of professionals and managers that can advocate for the importance of oral health as a major priority in public health policies.

How Has Teledentistry Been Applied in Public Dental Health Services? An Integrative Review

Background: There are inequities in the provision of oral health care, and a large proportion of the population face challenges in accessing public dental health care options. Introduction: Teledentistry (TD), a new branch of telemedicine dedicated to dentistry, is a potential approach that can be used to overcome these challenges. Therefore, the purpose of this integrative review was to collect information regarding the inclusion of the application of TD tools in the public dental health services. Methods: Five electronic databases (PubMed/Medline, Virtual Health Library, CINAHL, Scopus, and Web of Science) were searched for relevant articles if they reported on original data related to the use of TD in public dental health services. Results/Discussion: Twenty-four studies met the inclusion criteria and were, consequently, included in the review. Our key findings indicated that TD can be used for training and continuing education of professionals, for remote patient care, to exchange information among health professionals, and orientation. It increases the access to dental care and enables general practitioners to interact with specialties. The benefits include cost-effective health equity services, improve dental knowledge, and reduce consultation waiting time. However, despite the advances made with the use of this technology, there are still some obstacles to overcome, such as limited infrastructure, low levels of motivation and the lack of compliance, professional resistance, and legal and security issues. Conclusion: TD may be very a useful tool for dental public health increasing the quality of the care by improving access, professional education, and patient satisfaction.

Management of prenatal nursing care at a Health Center in Angola

OBJECTIVE

To understand how care management in prenatal care in a Care Center in Angola happens.

METHOD

A qualitative study, which used the Constructivist Grounded Theory (GT) as a methodological framework. The theoretical sample consisted of 22 participants, including nursing professionals, pregnant women and nursing students from Huambo, Angola. The data were collected by interviews and analyzed according to initial and focused coding.

RESULTS

Five categories arose: Embracing the pregnant woman for prenatal care; Performing the prenatal consultation; Creating a bond and dialogical relationship with pregnant women; Establishing collaborative working relationships; and Inserting the pregnant woman's family into prenatal care.

CONCLUSION

The management of nursing care in the study setting is effective through complementary and interdependent steps, based on collaborative relationships among professionals and in the effort to establish bonds with pregnant women and their families.

Healthcare networks: trends of knowledge development in Brazil

ABSTRACT Objective: To analyze the trend of scientific production about Healthcare Networks in thesis and dissertations in Brazil. Methods: documental, descriptive and exploratory study, with a quantitative approach, on the published between 2013 and 2016. The data collection was based on the catalog of theses and dissertations of Brazilian Personnel Improvement Coordination of Superior Level, during January 2018. Results: The 190 papers founded were distributed in four main classes: Integrated Healthcare Networks Management; Thematic health networks; Primary Healthcare as network Ordinator; and Professional education in healthcare networks. Conclusion: It is trend in the scientific knowledge production the study of Primary Healthcare as the ordinator of network and its interface with the other levels, the professional education in healthcare networks, the continuing education in health, focused on the healthcare networks management.

Meaning of nursing care to brain dead potential organ donors

OBJECTIVE

To understand the meanings of care to brain dead potential organ donors for nurses, and construct a theoretical model.

METHOD

Qualitative study based on the Grounded Theory approach. Data were collected through open interviews with 12 nurses, distributed in three sample groups in a university hospital in northeastern Brazil, from December 2010 to June 2011.

RESULTS

The phenomenon Unveiling multiple relationships and interactions of nurses in the complexity of patient care in brain dead potential donors is supported by the interrelationship of five categories and results from the need to organize care practices in the context of the intensive care unit, considering the factors involved in the relationship between nurses, staff and family and reveals challenges for nurses imposed by the complexity of the care process.

CONCLUSIONS

The meaning of care to brain dead potential donors involves understanding the complexity of this patient who can save somebody's life through organ donation.

The Dentist's Role in Southern Brazilian Teaching Hospitals: A Grounded Theory Study

The aim of this study was to develop a theoretical model to describe the role that the dentist plays in Brazilian hospital settings. This qualitative study was based on the grounded theory research method. Participants were a total of 27 individuals in three groups: dentists and general practice and oral and maxillofacial surgery residents; faculty; and other health professionals who interacted with dental patients in the hospital setting during the 2012-13 year. Data were collected in three teaching hospitals in the state of Santa Catarina, Brazil, through scripted interviews using open-ended questions. The stages of collection, codification, ordination, and integration of data were guided by constant comparative techniques to formulate a theoretical model. The codes generated were organized into seven categories: identifying the hospital as a working and teaching environment; recalling the dentists' professional pathways; reflecting on the dentist's work in the hospital; considering the political and organizational dimension of the role of the dentist in the hospital; understanding patients' life and health contexts; education and professional practice; and moving on towards interdisciplinary practices in the hospital setting. Integrating the categories led to a theoretical model called "The Dentist's Role in the Hospital Setting: An Interdisciplinary Construction." This theoretical model provides a framework to understand how dentists perform in the hospital setting, with a focus on interdisciplinary practice, which in this study was shown to be incipient and heterogeneous.

Geriatric dentistry teaching and the curricular guidelines in dental schools in South American countries

Abstract Objective: to analyze the teaching of geriatric dentistry from the perspective of the National Curricular Guidelines (NCG) for undergraduate courses in dentistry in South American countries. Method: an exploratory and descriptive study with a qualitative approach was carried out, covering the dental schools of public universities in five South American countries which included a geriatric dentistry module in their curriculums. Twenty intentionally selected participants were included. Semi-structured open interviews were recorded using digital media and the content was analyzed using the Thematic Analysis technique with Atlas-Ti® software, based on the current NCG in each country. Results: the NCG evaluated in the five countries were similar in terms of the norms that guide the education of the dental surgeon. Three categories of analysis were identified: professional profile, skill development and the geriatric dentistry teaching-learning process for the undergraduate student. Conclusions: dentistry teaching has sought to connect with the NCG. However, the simple insertion of a geriatric dentistry module in the curriculum is not sufficient to promote a teaching-learning process that allows the student to develop skills to provide better care for the elderly.

Multidimensional measures validated for home health needs of older persons: A systematic review

OBJECTIVE

To conduct a systematic review of the literature on valid and reliable multidimensional instruments to assess home health needs of older persons.

DESIGN

Systematic review.

DATA SOURCE

Electronic databases, PubMed/Medline, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online and the Latin American and Caribbean Health Sciences Information.

REVIEW METHODS

All English, Portuguese and Spanish literature which included studies of reliability and validity of instruments that assessed at least two dimensions: physical, psychological, social support and functional independence, self-rated health behaviors and contextual environment and if such instruments proposed interventions after evaluation and/or monitoring changes over a period of time.

PARTICIPANTS

Older persons aged 60 years or older.

RESULTS

Of the 2397 studies identified, 32 were considered eligible. Two-thirds of the instruments proposed the physical, psychological, social support and functional independence dimensions. Inter-observer and intra-observer reliability and internal consistency values were 0.7 or above. More than two-thirds of the studies included validity (n=26) and more than one validity was tested in 15% (n=4) of these. Only 7% (n=2) proposed interventions after evaluation and/or monitoring changes over a period of time.

CONCLUSION

Although the multidimensional assessment was performed, and the reliability values of the reviewed studies were satisfactory, different validity tests were not present in several studies. A gap at the instrument conception was observed related to interventions after evaluation and/or monitoring changes over a period of time. Further studies with this purpose are necessary for home health needs of the older persons.

Rede regionalizada de atenção à saúde no Estado de Santa Catarina, Brasil, entre 2011 e 2015: sistema de governança e a atenção à saúde bucal

Resumo: Objetivou-se descrever o sistema de governança empreendido na estruturação da rede regionalizada de atenção à saúde no Estado de Santa Catarina, Brasil, baseando-se na Comissão Intergestores Bipartite (CIB), tendo como foco a estruturação da atenção à saúde bucal. Trata-se de um estudo de cunho qualitativo, exploratório-descritivo, do tipo documental, tendo por base os fundamentos da governança como ferramenta analítica, por meio da identificação das dimensões atores, normas, pontos nodais e processos. Dados secundários foram coletados em atas de reuniões realizadas pela CIB entre janeiro de 2011 e dezembro de 2015. A análise mostra fragilidades na governança empreendida pela CIB catarinense no que concerne à estruturação da atenção à saúde bucal de forma regionalizada e sob a perspectiva de rede. A estruturação da atenção à saúde bucal ocorre de forma paralela a outras redes temáticas no estado e apresenta a expansão dos serviços odontológicos, principalmente de média complexidade, como efeito do processo de governança vigente. As relações estabelecidas entre os gestores e os processos decisórios identificados permitiram reconhecer a “prescrição” dessa rede, visto que há pouca negociação e demanda local, sendo mais restrita ao seguimento de recomendações e incentivos da esfera federal/estadual, estes intermediados por técnicos da secretaria estadual. Dessa forma, a definição de agenda propícia à formulação de política voltada para a atenção à saúde bucal dos catarinenses torna-se fragilizada e apresenta um posicionamento periférico frente às demais ações de saúde.

The home care teaching and learning process in undergraduate health care degree courses

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

MUTUAL HELP GROUP FOR FAMILY MEMBERS OF OLDER ADULTS WITH DEMENTIA: UNVEILING PERSPECTIVES

ABSTRACT Objective: to understanding the reasons why members of a Mutual Help Group for family caregivers of older adults with Dementia participate in it and to identify the difficulties and benefits of such participation. Method: a qualitative exploratory descriptive study with data collected through observation and interviews with nine family caregivers, five family volunteers and five health professionals from the group. Data analysis involved content analysis and theoretical support of the Cultural Care Theory. Results: the respondents pointed out their reasons for seeking the group and the benefits they perceived from participating in it. However, difficulties to participate continuously in the group faced by both family caregivers and volunteers were also evidenced. Nontheless, all of them valued the possibility of being part of this group. Conclusion: the Mutual Help Group has proven to be an important supportive strategy for family caregivers of older adults with dementia, however, much remains to be done in order to make this strategy feasible for all families. Among the difficulties identified for maintaining the group are voluntary work and a way to attract more people to this work.

DEMAND AND TYPE OF CARE PROVIDED IN EMERGENCY SERVICES IN THE CITY OF FLORIANÓPOLIS, BRAZIL

ABSTRACT Objective: this study's aim was to characterize the demand of patients and the type of care provided in 2013, in emergency services, in the city of Florianópolis, SC, Brazil Method: this is a descriptive and analytical study with a quantitative approach. Secondary data were collected from general and managerial reports provided by the information system used by the city's department of health. Results: patients seek the emergency services nearest to their homes for situations not characterized as emergencies and that could be taken care of by primary health care units Conclusion: most patients originate from the same health district in which the emergency service is located and their reasons for seeking care could not be characterized as urgent or emergency situations. There is a need to qualify primary health care as the coordinator of care and instruct the population regarding the role of each service in the network

Home-based oral healthcare strategies of elderly people with Alzheimer's disease

Abstract Objective: To identify strategies used in the oral health care of elderly persons with Alzheimer's disease in the home. Method: an exploratory, descriptive study with a qualitative approach to collecting and analyzing data was performed. Data was collected through interviews with 30 caregivers and analyzed by the content analysis technique. Results: The majority of subjects were female, daughters of the elderly person, university graduates and aged 32-77 years. The strategies identified were grouped into categories according to the participation of the caregiver: does not participate in care actions or oral health assessments; reminds the elderly person about oral hygiene, demonstrates movements and assists with some procedures; directly carries out actions of care. Conclusion: The strategies employed are related to the degree of dependence of the elderly person, as the caregiver acts based on the need for oral health care and the difficulties in carrying out such care.

[Perception of the elderly regarding participation inexergaming-based exercise: a qualitative study]

Exergames are active video games that monitor body movement and are being used as an alternative to increase the level of physical activity of people from different age groups. This qualitative study investigated the perceptions of the elderly regarding exergaming. The focus group (FG) was conducted after 12 weeks of performing a program ofexergaming-based exercise (50 min, 3 days/week) using electronic games that simulate sports activities (Xbox 360 Kinect Sportstm). Fourteen people (55-77 years of age) participated in the FG, and a trained moderator led each group. The sessions were videotaped and transcribed for subsequent analysis. The content analysis technique was performed using ATLAS.ti® (qualitative analysis software). Participants reported psychological benefits (self-esteem, concentration, mood, reasoning, memory and well-being), physical benefits (agility and physical conditions) and social interaction (exchange of experiences, friendship and competitiveness). Regarding the experiences of the group, innovation, playfulness and visual stimulation were cited as characteristics of the games. The perception of benefits from participation in exergames fosters adherence to exercise and increases the motivation of the participants.

[Oral health care in the health network and the regionalization process]

The scope of this article is to outline the construction of the regionalized health network, focusing on oral health care and identifying the problems and the progress in its implementation. The context was the proposed national network model in the policies that underpin the Unified Health System. This is a descriptive-exploratory study with a qualitative approach methodologically supported by Grounded Theory. Interviews were conducted with managers, health professionals and teachers graduated in Dentistry, forming three sample groups. The core category was named "Enhancing the interaction of oral health care in the health network in the regionalization process." In the proposed theoretical model, the enhancement of interaction arises from conditions such as: the characterization of oral health care in the regionalized health network; the identification of difficulties in the implementation process; and the analysis of the operation of the oral health care network. The inclusion of oral health in the network is at an early stage, sometimes detached from the set of relations that constitutes the health network, which is also being consolidated. Evidence gathered in this study indicates the structuring of the regionalized health care network as a prerequisite to raise oral health care and assistance to a new level.

[An oral health care network organized by large municipalities in Santa Catarina State, Brazil]

This study aims to analyze the oral health care network in Santa Catarina State, Brazil, in municipalities with 100,000 inhabitants or more, focusing on the identification and integration of the network's essential elements. Primary data were obtained through a structured questionnaire applied to oral health care administrators. Secondary data were collected from official databases and provided by the Municipal and State Health Departments. The municipalities offer oral health services at all levels of care, but they are in different stages in implementation of the network. They have taken some measures to consolidate the network, such as inclusion of tools for integration of primary services to specialized care and reorientation of primary health care as the network's central coordinating element. Limitations include difficulty in defining the network's clientele based on epidemiological criteria, insufficient logistics and governance systems, and the need to expand oral health teams in the family health strategy, operating under health surveillance principles.

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.

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.

Avaliação da saúde bucal de idosos por enfermeiros: validade e confiabilidade do instrumentO ASBTO

O objetivo do estudo foi aplicar o Instrumento "Avaliação da Saúde Bucal para Triagem Odontológica" (ASBTO) em idosos institucionalizados para determinação dos índices de validade e confiabilidade, quando da aplicação por Enfermeiros. Os exames foram executados por um Enfermeiro e por um Cirurgião-Dentista (CD) em 50 idosos de uma instituição de longa permanência. A determinação da consistência interna foi verificada por meio do Coeficiente Alfa de Cronbach e ANOVA. Para determinação da estabilidade e confiabilidade foram considerados os percentuais de concordância e teste Kappa. Não houve diferença estatística significante entre as médias finais obtidas pelo CD e pelo Enfermeiro (p=0,41). Houve maior consistência interna nos exames procedidos pelo CD. Os percentuais de concordância variaram de 60%, na categoria Lábio, até 90%, na categoria "Dentes naturais". O Kappa total do instrumento alcançou 0,46. A utilização do ASBTO é passível por Enfermeiros. Faz-se necessária adequada capacitação e treinamento prático para padronização de critérios.

Validação de instrumento de avaliação das condições de saúde bucal de idosos institucionalizados

Objetivou-se trazer para a realidade brasileira, via tradução e validação, o instrumento Oral Health Assessment Tool, de Chalmers et al. (2005), que propõe instrumentalizar profissionais da enfermagem a averiguarem as condições de saúde bucal de idosos institucionalizados e, em sequência, definir a necessidade de cuidados diários e de encaminhamento para realização de procedimentos odontológicos específicos. O instrumento, em inglês, foi traduzido para a língua portuguesa. Seguiram-se as etapas de tradução reversa e análise por comitê de 10 experts convidados a validar o instrumento segundo as equivalências semântica, idiomática, cultural e conceitual. Na sequência, o instrumento foi submetido à análise por 21 profissionais de enfermagem de uma instituição de longa permanência, para que manifestassem suas opiniões sobre conteúdo, apresentação, leitura/clareza e aplicação prática do instrumento. Apresenta-se aos profissionais de enfermagem uma ferramenta de diagnóstico e encaminhamento de idosos com relação às demandas de saúde bucal em instituições de longa permanência.

A universidade promotora de saúde e as mudanças na formação profissional

Discute-se a Promoção da Saúde (PS) na perspectiva de um arranjo teórico-político, organizativo e prático capaz de influenciar processos de mudança na formação profissional em saúde. Com foco no conceito de Universidade Promotora de Saúde, particularmente em aspectos como intersetorialidade e ambientes saudáveis, discutem-se os movimentos históricos e institucionais de mudança, apresentando alguns limites e possibilidades, relativos aos processos de mudança em curso no setor da educação e da saúde, no Brasil contemporâneo. A incorporação da PS no cotidiano profissional faz emergir possibilidades e espaços de mudança, particularmente aqueles relativos ao processo de implementação de novos projetos pedagógicos e diretrizes curriculares nacionais. A construção do conhecimento e das novas práticas indica mudanças ainda tímidas, mas aponta para novas estratégias que poderão orientar a condução de ações pedagógicas mais potentes, voltadas para a PS e melhoria da qualidade de vida, e para a implementação de políticas públicas mais saudáveis e efetivas.

Assistência à saúde bucal em residências geriátricas de Granada, Espanha e Santa Catarina, Brasil*

Resumo Objetivo: Descrever a assistência à saúde bucal nas residências geriátricas da Província de Granada, Espanha, e Estado de Santa Catarina, Brasil, e comparar os dados obtidos. Metodologia: Trata-se de estudo exploratório, transversal. Os dados foram coletados por meio de questionário fechado, enviado pelo correio, para todas as residências geriátricas cadastradas em Granada (99) e Santa Catarina (78), em 2005. Resultados: O perfil das residências (29 em SC e 30 em Granada) foi semelhante, com predominância de instituições privadas. Não houve diferenças estatísticas significativas quanto aos residentes, exceto quanto ao número de instituições acima da mediana combinada para quantidade de mulheres e idosos totalmente dependentes, superiores em Granada. Embora as residências granadinas apresentassem maior número de profissionais da saúde, não houve diferenças quanto à insuficiente assistência à saúde bucal aos idosos, considerados: registro das condições de saúde bucal, circunstâncias em que essas condições são (re)avaliadas e realização sistemática de higiene bucal. Em face de um problema de saúde bucal apresentado pelo idoso, a família é comunicada, com maior frequência, nas residências granadinas. Conclusões: A assistência à saúde bucal não é prática sistemática nas instituições investigadas, em ambas as regiões, que transferem à família ou aos serviços locais de saúde o encaminhamento quando surgem problemas. Os procedimentos de higiene mais apontados foram escovação de dentes e próteses, porém práticas ineficazes são citadas. Foi frequente a alegação de falta de cooperação dos idosos para justificar a ausência de uma higiene bucal sistemática, revelando transferência de responsabilidades das instituições e cuidadores para o idoso.

Saúde bucal do idoso: por uma política inclusiva

Este artigo é parte de investigação realizada em instituições de longa permanência para idosos sobre cuidado à saúde bucal. Objetiva relacionar o significado do cuidado à saúde bucal do idoso institucionalizado a questões referentes às políticas públicas, no atual contexto nacional de implementação de políticas de saúde e saúde bucal. Trata-se de estudo qualitativo fundamentado na Grounded Theory. Participaram três idosos, quatro cuidadores, dois enfermeiros, três administradores (primeiro grupo amostral), três dentistas, três gestores públicos e um administrador (segundo grupo amostral). Após releitura dos dados recolhidos por entrevistas abertas e análise comparativa, a categoria Inserindo o cuidado à saúde bucal do idoso na dimensão político-organizacional engloba as políticas públicas de saúde e saúde bucal. Apesar das garantias legais, crescimento dos recursos e expansão dos serviços, a implementação de políticas públicas que incluam o idoso nas ações de saúde bucal é incipiente para assegurar comprometimento público-estatal-governamental e transformar a realidade epidemiológica.

Idosos de Florianópolis: autopercepção das condições de saúde bucal e utilização de serviços odontológicos

O presente artigo é um recorte do "Perfil do Idoso do Município de Florianópolis" (2004) obtido por meio do questionário Brazil Old Age Schedule (BOAS), aplicado a 875 idosos. Os dados focalizados no recorte são relativos à autopercepção dos entrevistados sobre suas condições de saúde bucal e uso dos serviços odontológicos, que foram associados com as variáveis sociodemográficas. A discrepância entre os dados sobre percepção de saúde bucal e reais condições de saúde bucal, como altas porcentagens de falta de dentes e presença de próteses, revela a maneira singular como o idoso percebe esse aspecto de sua saúde. O estado dos dentes somente mostrou-se associado significativamente à renda familiar. A consulta odontológica recente esteve associada à necessidade de próteses e por encaminhamento médico. O estudo permite concluir pela exigência de políticas públicas de atenção específica à saúde bucal dos idosos, de modo a promover saúde e bem-estar para todos, no irreversível processo de envelhecer.

Construindo um modelo de sistema de cuidados

OBJETIVO: Construir um modelo teórico explicativo de Sistema de Cuidados. METODO: Estudo exploratório qualitativo apoiado nos pressupostos da Grounded Theory. Participaram do estudo 15 profissionais e os dados foram coletados por entrevista aberta. RESULTADOS: O Modelo teórico foi delimitado a partir do fenômeno Construindo o Sistema Complexo de Cuidados determinado pelas categorias: Convivendo com a dinamicidade do sistema de cuidados e Organizando o sistema de cuidados a partir de múltiplas interações. CONCLUSÃO: O modelo de sistema de cuidados apresentou-se como sistema vital e dinâmico construído a partir de redes interacionais de vários saberes do agir humano expresso pelo trabalho compartilhado, multidisciplinar e em equipe.

Gestão das práticas de saúde na perspectiva do cuidado complexo

O avanço na gestão das práticas de saúde implica a reflexão sobre novas abordagens na construção do conhecimento pela compreensão do ser humano como um ser do cuidado, na perspectiva do cuidado complexo realizado por equipes de saúde interconectivas e potencializadas para as melhores práticas nos sistemas de cuidado. Este artigo propõe uma reflexão sobre a gestão das práticas de saúde a partir deste modo de pensar e ver o ser do cuidado, cognoscente, complexo, político, trabalhador de saúde, ator e construtor das relações, interações e associações no exercício do cuidado para o viver mais saudável, a promoção da saúde e a valorização da vida. O delineamento de pressupostos se constitui numa referência para a gestão das práticas de saúde na perspectiva do cuidado complexo.

Concepções de cuidado: uma análise das teses apresentadas para um programa de pós-graduação em enfermagem

O cuidado, nas suas diferentes dimensões e interfaces, tem sido objeto de estudo de profissionais de saúde, os quais apontam experiências e resultados que tem influenciado a prática em saúde e na enfermagem. É crescente a produção científica no sentido de resgatar e tornar visível os movimentos dinâmicos do cuidado. Sob esta perspectiva definiu-se como objetivo do estudo analisar as concepções de cuidado expressas nas teses de doutoramento de um programa de pós-graduação em enfermagem. A investigação caracterizou-se como bibliográfica, de natureza qualitativa, tendo como universo 34 teses, de um total de 111 defendidas no período de 1995 a dezembro de 2005. São várias as concepções de cuidado onde cada autor coloca, além de sua visão de mundo, um referencial de vida e de prática profissional.

As organizações de saúde na perspectiva da complexidade dos sistemas de cuidado

A construção de novas práticas de cuidado pressupõe um novo olhar para as organizações de saúde. O objetivo é interpretar o tema da complexidade na saúde e na Enfermagem na perspectiva dos sistemas de cuidado, buscando um repensar das práticas de cuidado no contexto das organizações de saúde. O pensamento complexo traz consigo uma nova maneira de conceber a ação e a condição humana sob diferentes perspectivas. Surge como possibilidade para visualizar o sistema de cuidado como sistema complexo nas suas estruturas e propriedades, nos movimentos de inter-retroações nos espaços organizacionais e nos seus processos auto-organizadores. Espera-se uma ação transformadora das organizações de saúde que considere as ambigüidades, as incertezas e a dinâmica social contemporânea para um viver mais saudável.

REFLETINDO SOBRE O CUIDADO ODONTOLÓGICO E A RESPONSABILIDADE PARA COM A VIDA E O VIVER MAIS SAUDÁVEL DAS PESSOAS IDOSAS

The article presents a reflection about some questions that are involved with oral health care provided to elderly people according to the ethic of responsability of Hans Jonas. Considering the oral health conditions of elderly people, the article discuss the dimensions of care and reflects if the knowledge and practices of oral health care are compromised with an ethics of responsibility of life and with a better and healthy living.