RESUMEN

OBJECTIVE: To increase knowledge and promote cultural change toward valuing normal birth, and to lower rates of cesarean and unnecessary interventions during childbirth in Brazil via the Senses of Birth (SoB) exhibition. METHODS: The SoB intervention targeted 22 621 participants in three Brazilian cities in 2015. The effects of the exhibition in knowledge, perceptions, and preferences regarding childbirth were analyzed in a multi-method study. Pre- and post-exhibition survey responses of 17 501 (77.0%) visitors, 1947 (8.6%) non-pregnant women, and all pregnant women (n=1287) were collected at the exhibition. A follow-up survey was completed by 555 (43.0%) postpartum women who had participated at SoB while pregnant. Univariate analyses were used to compare before and after changes. RESULTS: There was a significant increase in knowledge about normal birth, varying from 10.0% to 25.0% among general visitors (P<0.001) and 27.3% to 42.0% among pregnant women (P<0.001). Perceptions and preferences for normal birth also changed, reaching 83.0% of general visitors and 87.4% of pregnant women. CONCLUSION: SoB was found to effectively improve knowledge about and preference for normal birth. Scaling-up the intervention might contribute to cultural change toward valuing normal birth, and might decrease the rate of unnecessary cesarean and premature birth in Brazil.

Asunto(s)

RESUMEN

OBJECTIVE: To identify the psychic workload present in the work process of nurses working in Maternity and Obstetric Centers. METHOD: A descriptive qualitative study developed with 14 nurses working in obstetric centers and maternity units of two hospitals. The data were collected through a semi-structured interview, developed from October of 2015 to January of 2016, and exploited based on Content Analysis. RESULTS: The results were grouped into two categories: the nurses' working process and their psychic workload; and the maintenance of (in)appropriate practices such as psychic workload, demonstrating that the psychic workload is materialized in multiple elements of the work process, passing through assignments, interpersonal relationship and maintaining inadequate pipelines. CONCLUSIONS: It was identified that the psychic workload in the nurses' work process in the studied context is related to the perpetuation of dehumanized practices and to the challenge of maintaining humanized practices.

Asunto(s)

RESUMEN

Complementary examinations are "inadequate" whenever the likelihood of benefits from their indication is lower than the negative results. The low benefit is a result of poor performance in detecting relevant changes that lead to improved behavior. However, inadequate examinations are prevalent and little is known about patients' notions of the usefulness of such indications. The aim of this study was to describe relevant findings in inappropriate echocardiograms and to assess the level of agreement between patients and cardiologists regarding their usefulness. Adults without known cardiovascular disease who were referred for echocardiogram by inappropriate criteria according to the American College of Cardiology were selected. Relevant findings were defined by any change in the degree of moderate to severe, according to the American Society of Echocardiography. We tested the level of agreement between the patients who underwent echocardiographic examination and the physicians who requested the exam through a standard questionnaire. Five hundred patients were included, with average age of 52±17 years (47% males). Only 17 patients had any relevant changes (3.4%, 95%CI=2 to 5.4%). The most frequent alterations included valve changes in 8 and diastolic dysfunction grade II in 6 patients. Eighty-seven examinations were performed to determine the level of agreement between patients and cardiologists. For the question "Is this test really necessary?", 92% of patients responded positively, compared with 5% of cardiologists (Kappa negative 0.04; P=0.01). The frequency of relevant findings was low in inadequate echocardiograms and patients and cardiologists had a different perception regarding its usefulness.

Asunto(s)

RESUMEN

Resumo OBJETIVO Identificar as cargas de trabalho psíquicas presentes no processo de trabalho de enfermeiros atuantes em Maternidades e Centros Obstétricos. MÉTODO Estudo qualitativo descritivo, desenvolvido com 14 enfermeiros atuantes em Centros Obstétricos e Maternidades de dois hospitais. Os dados foram coletados por meio de entrevista semiestruturada, desenvolvidas de outubro de 2015 a janeiro de 2016, e explorados com base na Análise de Conteúdo. RESULTADOS Os resultados foram agrupados em duas categorias: o processo de trabalho do enfermeiro e sua carga psíquica; e a manutenção de práticas (in)adequadas como carga psíquica, demonstrando que as cargas de trabalho psíquicas concretizam-se em múltiplos elementos do processo de trabalho, perpassando as atribuições, as relações interpessoais e a manutenção de condutas inadequadas. CONCLUSÕES Identificou-se que as cargas de trabalho psíquicas no processo de trabalho de enfermeiros no contexto estudado estão relacionadas à perpetuação de práticas desumanizadas e ao desafio para manutenção de práticas humanizadas.

Resumen OBJETIVO Identificar las cargas de trabajo psíquicas en el proceso de trabajo de los enfermeros que trabajan en centros de maternidad y de obstetricia. MÉTODO Estudio cualitativo y descriptivo, desarrollado con 14 enfermeros que trabajan en centros de obstetricia y en unidades de la maternidad de dos hospitales. Se recolectaron los datos a través de entrevistas semiestructuradas, desarrolladas de octubre de 2015 a enero de 2016, y se analizaron los mismos a través del análisis de contenido. RESULTADOS Los resultados se agrupan en dos categorías: El proceso de trabajo del enfermero y su carga psíquica; y Prácticas de mantenimiento (in)adecuada como la carga psíquica, lo que demuestra que las cargas de trabajo psíquicas se materializan en múltiples elementos del proceso de trabajo, atraviesan las tareas, la relación interpersonal y dan continuidad a las prácticas inadecuadas. CONCLUSIONES Se identificó que las cargas de trabajo psíquicas en el proceso de trabajo de los enfermeros, en el contexto estudiado, están relacionadas a la perpetuación de prácticas deshumanizadas y al desafío de mantener prácticas humanizadas.

Abstract OBJECTIVE To identify the psychic workload present in the work process of nurses working in Maternity and Obstetric Centers. METHOD A descriptive qualitative study developed with 14 nurses working in obstetric centers and maternity units of two hospitals. The data were collected through a semi-structured interview, developed from October of 2015 to January of 2016, and exploited based on Content Analysis. RESULTS The results were grouped into two categories: the nurses' working process and their psychic workload; and the maintenance of (in)appropriate practices such as psychic workload, demonstrating that the psychic workload is materialized in multiple elements of the work process, passing through assignments, interpersonal relationship and maintaining inadequate pipelines. CONCLUSIONS It was identified that the psychic workload in the nurses' work process in the studied context is related to the perpetuation of dehumanized practices and to the challenge of maintaining humanized practices.

Asunto(s)

RESUMEN

Complementary examinations are "inadequate" whenever the likelihood of benefits from their indication is lower than the negative results. The low benefit is a result of poor performance in detecting relevant changes that lead to improved behavior. However, inadequate examinations are prevalent and little is known about patients' notions of the usefulness of such indications. The aim of this study was to describe relevant findings in inappropriate echocardiograms and to assess the level of agreement between patients and cardiologists regarding their usefulness. Adults without known cardiovascular disease who were referred for echocardiogram by inappropriate criteria according to the American College of Cardiology were selected. Relevant findings were defined by any change in the degree of moderate to severe, according to the American Society of Echocardiography. We tested the level of agreement between the patients who underwent echocardiographic examination and the physicians who requested the exam through a standard questionnaire. Five hundred patients were included, with average age of 52±17 years (47% males). Only 17 patients had any relevant changes (3.4%, 95%CI=2 to 5.4%). The most frequent alterations included valve changes in 8 and diastolic dysfunction grade II in 6 patients. Eighty-seven examinations were performed to determine the level of agreement between patients and cardiologists. For the question "Is this test really necessary?", 92% of patients responded positively, compared with 5% of cardiologists (Kappa negative 0.04; P=0.01). The frequency of relevant findings was low in inadequate echocardiograms and patients and cardiologists had a different perception regarding its usefulness.

Asunto(s)

Asunto(s)