Assuntos
Esgotamento Profissional , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Pandemias , Papel do Médico/psicologia , Pneumonia Viral , Lacunas da Prática Profissional , Atitude do Pessoal de Saúde , Betacoronavirus , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , COVID-19 , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribuição , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Lacunas da Prática Profissional/normas , Lacunas da Prática Profissional/tendências , SARS-CoV-2 , Venezuela/epidemiologiaRESUMO
PURPOSE: To study whether ICU staffing features are associated with improved hospital mortality, ICU length of stay (LOS) and duration of mechanical ventilation (MV) using cluster analysis directed by machine learning. METHODS: The following variables were included in the analysis: average bed to nurse, physiotherapist and physician ratios, presence of 24/7 board-certified intensivists and dedicated pharmacists in the ICU, and nurse and physiotherapist autonomy scores. Clusters were defined using the partition around medoids method. We assessed the association between clusters and hospital mortality using logistic regression and with ICU LOS and MV duration using competing risk regression. RESULTS: Analysis included data from 129,680 patients admitted to 93 ICUs (2014-2015). Three clusters were identified. The features distinguishing between the clusters were: the presence of board-certified intensivists in the ICU 24/7 (present in Cluster 3), dedicated pharmacists (present in Clusters 2 and 3) and the extent of nurse autonomy (which increased from Clusters 1 to 3). The patients in Cluster 3 exhibited the best outcomes, with lower adjusted hospital mortality [odds ratio 0.92 (95% confidence interval (CI), 0.87-0.98)], shorter ICU LOS [subhazard ratio (SHR) for patients surviving to ICU discharge 1.24 (95% CI 1.22-1.26)] and shorter durations of MV [SHR for undergoing extubation 1.61(95% CI 1.54-1.69)]. Cluster 1 had the worst outcomes. CONCLUSION: Patients treated in ICUs combining 24/7 expert intensivist coverage, a dedicated pharmacist and nurses with greater autonomy had the best outcomes. All of these features represent achievable targets that should be considered by policy makers with an interest in promoting equal and optimal ICU care.
Assuntos
Mortalidade Hospitalar/tendências , Admissão e Escalonamento de Pessoal/normas , Aprendizado de Máquina não Supervisionado/tendências , Brasil , Análise por Conglomerados , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Modelos Logísticos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermeiras e Enfermeiros/provisão & distribuição , Razão de Chances , Escores de Disfunção Orgânica , Admissão e Escalonamento de Pessoal/classificação , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Fisioterapeutas/estatística & dados numéricos , Fisioterapeutas/provisão & distribuição , Médicos/estatística & dados numéricos , Médicos/provisão & distribuição , Estudos Retrospectivos , Fatores de TempoRESUMO
PURPOSE: The purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian's structure, process and outcome model and in specific domains (quality, safety, infection and mortality) in two care divisions: inpatient and emergency services. DESIGN/METHODOLOGY/APPROACH: A systematic review identified hospital clinical indicators. Two independent investigators evaluated 70 articles/documents located in electronic databases and nine documents from the grey literature, 35 were included in the systematic review. FINDINGS: In total, 248 hospital-based indicators were classified as infection, safety, quality and mortality domains. Only 10.2 percent were identified in more than one article/document and 47 percent showed how they were calculated/obtained. Although there are scientific papers on developing, validating and hospital indicator assessment, most indicators were obtained from technical reports, government publications or health professional associations. RESEARCH LIMITATIONS/IMPLICATIONS: This review identified several hospital structure, process and outcome quality indicators, which are used by different national and international groups in both research and clinical practice. Comparing performance between healthcare organizations was difficult. Common clinical care standard indicators used by different networks, programs and institutions are essential to hospital quality benchmarking. ORIGINALITY/VALUE: To the authors' knowledge, this is the first systematic review to identify and describe hospital quality indicators after a comprehensive search in MEDLINE/PubMed, etc., and the grey literature, aiming to identify as many indicators as possible. Few studies evaluate the indicators, and most are found only in the grey literature, and have been published mostly by government agencies. Documents published in scientific journals usually refer to a specific indicator or to constructing an indicator. However, indicators most commonly found are not supported by reliability or validity studies.
Assuntos
Infecção Hospitalar/prevenção & controle , Mortalidade Hospitalar , Segurança do Paciente/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estatura Cabeça-Cóccix , Humanos , Admissão e Escalonamento de Pessoal/normas , Qualidade da Assistência à Saúde/normasRESUMO
BACKGROUND: It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. METHODS AND FINDINGS: Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. CONCLUSION: Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.
Assuntos
Serviços de Saúde da Criança/normas , Países em Desenvolvimento , Equipamentos e Provisões/provisão & distribuição , Instalações de Saúde , Pessoal de Saúde/educação , Admissão e Escalonamento de Pessoal/normas , Preparações Farmacêuticas/provisão & distribuição , Qualidade da Assistência à Saúde , Serviços de Saúde Reprodutiva/normas , Adulto , Criança , Estudos Transversais , Serviços de Planejamento Familiar/normas , Feminino , Fidelidade a Diretrizes , Haiti , Humanos , Recém-Nascido , Quênia , Malaui , Serviços de Saúde Materna/normas , Namíbia , Guias de Prática Clínica como Assunto , Gravidez , Ruanda , Senegal , Tanzânia , UgandaRESUMO
OBJECTIVE:: To analyze whether an increase in patient severity and nursing workload are correlated to a greater incidence of adverse events (AEs) in critical patients. METHOD:: A prospective single cohort study was performed on a sample of 138 patients hospitalized in an intensive care unit (ICU). RESULTS:: A total of 166 AEs, occurred, affecting 50.7% of the patients. Increased patient severity presented a direct relationship to the probability of AEs occurring. However, nursing workload did not present a statistically significant relationship with the occurrence of AEs. CONCLUSION:: The results cast light on the importance of using evaluation tools by the nursing personnel in order to optimize their daily activities and focus on patient safety. OBJETIVO:: Analisar se o aumento da gravidade do paciente e a carga de trabalho de enfermagem está relacionado à maior incidência de Eventos Adversos (EAs) em pacientes críticos. MÉTODO:: Estudo de coorte única, prospectivo, com amostra de 138 pacientes internados em uma Unidade de Terapia Intensiva (UTI). RESULTADOS:: Ao todo, foram evidenciados 166 EAs, que acometeram 50,7% dos pacientes. O aumento da gravidade do paciente apresentou relação direta com a chance de ocorrência de EAs. Entretanto, a carga de trabalho de enfermagem não apresentou relação estatisticamente significativa, na ocorrência de EAs. CONCLUSÃO:: Os resultados permitem refletir acerca da importância da equipe de enfermagem, em utilizar instrumentos de avaliação, com o objetivo de melhorar e planejar suas ações diárias, com foco na segurança do paciente.
Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Gravidade do Paciente , Carga de Trabalho/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estado Terminal/epidemiologia , Estado Terminal/enfermagem , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Prospectivos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricosRESUMO
ABSTRACT Objective: To analyze whether an increase in patient severity and nursing workload are correlated to a greater incidence of adverse events (AEs) in critical patients. Method: A prospective single cohort study was performed on a sample of 138 patients hospitalized in an intensive care unit (ICU). Results: A total of 166 AEs, occurred, affecting 50.7% of the patients. Increased patient severity presented a direct relationship to the probability of AEs occurring. However, nursing workload did not present a statistically significant relationship with the occurrence of AEs. Conclusion: The results cast light on the importance of using evaluation tools by the nursing personnel in order to optimize their daily activities and focus on patient safety.
RESUMEN Objetivo: Analizar si el aumento de la gravedad del paciente y la carga de trabajo de enfermería está relacionada con mayor incidencia de Eventos Adversos (EAs) en pacientes críticos. Método: Estudio de cohorte única, prospectivo, con muestra de 138 pacientes internados en una Unidad de Terapia Intensiva (UTI). Resultados: En total, fueron evidenciados 166 EAs, incidiendo sobre 50,7% de los pacientes. El aumento de la gravedad del paciente mostró relación directa con la posibilidad de ocurrencia de EAs. Sin embargo, la carga de trabajo de enfermería no demostró relación estadísticamente significativa en la ocurrencia de EAs. Conclusión: Los resultados permiten reflexionar sobre la importancia del equipo de enfermería, en utilizar instrumentos de evaluación, con el objeto de mejorar y planificar sus acciones diarias, enfocándose en la seguridad del paciente.
RESUMO Objetivo: Analisar se o aumento da gravidade do paciente e a carga de trabalho de enfermagem está relacionado à maior incidência de Eventos Adversos (EAs) em pacientes críticos. Método: Estudo de coorte única, prospectivo, com amostra de 138 pacientes internados em uma Unidade de Terapia Intensiva (UTI). Resultados: Ao todo, foram evidenciados 166 EAs, que acometeram 50,7% dos pacientes. O aumento da gravidade do paciente apresentou relação direta com a chance de ocorrência de EAs. Entretanto, a carga de trabalho de enfermagem não apresentou relação estatisticamente significativa, na ocorrência de EAs. Conclusão: Os resultados permitem refletir acerca da importância da equipe de enfermagem, em utilizar instrumentos de avaliação, com o objetivo de melhorar e planejar suas ações diárias, com foco na segurança do paciente.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Carga de Trabalho/normas , Erros Médicos/estatística & dados numéricos , Gravidade do Paciente , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Prospectivos , Estudos de Coortes , Carga de Trabalho/estatística & dados numéricos , Estado Terminal/enfermagem , Estado Terminal/epidemiologia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Practice guidelines aim to improve the standard of care for people living with HIV/AIDS. Successfully implementing guidelines requires tailoring them to populations served and to social and organizational influences on care. AIMS: To examine dimensions of context, which nurses and midwives described as having a significant impact on their care of patients living with HIV/AIDS in Kenya, Uganda, South Africa, and Jamaica and to determine whether HIV/AIDS guidelines include adaptations congruent with these dimensions of context. METHODS: Two sets of data were used. The first came from a qualitative study. In-depth interviews were conducted with purposively selected nurses, midwives, and nurse managers from 21 districts in four study countries. A coding framework was iteratively developed and themes inductively identified. Context dimensions were derived from these themes. A second data set of published guidelines for HIV/AIDS care was then assembled. Guidelines were identified through Google and PubMed searches. Using a deductive integrative analysis approach, text related to context dimensions was extracted from guidelines and categorized into problem and strategy statements. RESULTS: Ninety-six individuals participated in qualitative interviews. Four discrete dimensions of context were identified: health workforce adequacy, workplace exposure risk, workplace consequences for nurses living with HIV/AIDS, and the intersection of work and family life. Guidelines most often acknowledged health human resource constraints and presented mitigation strategies to offset them, and least often discussed workplace consequences and the intersections of family and work life. LINKING EVIDENCE TO ACTION: Guidelines should more consistently acknowledge diverse implementation contexts, propose how recommendations can be adapted to these realities, and suggest what role frontline healthcare providers have in realizing the structural changes necessary for healthier work environments and better patient care. Guideline recommendations should include more explicit advice on adapting their recommendations to different care conditions.
Assuntos
Atitude do Pessoal de Saúde , Guias como Assunto/normas , Infecções por HIV/psicologia , Enfermeiras e Enfermeiros/psicologia , Padrão de Cuidado/normas , Adulto , Feminino , Infecções por HIV/enfermagem , Infecções por HIV/prevenção & controle , Humanos , Jamaica , Quênia , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/normas , Pesquisa Qualitativa , África do Sul , Uganda , Precauções Universais/economia , Precauções Universais/instrumentação , Local de Trabalho/psicologiaRESUMO
More injuries were reported with night shifts or eight or more hours of overtime in a week.
Assuntos
Recursos Humanos de Enfermagem Hospitalar/organização & administração , Traumatismos Ocupacionais/epidemiologia , Admissão e Escalonamento de Pessoal/normas , Tolerância ao Trabalho Programado , Humanos , Recursos Humanos de Enfermagem Hospitalar/normas , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Traumatismos Ocupacionais/etiologia , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Medição de RiscoRESUMO
This article presents a macroergonomic intervention in a Brazilian footwear company and its evaluation by the workers. Using participatory ergonomics, the traditional Taylor/Ford production system was transformed into a socio-technical one and tested by 100 volunteers working during 3.5 years in a pilot production line. Multiskilling and teamwork were the major changes promoted to enlarge and enrich work and make it more flexible. The workers' evaluation pre- and post-intervention showed an increase in overall satisfaction with the work and more commitment to the results and company targets. STATEMENT OF RELEVANCE: This study showed that problems and solutions can be identified through participatory ergonomics, that it is easier to involve workers than the managerial staff, and that a macroergonomic intervention, mainly focusing on work organization, led to positive personnel, health and production outcomes, despite management's resistance to changes.
Assuntos
Ergonomia/normas , Indústria Manufatureira , Sapatos , Brasil , Ergonomia/métodos , Feminino , Humanos , Satisfação no Emprego , Masculino , Indústria Manufatureira/métodos , Indústria Manufatureira/organização & administração , Indústria Manufatureira/normas , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/normas , Projetos Piloto , Local de Trabalho/organização & administração , Local de Trabalho/psicologia , Local de Trabalho/normasRESUMO
OBJECTIVE: With the assumption that circadian rhythms influence human performance, the work of live line electricians was reorganized and evaluated. The hypothesis was that in highly physical and attention-demanding work, the organization of tasks, according to the ideal period of day and day of week, should diminish stress and consequent work risks. BACKGROUND: There are only a few studies reporting the work of electricians and even fewer approaching work organization. Moreover, these investigations often do not consider human physiological limitations and capabilities as well as task demands. METHOD: A new work system was proposed with consideration of (a) the circadian cycles and homeostatic processes; (b) the effect of heat, which is a zeitgeber (synchronizer) for the biological clocks; and (c) the degree of physical and mental demands of the different performed tasks, which was assessed on the basis of opinions of the electricians and physiological markers of stress that are controlled by circadian rhythms. The traditional and new systems were compared on the basis of two cognitive indices (the arrangement of matchsticks and the perception of a minute) and three physiological markers of mental-to-physical loads (heart frequency and the level of adrenaline and noradrenaline). RESULTS: Both physical and mental loads were reduced in the new system. CONCLUSION: Work organization should include consideration of human circadian rhythms, mainly when stressful and high-risk tasks are involved. APPLICATION: The findings can be applied in any work design, but they are especially suited for highly demanding work carried out outdoors.
Assuntos
Ritmo Circadiano/fisiologia , Admissão e Escalonamento de Pessoal/organização & administração , Estresse Fisiológico , Estresse Psicológico/prevenção & controle , Tolerância ao Trabalho Programado , Adulto , Análise de Variância , Atenção , Ergonomia , Humanos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/normas , Centrais Elétricas , Estresse Psicológico/fisiopatologia , Tempo (Meteorologia)RESUMO
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) duty hour standards that began July 2011 will further limit resident duty hours. OBJECTIVE: To survey neurosurgery residents in the United States on duty hour violations under the current system and the predicted effects on education and patient safety of the new regulations. METHODS: Surveys were mailed to every neurosurgery training program in the United States and Puerto Rico. Program directors and coordinators were asked to distribute surveys to their residents. RESULTS: Three hundred seventy-seven neurosurgery residents mailed surveys back to the study center (34% response rate). More than one-third of respondents reported violating the 80-hour rule occasionally or frequently (36%). Thirty-one residents (8%) reported having been involved in a motor vehicle collision or life-threatening event and 20 (6%) reported having made a medical error resulting in patient harm after an extended shift. Eighty-three percent disagreed with the 16-hour proposed regulation for postgraduate year 1. The majority of respondents thought that the new standards will have a negative or strongly negative effect on their residency training (72%). CONCLUSION: This national duty hour survey of neurosurgical residents reveals considerable concern over the new ACGME proposed standards. The majority of respondents believe that the new standards will have a negative effect on their residency training. Furthermore, this survey indicates an overwhelming negative attitude toward mandated duty hour regulations among neurosurgical residents. Duty hour violations reported in this survey may be a more honest depiction of true violations than previous surveys and are higher than expected.
Assuntos
Internato e Residência , Neurocirurgia/educação , Admissão e Escalonamento de Pessoal/normas , Carga de Trabalho/normas , Adulto , Coleta de Dados , Feminino , Humanos , Masculino , Porto Rico , Estados UnidosRESUMO
Fundamento: Concursos para emprego excluem candidatos com exames anormais e/ou hipertensos e há incentivo à aposentadoria ou exclusão, se empregados.Objetivo: Demonstrar que, em motoristas de ônibus, a seleção e o incentivo à aposentadoria estavam relacionados à HAS.Métodos: Estudo epidemiológico transversal em população pré-definida. Pressão arterial(PA)sistólica(PAS): 1ªfase dos sons de Korotkof e PA diastólica(PAD) na 5ª(esfignomanômetro de coluna de mercúrio). HAS:PA maior igual 140/90 mmhg ou normotensos usando medicação anti-hipertensiva. Estatística:Stata5:Qui quadrado e prevalência.Resultados:Examinados 559 de 610(sexo masculino) motoristas de ônibus. Média de idade 41,3 anos. A prevalência de HAS foi 20,8 por cento(116/559) no grupo estudado, sendo: até 12 meses de trabalho(89,5 por cento maior que 30 anos de idade) de 5,3 por cento(1/19) - este hipertenso tinha PA normal na admissão; na faixa 12-24 meses foi de 9,8 por cento(6/61). Na faixa etária 30-39 anos foi de 10,7 por cento(22/205) e na de maior igual 60 anos de 11,1 por cento(1/9). A prevalência dentro das faixas de tempo de trabalho, elevou-se de faixas etárias menores para maiores, menos na faixa maior igual 300 meses(25 anos), quando ocorreu o contrário. Houve redução abrupta da prevalência (52,4 por cento para 18,4 por cento) na faixa etária 50-59 anos, entre as faixas de 240-299 meses(20-24,9 anos) e maior que 300 meses de trabalho.Conclusão/discussão: A prevalência da HAS deveu-se provavelmente, à não contratação, ao incentivo à aposentadoria ou à demissão dos chamados hipertensos. A redução da prevalência da faixa etária 50-59 anos, entre as faixas 20-25 anos e maior igual 25 anos de trabalho,a baixa prevalência (11,1 por cento) nos idosos (maior igual 60 anos) e a prevalência decrescente com aumento da faixa etária entre os maiores de 25 anos de trabalho, demostram seleção rigorosa nestes. Apesar disso, a prevalência foi elevada (fator laboral?). Deve-se rastrear a HAS visando à prevenção/tratamento e não a exclusão
Assuntos
Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal , Aposentadoria/estatística & dados numéricos , Pressão Arterial/fisiologia , Testes Diagnósticos de Rotina/tendências , Testes Diagnósticos de RotinaRESUMO
PURPOSE: In 1981, Brazil's National Committee on Medical Residency established the Common Program Requirements (CPRs), to regulate residents' work hours. The authors studied whether program violations of the CPRs regarding residents' duty hours, time for educational activities, and faculty supervision adversely affected residents' perceptions about the quality of their lives and about the educational environment. METHOD: From October through December 2003, 88 residents from four institutions in Florianopolis (SC), Brazil were invited to participate of the study. Residents completed four instruments: a questionnaire about their program's compliance with CPRs; the Dundee Ready Educational Environment Measure (DREEM) that assesses perceptions about the learning environment; the Quality of School Life Scale (QSL), which assesses the quality of life at school; and the WHO Quality of Life Assessment (WHOQOL), which assesses the general quality of life. Residents were categorized according to gender, institution, year of training, specialty, and their answers on the CPRs questionnaire. DREEM, SQL, and WHOQOL scores were compared between categories. RESULTS: A total of 62 residents (70%) responded. A significant number of residents reported their program's noncompliance with CPRs. Residents reporting program compliance rated higher parameters of general quality of life, quality of life in residency, and the educational environment. CONCLUSION: Violations of Brazil's residency program CPRs are associated with residents' worse perceptions of several aspects of general quality of life, quality of life in residency, and the educational environment.
Assuntos
Atitude do Pessoal de Saúde , Currículo , Fidelidade a Diretrizes/estatística & dados numéricos , Internato e Residência/normas , Admissão e Escalonamento de Pessoal/normas , Qualidade de Vida , Adulto , Brasil , Educação de Pós-Graduação em Medicina/normas , Feminino , Humanos , Masculino , Percepção Social , Inquéritos e Questionários , Recursos HumanosRESUMO
This article was based on research carried out to characterize the pre- natal care offered to pregnant women at the outpatient unit of a university hospital. This qualitative study used ethnography, more precisely miniethnography. The methodological approach and data collection were done through participating observation. Results showed that pregnant in touch with health professionals are able to filter information and at t he same time, behave as nonparticipating clients, since they do not question the care offered to them even if the care is not good. Although women think that the care offered at this hospital is better than the one offered elsewhere, they admit that it does not respond successfully to their real expectations and needs. Generally speaking, they would like to receive more orientation and more personal assistance. They do not like this care very much mainly because of students' rotativity.
Assuntos
Assistência Ambulatorial/psicologia , Mães/psicologia , Satisfação do Paciente , Gravidez/psicologia , Cuidado Pré-Natal/normas , Adulto , Antropologia Cultural , Feminino , Hospitais Universitários , Humanos , Pesquisa Metodológica em Enfermagem , Educação de Pacientes como Assunto , Admissão e Escalonamento de Pessoal/normas , Estudantes de Enfermagem , Inquéritos e QuestionáriosRESUMO
The author evaluates shift changes on the Nursing Unit in the Radiology Department of Hospital de Clínicas de Porto Alegre which were established two years ago. She emphasizes the importance of communication among members of the team and presents the results of an observation done by auxiliary personnel during shift changes.