Juliana Dias Reis Pessalacia

Uso da casuística no processo ensino-aprendizagem de bioética em saúde

There are several bioethical models capable of contributing to decision making in health. The casuistic model works with the analysis of real cases for decision making regarding bioethical problems. It is conducted with 16 academic scholars from the health field with the objective of identifying academic experiences in the teaching-learning process of bioethics. It uses the case method, based on the casuistic model. It is a descriptive, qualitative study using thematic analysis, where two categories emerged: “the difficulty of practical application of paradigms and analogies in the casuistic model’’ and ‘’how the casuistic model facilitates the formation of ethical positioning and the decision making process’’. From the reported experiences, it is concluded that the casuistic model significantly contributes to decision making in bioethical issues and assists in the teaching- -learning process of bioethics during undergraduate study in the health field.

Novas demandas para a atenção primária à saúde no Brasil: os cuidados paliativos

OBJECTIVE Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. METHODS Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. RESULTS 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). CONCLUSION It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.

Nuevas demandas para la atención primaria em salud en Brasil: los cuidados paliativos

OBJECTIVE Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. METHODS Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. RESULTS 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). CONCLUSION It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.

New demands for primary health care in Brazil: palliative care

OBJECTIVE Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. METHODS Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. RESULTS 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). CONCLUSION It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.

EFECTO DE LA INTERVENCIÓN DEL PAYASO EN LOS NIVELES DE DEPRESIÓN EN ANCIANOS EN UNA INSTITUCIÓN LARGA ESTANCIA

Objective: To evaluate the effects of clown interventions on depression levels along the institutionalized elderly. Method: Quantitative study with an experimental approach, performed in institution geriatric long term Divinopolis, Minas Gerais, Brazil. The Geriatric Depression Scale was used in the reduced version of Yesavage (GDS-15) applied at two points and two elderly groups, having an intervention group (n = 14) and the other control (n = 10). The intervention consisted of visits, where academic gowns clown performed activities in clown mode. The statistical comparison of the effectiveness of interventions was performed using the JT method. Results: Of the 24 elderly participants, 14 (63.6%) were female and 10 (36.4%) were male. The application of the scale in the first time demonstrated that in the control group 40% had depression and after activities 50% had such a framework. You experimental group no changes were observed in the number of individuals with depressive disorder before and after the interventions. Thus, it can be inferred that therapy was beneficial humor point of view of non-progression of depression among institutionalized elderly. Conclusion: Become necessary new studies about the effectiveness of clown animation for improvement of traits of depression in institutionalized elderly. Key words: Laughter therapy, depression, elderly, geriatric long-term care institutionObjetivo: Evaluar los efectos de las intervenciones de payasos en los niveles de depresion en los ancianos institucionalizados. Material y metodo: Estudio de abordaje cuantitativo experimental, realizado en institucion geriatrica de larga estancia en Divinopolis, Minas Gerais, Brasil. La Escala de Depresion Geriatrica se utilizo en la version abreviada de la Yesavage (GDS-15), aplicada en dos momentos y en dos grupos de edad avanzada, con un grupo de intervencion (n = 14) y control (n = 10). La intervencion consistio en visitas de academicos vestidos de payasos, en las cuales se llevaron a cabo actividades ludicas. La comparacion estadistica de la eficacia se realizo a traves del metodo de JT. Resultados: De los 24 ancianos, 14 (63,6%) fueron mujeres y 10 (36,4%) eran hombres. La aplicacion de la escala, en un primer momento, mostro que en el grupo control, el 40% presentaban depresion y despues de las actividades, el 50% presentaban dicho cuadro. En el grupo experimental no hubo cambios en el numero de individuos con trastorno depresivo antes y despues de las intervenciones. Se puede inferir que la terapia del humor fue beneficiosa desde el punto de vista de la progresion de la depresion entre ancianos institucionalizados. Conclusion: Se necesitan nuevos estudios con respecto a la efectividad de las intervenciones con payasos para la mejora de los rasgos de la depresion en los ancianos institucionalizados.

Cuidados paliativos na atenção primária à saúde: considerações éticas

Palliative Care (PC) is presented as a public health problem, due to the substantial increase in the number of elderly and the prevalence of non-communicable chronic degenerative diseases. The importance of the reorganization of Primary Health Care Services (PHCS) to ensure the provision of this care has become evident. The objective was to identify cases of users, in order to inventory the ethical problems that the team experienced. This is a case study based on a Qualitative approach, using thematic analysis. Two cases were identified, that revealed, as ethical problems, the “responsibility of the PHCS towards the caregivers and families” and the “difficulty of frank and honest communication between the team and the family”. The results indicate that the training of human resources with technical competence and the continuity of assistance in the transition from curative to palliative treatment are factors favorable to the integrality and the obtention of more adequate responses to the ethical challenges that the teams experienced.Palliative care in primary health care: ethical considerations Palliative Care (PC) is presented as a public health problem, due to the substantial increase in the number of elderly and the prevalence of non-communicable chronic degenerative diseases. The importance of the reorganization of Primary Health Care Services (PHCS) to ensure the provision of this care has become evident. The objective was to identify cases of users, in order to inventory the ethical problems that the team experienced. This is a case study based on a Qualitative approach, using thematic analysis. Two cases were identified, that revealed, as ethical problems, the “responsibility of the PHCS towards the caregivers and families” and the “difficulty of frank and honest communication between the team and the family”. The results indicate that the training of human resources with technical competence and the continuity of assistance in the transition from curative to palliative treatment are factors favorable to the integrality and the obtention of more adequate responses to the ethical challenges that the teams experienced.

Cuidados paliativos en la atención primaria de la salud: consideraciones éticas

Palliative Care (PC) is presented as a public health problem, due to the substantial increase in the number of elderly and the prevalence of non-communicable chronic degenerative diseases. The importance of the reorganization of Primary Health Care Services (PHCS) to ensure the provision of this care has become evident. The objective was to identify cases of users, in order to inventory the ethical problems that the team experienced. This is a case study based on a Qualitative approach, using thematic analysis. Two cases were identified, that revealed, as ethical problems, the “responsibility of the PHCS towards the caregivers and families” and the “difficulty of frank and honest communication between the team and the family”. The results indicate that the training of human resources with technical competence and the continuity of assistance in the transition from curative to palliative treatment are factors favorable to the integrality and the obtention of more adequate responses to the ethical challenges that the teams experienced.Palliative care in primary health care: ethical considerations Palliative Care (PC) is presented as a public health problem, due to the substantial increase in the number of elderly and the prevalence of non-communicable chronic degenerative diseases. The importance of the reorganization of Primary Health Care Services (PHCS) to ensure the provision of this care has become evident. The objective was to identify cases of users, in order to inventory the ethical problems that the team experienced. This is a case study based on a Qualitative approach, using thematic analysis. Two cases were identified, that revealed, as ethical problems, the “responsibility of the PHCS towards the caregivers and families” and the “difficulty of frank and honest communication between the team and the family”. The results indicate that the training of human resources with technical competence and the continuity of assistance in the transition from curative to palliative treatment are factors favorable to the integrality and the obtention of more adequate responses to the ethical challenges that the teams experienced.

EFEITO DA INTERVENÇÃO CLOWN NO PADRÃO DE DEPRESSÃO DE IDOSOS EM INSTITUIÇÃO DE LONGA PERMANÊNCIA

Objective: To evaluate the effects of clown interventions on depression levels along the institutionalized elderly. Method: Quantitative study with an experimental approach, performed in institution geriatric long term Divinopolis, Minas Gerais, Brazil. The Geriatric Depression Scale was used in the reduced version of Yesavage (GDS-15) applied at two points and two elderly groups, having an intervention group (n = 14) and the other control (n = 10). The intervention consisted of visits, where academic gowns clown performed activities in clown mode. The statistical comparison of the effectiveness of interventions was performed using the JT method. Results: Of the 24 elderly participants, 14 (63.6%) were female and 10 (36.4%) were male. The application of the scale in the first time demonstrated that in the control group 40% had depression and after activities 50% had such a framework. You experimental group no changes were observed in the number of individuals with depressive disorder before and after the interventions. Thus, it can be inferred that therapy was beneficial humor point of view of non-progression of depression among institutionalized elderly. Conclusion: Become necessary new studies about the effectiveness of clown animation for improvement of traits of depression in institutionalized elderly. Key words: Laughter therapy, depression, elderly, geriatric long-term care institutionObjetivo: Evaluar los efectos de las intervenciones de payasos en los niveles de depresion en los ancianos institucionalizados. Material y metodo: Estudio de abordaje cuantitativo experimental, realizado en institucion geriatrica de larga estancia en Divinopolis, Minas Gerais, Brasil. La Escala de Depresion Geriatrica se utilizo en la version abreviada de la Yesavage (GDS-15), aplicada en dos momentos y en dos grupos de edad avanzada, con un grupo de intervencion (n = 14) y control (n = 10). La intervencion consistio en visitas de academicos vestidos de payasos, en las cuales se llevaron a cabo actividades ludicas. La comparacion estadistica de la eficacia se realizo a traves del metodo de JT. Resultados: De los 24 ancianos, 14 (63,6%) fueron mujeres y 10 (36,4%) eran hombres. La aplicacion de la escala, en un primer momento, mostro que en el grupo control, el 40% presentaban depresion y despues de las actividades, el 50% presentaban dicho cuadro. En el grupo experimental no hubo cambios en el numero de individuos con trastorno depresivo antes y despues de las intervenciones. Se puede inferir que la terapia del humor fue beneficiosa desde el punto de vista de la progresion de la depresion entre ancianos institucionalizados. Conclusion: Se necesitan nuevos estudios con respecto a la efectividad de las intervenciones con payasos para la mejora de los rasgos de la depresion en los ancianos institucionalizados.

EFFECT OF CLOWN INTERVENTIONS ON DEPRESSION LEVELS AMONG THE GERIATRIC LONG-TERM CARE INSTITUTIONS

Objective: To evaluate the effects of clown interventions on depression levels along the institutionalized elderly. Method: Quantitative study with an experimental approach, performed in institution geriatric long term Divinopolis, Minas Gerais, Brazil. The Geriatric Depression Scale was used in the reduced version of Yesavage (GDS-15) applied at two points and two elderly groups, having an intervention group (n = 14) and the other control (n = 10). The intervention consisted of visits, where academic gowns clown performed activities in clown mode. The statistical comparison of the effectiveness of interventions was performed using the JT method. Results: Of the 24 elderly participants, 14 (63.6%) were female and 10 (36.4%) were male. The application of the scale in the first time demonstrated that in the control group 40% had depression and after activities 50% had such a framework. You experimental group no changes were observed in the number of individuals with depressive disorder before and after the interventions. Thus, it can be inferred that therapy was beneficial humor point of view of non-progression of depression among institutionalized elderly. Conclusion: Become necessary new studies about the effectiveness of clown animation for improvement of traits of depression in institutionalized elderly. Key words: Laughter therapy, depression, elderly, geriatric long-term care institutionObjetivo: Evaluar los efectos de las intervenciones de payasos en los niveles de depresion en los ancianos institucionalizados. Material y metodo: Estudio de abordaje cuantitativo experimental, realizado en institucion geriatrica de larga estancia en Divinopolis, Minas Gerais, Brasil. La Escala de Depresion Geriatrica se utilizo en la version abreviada de la Yesavage (GDS-15), aplicada en dos momentos y en dos grupos de edad avanzada, con un grupo de intervencion (n = 14) y control (n = 10). La intervencion consistio en visitas de academicos vestidos de payasos, en las cuales se llevaron a cabo actividades ludicas. La comparacion estadistica de la eficacia se realizo a traves del metodo de JT. Resultados: De los 24 ancianos, 14 (63,6%) fueron mujeres y 10 (36,4%) eran hombres. La aplicacion de la escala, en un primer momento, mostro que en el grupo control, el 40% presentaban depresion y despues de las actividades, el 50% presentaban dicho cuadro. En el grupo experimental no hubo cambios en el numero de individuos con trastorno depresivo antes y despues de las intervenciones. Se puede inferir que la terapia del humor fue beneficiosa desde el punto de vista de la progresion de la depresion entre ancianos institucionalizados. Conclusion: Se necesitan nuevos estudios con respecto a la efectividad de las intervenciones con payasos para la mejora de los rasgos de la depresion en los ancianos institucionalizados.

Divine clowns and the art of animating elderly: experience report

Objective: report the activities of a university outreach project as a proposal for the humanization of assistance and a tool for academic education in the health field. Method: descriptive study, with an experience report design, conducted by means of observational methods, within the period from April 2011 to March 2012, in a home for the aged in Divinópolis, Minas Gerais, Brazil. Results: the study was approved by the institutions involved and creating the group “Divine Clowns” enabled the making of the “Divine Medical Record”, the preparation of clown actors, and the participation of elderly people in clown activities. Conclusion: in the project reported in this study, the theoretical knowledge about the health of the elderly are put into practice when the student plays the role of a clown, constituting both a proposal for humanization of assistance and a teaching tool in the health field. Descriptors: Home for the Aged; Laugh; Humanization of Assistance; Health of the Elderly. RESUMO Objetivo: relatar as atividades de um projeto de extensão universitária como proposta de humanização da assistência e ferramenta de formação acadêmica na área da saúde. Método: estudo descritivo, do tipo relato de experiência, realizado a partir de métodos observacionais, no período de abril de 2011 a março de 2012, em uma instituição de longa permanência em Divinópolis (MG). Resultados: o estudo obteve aprovação das instituições envolvidas e a criação do grupo “Divinos Palhaços” proporcionou a elaboração do “Divino Prontuário”, a preparação de atores palhaços e a participação de idosos em atividades de clown. Conclusão: no projeto relatado neste estudo, os conhecimentos teóricos sobre a saúde do idoso são postos em prática na atuação do discente como clown, constituindo tanto uma proposta de humanização da assistência como uma ferramenta de ensino na área da saúde. Descritores: Instituição de Longa Permanência para Idosos; Riso; Humanização da Assistência; Saúde do Idoso. RESUMEN Objetivo: relatar las actividades de un proyecto de extensión universitaria como una propuesta para humanización de la atención y una herramienta para la formación académica en el área de la salud. Método: estudio descriptivo, del tipo relato de experiencia, llevado a cabo por medio de métodos de observación, en el período comprendido entre abril de 2011 y marzo de 2012, en un hogar para ancianos en Divinópolis, Minas Gerais, Brasil. Resultados: el estudio fue aprobado por las instituciones involucradas y la creación del grupo “Payasos Divinos” proporcionó la elaboración del “Divino Prontuario”, la preparación de payasos actores y la participación de ancianos en actividades de clown. Conclusión: en el proyecto relatado en este estudio, los conocimientos teóricos acerca de la salud del anciano se ponen en práctica durante la actuación del discente como clown, lo que constituye tanto una propuesta de humanización de la atención como una herramienta de enseñanza en el área de la salud. Descriptores: Hogar de Ancianos; Risa; Humanización de la Atención; Salud del Anciano. Nurse. MS in Health Sciences. Ph.D Nursing student at the University of São Paulo (USP). Professor at the Federal University of São João del-Rei (UFSJ). Divinópolis (MG), Brazil. Email: ecr.gesteira@hotmail.com; Nurse. Post-Ph.D Nursing student at USP. Professor at UFSJ. Divinópolis (MG), Brazil. Email: juliana@pessalacia.com.br; Nurse. MS in Nursing. Ph.D Nursing student at the Federal University of Minas Gerais (UFMG). Professor at UFSJ. Divinópolis (MG), Brazil. Email: tati_prette@yahoo.com.br; Undergraduate student in Medicine at UFSJ. Divinópolis (MG), Brazil. Email: wrgelles@gmail.com CASE REPORT ARTICLE Gesteira ER, Pessalacia JDR, Kuznier TP et al. Divine clowns and the art of animating... English/Portuguese J Nurs UFPE on line., Recife, 8(Suppl. 3):4159-64, Nov., 2014 4160 ISSN: 1981-8963 DOI: 10.5205/reuol.5353-44734-1-RV.0811supl201416 In developing countries, where poverty and social inequality coexist, population aging has posed a great challenge by requiring more attention from public health mainly with regard to the allocation of resources. As this scenario takes place, our country has shown an accelerated demographic transition process, with an increased elderly population that, as a consequence, will boost the demand for homes for the aged (HAs). The HA is regarded as a social and organizational system whose purpose is embracing elderly people devoid of financial resources, with no family group, or even in a situation of family abandonment. A part of the Brazilian population may, at some point in its life, live and/or need the care provided by these institutions. In addition to these assignments, it is worth highlighting that the HA must provide the elderly person with a comprehensive living, with a daily life of his own, as well as her/his senses, her/his intellectual capabilities, her/his feelings, and her/his ideologies. According to the Elderly Health Program and the Brazilian Elderly Statute, we must seek innovative proposals regarding elderly health, encouraging their citizenship, identity, autonomy, and well-being, that can be achieved through projects and/or programs that encourage hours of entertainment, including activities aimed at this audience. Thus, the activities aimed at the elderly should include activities that encourage them to a more active and creative life, covering humanization aspects that favor the elderly communication, socialization, and autonomy. It is worth stressing that humanize includes the act of listening to the other, identifying themselves as human beings. In line with this thinking, a physician, founder and director of the Gesundheit Institute, who works as a clown for over thirty years, claims that joy, laugh, and kindness help people maintaining or improving their health, because there is encouragement for life. By means of this view, there emerged the university outreach project “Divine Clowns and the art of animating elderly people” by a federal public university in Divinópolis, Minas Gerais, Brazil, where students from the courses of Medicine, Nursing, and Pharmacy, along with professors from the Nursing course, this project for humanization in the institutionalized environment of the elderly. Thus, this experience report aims to introduce the activities conducted in this outreach project, as an innovative proposal in the elderly health area and as an academic education tool. Descriptive study, with an experience report, on the activities conducted in an outreach project, as an innovative proposal in the elderly health area and as an academic education tool. The activities were introduced through descriptive and observational methods. The experience report is regarded as a tool for descriptive research, which aims to present a reflection on an action or set of actions related to a practice experienced in the professional or educational context and having interest on the part of the scientific community. The activities that resulted in the writing of this report occurred within the period from April 2011 to March 2012 in a HA in Divinópolis. There was no need to submit it to an Ethics Committee on Research involving Human Beings, because it reports an experience of authors themselves. However, confidentiality and anonymity were guaranteed for the subjects participating in the project and the institution where the activities took place. The outreach project “Divine Clowns and the art of animating elderly people” started through the expression of interest from a group of students of Medicine in engaging in clown activities (clown’s art) along with hospitalized people. Initially, the proposal was focused on animation for hospitalized children and adults, however, during group meetings, a need for working along with HAs in Divinópolis was found out. Thus, students’ interest in clown activities enabled the construction of this project, something which reinforces the importance of university outreach in academic education, by providing students with the opportunity to freely think and learn the interaction with other services beyond the curriculum, favoring an autonomous learning that consolidates knowledge. The practice of animation poses a challenge and a new working perspective in the Brazilian public and private institutions. In Brazil, such experiences are scattered throughout the territory and they have a huge potential towards humanization. However, RESULTS AND DISCUSSION METHOD INTRODUCTION Gesteira ER, Pessalacia JDR, Kuznier TP et al. Divine clowns and the art of animating... English/Portuguese J Nurs UFPE on line., Recife, 8(Suppl. 3):4159-64, Nov., 2014 4161 ISSN: 1981-8963 DOI: 10.5205/reuol.5353-44734-1-RV.0811supl201416 such experiences are often conducted with the hospitalized population, there are few reports of projects involving animation for institutionalized elderly people. The need for humanizing the relations and care provided for the elderly living in a HA confirms the importance of an activity that aims to bring joy to the elderly, dealing in a playful way with her/his routine and the procedures to which they are exposed. Scholars from a university in Ontario, Canada, highlight that clown interventions along with the elderly population are relatively new, but recent researches have suggested that some elderly people who use humor as a way to deal with the challenges of aging may be more likely to live longer, age well, and be more satisfied with their physical health, enjoying better quality of life. The purpose of this project was inspired by the history of Hunter Adams, a physician who, in the 1960s, proposed a bond between doctor and patient not focused on disease, providing “medical care” in a playful way, through clown characters. The project had the support from the university campus principal’s office, the Dean’s Office for University Outreach, and a theater group responsible for training the group, wh