Luiza Maria Gerhardt

Segurança do paciente na tríade assistência ensino pesquisa

La asistencia segura es el tema central de discusiones en el area de la salud en casi todas las partes del mundo. La Organizacion Mundial de la Salud (OMS) viene lanzando, aisladamente o en conjunto con otras organizaciones, varios desafios y directrices con el intuito de dar subsidios para la discusion de las realidades locales y, especialmente, para que las instituciones de salud tengan un punto de partida para implantar y promover medidas de seguridad imperativas y urgentes. El tema no es nuevo, al contrario, es tan antiguo como el cuidado a la salud. Sin embargo, su importancia y los altos riesgos asociados a la asistencia a la salud empezaron a ser reconocidos a partir de la publicacion, en 1999, del informe del Institute of Medicine de los Estados Unidos, To Err is Huma(1). En Brasil, el Ministerio de la Salud instituyo, en abril de este ano, el Programa Nacional de Seguridad del Paciente, en resonancia con el apelo individual y/o colectivo de los profesionales de la salud y de la poblacion en general por una atencion segura, libre de incidentes que puedan generar danos a la salud de la persona. En la enfermeria, profesionales vinculados a la ensenanza, asistencia, investigacion y estudiantes de grado/postgrado se viene movilizando voluntariamente desde 2008 para crear y desarrollar la Red Brasilena de Enfermeria y Seguridad del Paciente (REBRAENSP). Casi todos los estados del pais tienen polos y nucleos de REBRAENSP, creando espacios valiosos de debates con repercusion para las practicas asistenciales, de ensenanza y de investigacion. Para que el cuidado sea seguro, es necesario construir una cultura de seguridad, definida por el Programa Nacional de Seguridad del Paciente(2) como: cultura en la cual todos los trabajadores, incluyendo profesionales involucrados en el cuidado y gestores, asumen responsabilidad por su propia seguridad, por la seguridad de sus colegas, pacientes y familiares; cultura que prioriza la seguridad por encima de las metas financieras y operacionales; cultura que anima y recompensa la identificacion, la notificacion y la resolucion de los problemas relacionados a la seguridad; cultura que, a partir del acontecimiento de incidentes, promueve el aprendizaje organizacional; y cultura que proporciona recursos, estructura y responsabilizacion para el mantenimiento efectivo de la seguridad. Como se puede ver, los desafios para el desarrollo de la cultura de seguridad del paciente son inmensos, pero no insuperables, y engloban la necesidad de establecimiento de estrategias efectivas en tres ambitos: formacion de profesionales de la salud, asistencia en todos los niveles de atencion a la salud e investigacion. En la ensenanza el tema de la seguridad del paciente debe parar por todo el curriculo y enfocar especificidades de riesgos y medidas preventivas de dano en los variados escenarios de asistencia a la salud. Se lo debe desarrollar por medio de acciones de ensenanza aprendizaje en que el alumno y el educador experimenten practicas significativas, que repercutan en una actuacion segura a lo largo de la formacion y que se sustenten tambien en la actuacion profesional. Para tanto, los educadores necesitan mantener estrategias de educacion permanente/continuada y los proyectos pedagogicos de los cursos de grado/postgrado y tecnicos necesitan alineaciones claras, para que este aspecto no se minimice entre otros tan importantes en la ensenanza en salud.Safe healthcare has been at the core of discussions in the field of health nearly everywhere in the world. On its own or in collaboration with other organizations, the World Health Organization (WHO) has been launching several challenges and guidelines meant to provide inputs for discussions about local circumstances and especially for healthcare institutions to have a starting point to implement and foster imperative, urgent safety measures. The topic is not new. Much to the contrary, it is as old as healthcare itself. However, the importance of healthcare and the high risks associated to it began being acknowledged after the 1999 publication of the US Institute of Medicine report, To Err is Human(1). Last April in Brazil, the Ministry of Health instituted the National Patient Safety Program in response to individual and/or collective entreaties by healthcare professionals and the population at large for safe healthcare free of incidents that may compromise people’s health. In nursing, educators, care providers, researchers and undergraduate and graduate students have been voluntarily rallying since 2008 to create and develop the Brazilian Nursing and Patient Safety Network (REBRAENSP, in Portuguese). Nearly all Brazilian states have REBRAENSP hubs and centers, which create valuable settings for discussions that impact healthcare, teaching and research practices. For healthcare to be safe, it is necessary to build a culture of safety, which the National Patient Safety Program(2) defines as: a culture under which all workers, including healthcare providers and managers, take responsibility for their own safety and that of their coworkers, patients, and family members; a culture that places safety above financial and operating goals; a culture that encourages and rewards people to spot, notify about, and solve safety-related problems; a culture which, after an incident has taken place, fosters education within the organization; and a culture that supplies resources, a framework, and accountability for safety to be effectively upheld. As we can see, the challenges in the way of developing a patient safety culture are massive but not insurmountable, and encompass the need to set effective strategies on three fronts: healthcare professional education, overall healthcare, and research. In education, the topic of patient safety should be included throughout the curriculum and focus on specific risks and measures to prevent harm in the various healthcare scenarios. Patient safety should be addressed by means of teaching-learning actions through which students and educators experience significant practices that lead to safe work in the course of their training and which are sustained into their professional work. To that end, educators need to uphold permanent/continued education strategies, and the teaching projects for undergraduate/graduate and technical programs need clear guidelines so the safety aspect is not minimized among other important ones in healthcare education. When providing healthcare at all levels, one’s eyes must look beyond one’s own professional practice towards the multiple factors that endanger patient safety in the process of care. All actions become more complex within this scope of healthcare and require intense, coordinated efforts for healthcare processes to be feasible starting from their planning. In other words, regulations, procedures, routines, strategic maps, checklists, and others must be actually implemented to advance safety and impact the quality of healthcare. Another extremely relevant aspect requires changing the culture of punishment that penalizes the professionals and fails to look into the context in which a safety incident has occurred. Such outdated model still guides the actions of many managers and institutions, and ends up leading tothe recurrence of safety incidents instead of to their prevention.A assistencia segura tem sido o tema central de discussoes na area da saude em quase todas as partes do mundo. A Organizacao Mundial da Saude (OMS) tem lancado, isoladamente ou em parceria com outras organizacoes, varios desafios e diretrizes com o intuito de fornecer subsidios para a discussao das realidades locais e, especialmente, para que as instituicoes de saude tenham um ponto de partida para implantar e promover medidas de seguranca imperativas e urgentes. O tema nao e novo, ao contrario, e tao antigo quanto o cuidado a saude. No entanto, sua importância e os altos riscos associados a assistencia a saude comecaram a ser reconhecidos a partir da publicacao, em 1999, do relatorio do Institute of Medicine dos Estados Unidos, To Err is Huma(1). No Brasil, o Ministerio da Saude instituiu, em abril deste ano, o Programa Nacional de Seguranca do Paciente, em ressonância com o apelo individual e/ou coletivo dos profissionais da saude e da populacao em geral por uma atencao segura, livre de incidentes que posam gerar danos a saude da pessoa. Na enfermagem, profissionais vinculados ao ensino, assistencia, pesquisa e estudantes de graduacao/pos- -graduacao vem se mobilizando voluntariamente desde 2008 para criar e desenvolver a Rede Brasileira de Enfermagem e Seguranca do Paciente (REBRAENSP). Quase todos os estados do pais tem polos e nucleos da REBRAENSP, criando espacos valiosos de debates com repercussao para as praticas assistenciais, de ensino e de pesquisa. Para que o cuidado seja seguro, e necessario construir uma cultura de seguranca, definida pelo Programa Nacional de Seguranca do Paciente(2) como: cultura na qual todos os trabalhadores, incluindo profissionais envolvidos no cuidado e gestores, assumem responsabilidade pela sua propria seguranca, pela seguranca de seus colegas, pacientes e familiares; cultura que prioriza a seguranca acima de metas financeiras e operacionais; cultura que encoraja e recompensa a identificacao, a notificacao e a resolucao dos problemas relacionados a seguranca; cultura que, a partir da ocorrencia de incidentes, promove o aprendizado organizacional; e cultura que proporciona recursos, estrutura e responsabilizacao para a manutencao efetiva da seguranca. Como se pode ver, os desafios para o desenvolvimento da cultura de seguranca do paciente sao imensos, mas nao intransponiveis, e englobam a necessidade de estabelecimento de estrategias efetivas em tres âmbitos: formacao de profissionais da saude, assistencia em todos os niveis de atencao a saude e pesquisa. No ensino o tema da seguranca do paciente deve perpassar todo o curriculo e enfocar especificidades de riscos e medidas preventivas de dano nos variados cenarios de assistencia a saude. Deve ser desenvolvido por meio de acoes de ensino-aprendizagem em que o aluno e o educador experienciem praticas significativas, que repercutam em uma atuacao segura ao longo da formacao e que se sustentem tambem na atuacao profissional. Para tanto, os educadores precisam manter estrategias de educacao permanente/continuada e os projetos pedagogicos dos cursos de graduacao/pos-graduacao e tecnicos precisam de alinhamentos claros, para que este aspecto nao seja minimizado dentre outros tao importantes no ensino em saude.

The Millennium Development Goals and the social commitment of Nursing research

In 2000, the United Nations (UN) brought together representatives from 191 countries, heads of state and government at the UN Millennium Summit. The discussions outlined eight “Millennium Development Goals” (MDG) to be achieved by 2015. Driven by growing concerns for the planet’s sustainability and the serious problems aff ecting humankind, the international community set goals targeted at priority areas to improve health and education conditions as well as reduce extreme poverty worldwide. The eight Millennium Development Goals are to: 1 – eradicate extreme poverty and hunger; 2 – achieve universal primary education; 3 – promote gender equality and empower women; 4 – reduce child mortality; 5 – improve maternal health; 6 – combat AIDS, malaria and other diseases; 7 – ensure environmental sustainability; and 8 – develop a global partnership for development. The global commitment to the MDGs requires international cooperation and, locally, cooperation between the public and private sectors. These goals should be pursued by means of public policies and discussions and initiatives jointly carried out by people in diff erent occupations, especially healthcare. Hence, the eight goals mutually reinforce and support one another as they represent basic human needs and seek to guarantee fundamental rights. As 2015 begins, it should be noted that Brazil has come a long way in terms of achieving the MDGs. The Brazilian performance is owed to social participation and a host of public social and healthcare policies put in place in the past few years that have had positive impacts on them. There are good indicators. However, many challenges still lay ahead . The country realizes it is important to achieve these goals to foster the Brazilian population’s health and welfare . Pursuing the MDGs along with researchers’ dedication to topics involving worldwide development, whether economic, social or environmental, allow the civil society, the healthcare industry, and the government to work towards improving the quality of life of everyone across the country. There is a need for studies that actually create useful knowledge enabling social players and the government to attain important results for society by providing an updated, integrated view of the populations’ life and health context . This year marks the deadline set by the UN for the MDGs to be achieved, and the international community has been assessing the progress and defi ning a global development agenda for the post-2015 period. The world has changed signifi cantly since the MDGs were ser in 2000, and the new agenda must refl ect such changes in order to have a positive impact. It should be noted that, promisingly, there is broader consensus about several basic aspects such as the core place of people and human rights in development processes, as well as the urgent need to tackle the growing inequality in a wide variety of fi elds . These issues are also pertinent to the work routinely carried out in Nursing, which has been taking on commitments and responsibilities towards the sustainable development of populations worldwide. The International Council of Nurses is a federation of more than 130 national nurses’ associations and has been encouraging its members to have nurses step up their eff orts in pursuit of healthcare-related MDGs. It is indisputable that the participation of nurses, the largest workforce in the fi eld of health, has been essential for these goals to be achieved around the world. The Millennium Development Goals and the social commitment of Nursing research

Os Objetivos de Desenvolvimento do Milênio e o compromisso social das pesquisas de Enfermagem

In 2000, the United Nations (UN) brought together representatives from 191 countries, heads of state and government at the UN Millennium Summit. The discussions outlined eight “Millennium Development Goals” (MDG) to be achieved by 2015. Driven by growing concerns for the planet’s sustainability and the serious problems aff ecting humankind, the international community set goals targeted at priority areas to improve health and education conditions as well as reduce extreme poverty worldwide. The eight Millennium Development Goals are to: 1 – eradicate extreme poverty and hunger; 2 – achieve universal primary education; 3 – promote gender equality and empower women; 4 – reduce child mortality; 5 – improve maternal health; 6 – combat AIDS, malaria and other diseases; 7 – ensure environmental sustainability; and 8 – develop a global partnership for development. The global commitment to the MDGs requires international cooperation and, locally, cooperation between the public and private sectors. These goals should be pursued by means of public policies and discussions and initiatives jointly carried out by people in diff erent occupations, especially healthcare. Hence, the eight goals mutually reinforce and support one another as they represent basic human needs and seek to guarantee fundamental rights. As 2015 begins, it should be noted that Brazil has come a long way in terms of achieving the MDGs. The Brazilian performance is owed to social participation and a host of public social and healthcare policies put in place in the past few years that have had positive impacts on them. There are good indicators. However, many challenges still lay ahead . The country realizes it is important to achieve these goals to foster the Brazilian population’s health and welfare . Pursuing the MDGs along with researchers’ dedication to topics involving worldwide development, whether economic, social or environmental, allow the civil society, the healthcare industry, and the government to work towards improving the quality of life of everyone across the country. There is a need for studies that actually create useful knowledge enabling social players and the government to attain important results for society by providing an updated, integrated view of the populations’ life and health context . This year marks the deadline set by the UN for the MDGs to be achieved, and the international community has been assessing the progress and defi ning a global development agenda for the post-2015 period. The world has changed signifi cantly since the MDGs were ser in 2000, and the new agenda must refl ect such changes in order to have a positive impact. It should be noted that, promisingly, there is broader consensus about several basic aspects such as the core place of people and human rights in development processes, as well as the urgent need to tackle the growing inequality in a wide variety of fi elds . These issues are also pertinent to the work routinely carried out in Nursing, which has been taking on commitments and responsibilities towards the sustainable development of populations worldwide. The International Council of Nurses is a federation of more than 130 national nurses’ associations and has been encouraging its members to have nurses step up their eff orts in pursuit of healthcare-related MDGs. It is indisputable that the participation of nurses, the largest workforce in the fi eld of health, has been essential for these goals to be achieved around the world. The Millennium Development Goals and the social commitment of Nursing research

Patient safety in the healthcare education research triad

La asistencia segura es el tema central de discusiones en el area de la salud en casi todas las partes del mundo. La Organizacion Mundial de la Salud (OMS) viene lanzando, aisladamente o en conjunto con otras organizaciones, varios desafios y directrices con el intuito de dar subsidios para la discusion de las realidades locales y, especialmente, para que las instituciones de salud tengan un punto de partida para implantar y promover medidas de seguridad imperativas y urgentes. El tema no es nuevo, al contrario, es tan antiguo como el cuidado a la salud. Sin embargo, su importancia y los altos riesgos asociados a la asistencia a la salud empezaron a ser reconocidos a partir de la publicacion, en 1999, del informe del Institute of Medicine de los Estados Unidos, To Err is Huma(1). En Brasil, el Ministerio de la Salud instituyo, en abril de este ano, el Programa Nacional de Seguridad del Paciente, en resonancia con el apelo individual y/o colectivo de los profesionales de la salud y de la poblacion en general por una atencion segura, libre de incidentes que puedan generar danos a la salud de la persona. En la enfermeria, profesionales vinculados a la ensenanza, asistencia, investigacion y estudiantes de grado/postgrado se viene movilizando voluntariamente desde 2008 para crear y desarrollar la Red Brasilena de Enfermeria y Seguridad del Paciente (REBRAENSP). Casi todos los estados del pais tienen polos y nucleos de REBRAENSP, creando espacios valiosos de debates con repercusion para las practicas asistenciales, de ensenanza y de investigacion. Para que el cuidado sea seguro, es necesario construir una cultura de seguridad, definida por el Programa Nacional de Seguridad del Paciente(2) como: cultura en la cual todos los trabajadores, incluyendo profesionales involucrados en el cuidado y gestores, asumen responsabilidad por su propia seguridad, por la seguridad de sus colegas, pacientes y familiares; cultura que prioriza la seguridad por encima de las metas financieras y operacionales; cultura que anima y recompensa la identificacion, la notificacion y la resolucion de los problemas relacionados a la seguridad; cultura que, a partir del acontecimiento de incidentes, promueve el aprendizaje organizacional; y cultura que proporciona recursos, estructura y responsabilizacion para el mantenimiento efectivo de la seguridad. Como se puede ver, los desafios para el desarrollo de la cultura de seguridad del paciente son inmensos, pero no insuperables, y engloban la necesidad de establecimiento de estrategias efectivas en tres ambitos: formacion de profesionales de la salud, asistencia en todos los niveles de atencion a la salud e investigacion. En la ensenanza el tema de la seguridad del paciente debe parar por todo el curriculo y enfocar especificidades de riesgos y medidas preventivas de dano en los variados escenarios de asistencia a la salud. Se lo debe desarrollar por medio de acciones de ensenanza aprendizaje en que el alumno y el educador experimenten practicas significativas, que repercutan en una actuacion segura a lo largo de la formacion y que se sustenten tambien en la actuacion profesional. Para tanto, los educadores necesitan mantener estrategias de educacion permanente/continuada y los proyectos pedagogicos de los cursos de grado/postgrado y tecnicos necesitan alineaciones claras, para que este aspecto no se minimice entre otros tan importantes en la ensenanza en salud.Safe healthcare has been at the core of discussions in the field of health nearly everywhere in the world. On its own or in collaboration with other organizations, the World Health Organization (WHO) has been launching several challenges and guidelines meant to provide inputs for discussions about local circumstances and especially for healthcare institutions to have a starting point to implement and foster imperative, urgent safety measures. The topic is not new. Much to the contrary, it is as old as healthcare itself. However, the importance of healthcare and the high risks associated to it began being acknowledged after the 1999 publication of the US Institute of Medicine report, To Err is Human(1). Last April in Brazil, the Ministry of Health instituted the National Patient Safety Program in response to individual and/or collective entreaties by healthcare professionals and the population at large for safe healthcare free of incidents that may compromise people’s health. In nursing, educators, care providers, researchers and undergraduate and graduate students have been voluntarily rallying since 2008 to create and develop the Brazilian Nursing and Patient Safety Network (REBRAENSP, in Portuguese). Nearly all Brazilian states have REBRAENSP hubs and centers, which create valuable settings for discussions that impact healthcare, teaching and research practices. For healthcare to be safe, it is necessary to build a culture of safety, which the National Patient Safety Program(2) defines as: a culture under which all workers, including healthcare providers and managers, take responsibility for their own safety and that of their coworkers, patients, and family members; a culture that places safety above financial and operating goals; a culture that encourages and rewards people to spot, notify about, and solve safety-related problems; a culture which, after an incident has taken place, fosters education within the organization; and a culture that supplies resources, a framework, and accountability for safety to be effectively upheld. As we can see, the challenges in the way of developing a patient safety culture are massive but not insurmountable, and encompass the need to set effective strategies on three fronts: healthcare professional education, overall healthcare, and research. In education, the topic of patient safety should be included throughout the curriculum and focus on specific risks and measures to prevent harm in the various healthcare scenarios. Patient safety should be addressed by means of teaching-learning actions through which students and educators experience significant practices that lead to safe work in the course of their training and which are sustained into their professional work. To that end, educators need to uphold permanent/continued education strategies, and the teaching projects for undergraduate/graduate and technical programs need clear guidelines so the safety aspect is not minimized among other important ones in healthcare education. When providing healthcare at all levels, one’s eyes must look beyond one’s own professional practice towards the multiple factors that endanger patient safety in the process of care. All actions become more complex within this scope of healthcare and require intense, coordinated efforts for healthcare processes to be feasible starting from their planning. In other words, regulations, procedures, routines, strategic maps, checklists, and others must be actually implemented to advance safety and impact the quality of healthcare. Another extremely relevant aspect requires changing the culture of punishment that penalizes the professionals and fails to look into the context in which a safety incident has occurred. Such outdated model still guides the actions of many managers and institutions, and ends up leading tothe recurrence of safety incidents instead of to their prevention.A assistencia segura tem sido o tema central de discussoes na area da saude em quase todas as partes do mundo. A Organizacao Mundial da Saude (OMS) tem lancado, isoladamente ou em parceria com outras organizacoes, varios desafios e diretrizes com o intuito de fornecer subsidios para a discussao das realidades locais e, especialmente, para que as instituicoes de saude tenham um ponto de partida para implantar e promover medidas de seguranca imperativas e urgentes. O tema nao e novo, ao contrario, e tao antigo quanto o cuidado a saude. No entanto, sua importância e os altos riscos associados a assistencia a saude comecaram a ser reconhecidos a partir da publicacao, em 1999, do relatorio do Institute of Medicine dos Estados Unidos, To Err is Huma(1). No Brasil, o Ministerio da Saude instituiu, em abril deste ano, o Programa Nacional de Seguranca do Paciente, em ressonância com o apelo individual e/ou coletivo dos profissionais da saude e da populacao em geral por uma atencao segura, livre de incidentes que posam gerar danos a saude da pessoa. Na enfermagem, profissionais vinculados ao ensino, assistencia, pesquisa e estudantes de graduacao/pos- -graduacao vem se mobilizando voluntariamente desde 2008 para criar e desenvolver a Rede Brasileira de Enfermagem e Seguranca do Paciente (REBRAENSP). Quase todos os estados do pais tem polos e nucleos da REBRAENSP, criando espacos valiosos de debates com repercussao para as praticas assistenciais, de ensino e de pesquisa. Para que o cuidado seja seguro, e necessario construir uma cultura de seguranca, definida pelo Programa Nacional de Seguranca do Paciente(2) como: cultura na qual todos os trabalhadores, incluindo profissionais envolvidos no cuidado e gestores, assumem responsabilidade pela sua propria seguranca, pela seguranca de seus colegas, pacientes e familiares; cultura que prioriza a seguranca acima de metas financeiras e operacionais; cultura que encoraja e recompensa a identificacao, a notificacao e a resolucao dos problemas relacionados a seguranca; cultura que, a partir da ocorrencia de incidentes, promove o aprendizado organizacional; e cultura que proporciona recursos, estrutura e responsabilizacao para a manutencao efetiva da seguranca. Como se pode ver, os desafios para o desenvolvimento da cultura de seguranca do paciente sao imensos, mas nao intransponiveis, e englobam a necessidade de estabelecimento de estrategias efetivas em tres âmbitos: formacao de profissionais da saude, assistencia em todos os niveis de atencao a saude e pesquisa. No ensino o tema da seguranca do paciente deve perpassar todo o curriculo e enfocar especificidades de riscos e medidas preventivas de dano nos variados cenarios de assistencia a saude. Deve ser desenvolvido por meio de acoes de ensino-aprendizagem em que o aluno e o educador experienciem praticas significativas, que repercutam em uma atuacao segura ao longo da formacao e que se sustentem tambem na atuacao profissional. Para tanto, os educadores precisam manter estrategias de educacao permanente/continuada e os projetos pedagogicos dos cursos de graduacao/pos-graduacao e tecnicos precisam de alinhamentos claros, para que este aspecto nao seja minimizado dentre outros tao importantes no ensino em saude.

Percepção de familiares e cuidadores quanto à segurança do paciente em unidades de internação pediátrica

Objetivo: Conhecer a percepcao de familiares e cuidadores quanto a Seguranca do Paciente em unidades de internacao pediatrica. Metodo: Estudo qualitativo exploratorio-descritivo. Foram realizadas entrevistas semiestruturadas com 24 cuidadores, em tres areas de internacao pediatrica de hospital universitario do sul do Brasil, entre junho e agosto de 2016. A analise de conteudo tematica foi realizada com auxilio do QSR NVivo 11.0. Resultados: Foram identificados nove temas, agrupados em duas categorias: “Pressupostos de seguranca do paciente”, descrevendo conhecimentos que os cuidadores relacionaram a seguranca do paciente e a necessidade de inclusao e parceria da familia; e “Protocolos de seguranca do paciente implementados na instituicao”, destacando falas coerentes com protocolos ja estabelecidos no hospital que promovem seguranca. Conclusoes: As percepcoes dos cuidadores referentes a seguranca do paciente em unidades de internacao pediatrica demonstram que estes absorvem orientacoes que favorecem o cuidado seguro, embora nao tenham um conhecimento formal a respeito do assunto. Palavras-chave: Seguranca do paciente. Cuidadores. Familia. Crianca hospitalizada.

Association between nutritional status, exclusive breastfeeding and length of hospital stay of children

OBJECTIVE To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearsons and Spearmans correlation coefficients were used for data analysis. RESULTS The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.

Asociación entre estado nutricional, la lactancia materna exclusiva y el tiempo de hospitalización de los niños

OBJECTIVE To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearsons and Spearmans correlation coefficients were used for data analysis. RESULTS The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.

Associação entre estado nutricional, aleitamento materno exclusivo e tempo de internação hospitalar de crianças

OBJECTIVE To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearsons and Spearmans correlation coefficients were used for data analysis. RESULTS The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.

Los Objetivos de Desarrollo del Milenio y el compromiso social de las investigaciones de Enfermería

In 2000, the United Nations (UN) brought together representatives from 191 countries, heads of state and government at the UN Millennium Summit. The discussions outlined eight “Millennium Development Goals” (MDG) to be achieved by 2015. Driven by growing concerns for the planet’s sustainability and the serious problems aff ecting humankind, the international community set goals targeted at priority areas to improve health and education conditions as well as reduce extreme poverty worldwide. The eight Millennium Development Goals are to: 1 – eradicate extreme poverty and hunger; 2 – achieve universal primary education; 3 – promote gender equality and empower women; 4 – reduce child mortality; 5 – improve maternal health; 6 – combat AIDS, malaria and other diseases; 7 – ensure environmental sustainability; and 8 – develop a global partnership for development. The global commitment to the MDGs requires international cooperation and, locally, cooperation between the public and private sectors. These goals should be pursued by means of public policies and discussions and initiatives jointly carried out by people in diff erent occupations, especially healthcare. Hence, the eight goals mutually reinforce and support one another as they represent basic human needs and seek to guarantee fundamental rights. As 2015 begins, it should be noted that Brazil has come a long way in terms of achieving the MDGs. The Brazilian performance is owed to social participation and a host of public social and healthcare policies put in place in the past few years that have had positive impacts on them. There are good indicators. However, many challenges still lay ahead . The country realizes it is important to achieve these goals to foster the Brazilian population’s health and welfare . Pursuing the MDGs along with researchers’ dedication to topics involving worldwide development, whether economic, social or environmental, allow the civil society, the healthcare industry, and the government to work towards improving the quality of life of everyone across the country. There is a need for studies that actually create useful knowledge enabling social players and the government to attain important results for society by providing an updated, integrated view of the populations’ life and health context . This year marks the deadline set by the UN for the MDGs to be achieved, and the international community has been assessing the progress and defi ning a global development agenda for the post-2015 period. The world has changed signifi cantly since the MDGs were ser in 2000, and the new agenda must refl ect such changes in order to have a positive impact. It should be noted that, promisingly, there is broader consensus about several basic aspects such as the core place of people and human rights in development processes, as well as the urgent need to tackle the growing inequality in a wide variety of fi elds . These issues are also pertinent to the work routinely carried out in Nursing, which has been taking on commitments and responsibilities towards the sustainable development of populations worldwide. The International Council of Nurses is a federation of more than 130 national nurses’ associations and has been encouraging its members to have nurses step up their eff orts in pursuit of healthcare-related MDGs. It is indisputable that the participation of nurses, the largest workforce in the fi eld of health, has been essential for these goals to be achieved around the world. The Millennium Development Goals and the social commitment of Nursing research

SEGURIDAD DEL PACIENTE EN LA TRÍADE ASISTENCIA ENSEÑANZA INVESTIGACIÓN

La asistencia segura es el tema central de discusiones en el area de la salud en casi todas las partes del mundo. La Organizacion Mundial de la Salud (OMS) viene lanzando, aisladamente o en conjunto con otras organizaciones, varios desafios y directrices con el intuito de dar subsidios para la discusion de las realidades locales y, especialmente, para que las instituciones de salud tengan un punto de partida para implantar y promover medidas de seguridad imperativas y urgentes. El tema no es nuevo, al contrario, es tan antiguo como el cuidado a la salud. Sin embargo, su importancia y los altos riesgos asociados a la asistencia a la salud empezaron a ser reconocidos a partir de la publicacion, en 1999, del informe del Institute of Medicine de los Estados Unidos, To Err is Huma(1). En Brasil, el Ministerio de la Salud instituyo, en abril de este ano, el Programa Nacional de Seguridad del Paciente, en resonancia con el apelo individual y/o colectivo de los profesionales de la salud y de la poblacion en general por una atencion segura, libre de incidentes que puedan generar danos a la salud de la persona. En la enfermeria, profesionales vinculados a la ensenanza, asistencia, investigacion y estudiantes de grado/postgrado se viene movilizando voluntariamente desde 2008 para crear y desarrollar la Red Brasilena de Enfermeria y Seguridad del Paciente (REBRAENSP). Casi todos los estados del pais tienen polos y nucleos de REBRAENSP, creando espacios valiosos de debates con repercusion para las practicas asistenciales, de ensenanza y de investigacion. Para que el cuidado sea seguro, es necesario construir una cultura de seguridad, definida por el Programa Nacional de Seguridad del Paciente(2) como: cultura en la cual todos los trabajadores, incluyendo profesionales involucrados en el cuidado y gestores, asumen responsabilidad por su propia seguridad, por la seguridad de sus colegas, pacientes y familiares; cultura que prioriza la seguridad por encima de las metas financieras y operacionales; cultura que anima y recompensa la identificacion, la notificacion y la resolucion de los problemas relacionados a la seguridad; cultura que, a partir del acontecimiento de incidentes, promueve el aprendizaje organizacional; y cultura que proporciona recursos, estructura y responsabilizacion para el mantenimiento efectivo de la seguridad. Como se puede ver, los desafios para el desarrollo de la cultura de seguridad del paciente son inmensos, pero no insuperables, y engloban la necesidad de establecimiento de estrategias efectivas en tres ambitos: formacion de profesionales de la salud, asistencia en todos los niveles de atencion a la salud e investigacion. En la ensenanza el tema de la seguridad del paciente debe parar por todo el curriculo y enfocar especificidades de riesgos y medidas preventivas de dano en los variados escenarios de asistencia a la salud. Se lo debe desarrollar por medio de acciones de ensenanza aprendizaje en que el alumno y el educador experimenten practicas significativas, que repercutan en una actuacion segura a lo largo de la formacion y que se sustenten tambien en la actuacion profesional. Para tanto, los educadores necesitan mantener estrategias de educacion permanente/continuada y los proyectos pedagogicos de los cursos de grado/postgrado y tecnicos necesitan alineaciones claras, para que este aspecto no se minimice entre otros tan importantes en la ensenanza en salud.Safe healthcare has been at the core of discussions in the field of health nearly everywhere in the world. On its own or in collaboration with other organizations, the World Health Organization (WHO) has been launching several challenges and guidelines meant to provide inputs for discussions about local circumstances and especially for healthcare institutions to have a starting point to implement and foster imperative, urgent safety measures. The topic is not new. Much to the contrary, it is as old as healthcare itself. However, the importance of healthcare and the high risks associated to it began being acknowledged after the 1999 publication of the US Institute of Medicine report, To Err is Human(1). Last April in Brazil, the Ministry of Health instituted the National Patient Safety Program in response to individual and/or collective entreaties by healthcare professionals and the population at large for safe healthcare free of incidents that may compromise people’s health. In nursing, educators, care providers, researchers and undergraduate and graduate students have been voluntarily rallying since 2008 to create and develop the Brazilian Nursing and Patient Safety Network (REBRAENSP, in Portuguese). Nearly all Brazilian states have REBRAENSP hubs and centers, which create valuable settings for discussions that impact healthcare, teaching and research practices. For healthcare to be safe, it is necessary to build a culture of safety, which the National Patient Safety Program(2) defines as: a culture under which all workers, including healthcare providers and managers, take responsibility for their own safety and that of their coworkers, patients, and family members; a culture that places safety above financial and operating goals; a culture that encourages and rewards people to spot, notify about, and solve safety-related problems; a culture which, after an incident has taken place, fosters education within the organization; and a culture that supplies resources, a framework, and accountability for safety to be effectively upheld. As we can see, the challenges in the way of developing a patient safety culture are massive but not insurmountable, and encompass the need to set effective strategies on three fronts: healthcare professional education, overall healthcare, and research. In education, the topic of patient safety should be included throughout the curriculum and focus on specific risks and measures to prevent harm in the various healthcare scenarios. Patient safety should be addressed by means of teaching-learning actions through which students and educators experience significant practices that lead to safe work in the course of their training and which are sustained into their professional work. To that end, educators need to uphold permanent/continued education strategies, and the teaching projects for undergraduate/graduate and technical programs need clear guidelines so the safety aspect is not minimized among other important ones in healthcare education. When providing healthcare at all levels, one’s eyes must look beyond one’s own professional practice towards the multiple factors that endanger patient safety in the process of care. All actions become more complex within this scope of healthcare and require intense, coordinated efforts for healthcare processes to be feasible starting from their planning. In other words, regulations, procedures, routines, strategic maps, checklists, and others must be actually implemented to advance safety and impact the quality of healthcare. Another extremely relevant aspect requires changing the culture of punishment that penalizes the professionals and fails to look into the context in which a safety incident has occurred. Such outdated model still guides the actions of many managers and institutions, and ends up leading tothe recurrence of safety incidents instead of to their prevention.A assistencia segura tem sido o tema central de discussoes na area da saude em quase todas as partes do mundo. A Organizacao Mundial da Saude (OMS) tem lancado, isoladamente ou em parceria com outras organizacoes, varios desafios e diretrizes com o intuito de fornecer subsidios para a discussao das realidades locais e, especialmente, para que as instituicoes de saude tenham um ponto de partida para implantar e promover medidas de seguranca imperativas e urgentes. O tema nao e novo, ao contrario, e tao antigo quanto o cuidado a saude. No entanto, sua importância e os altos riscos associados a assistencia a saude comecaram a ser reconhecidos a partir da publicacao, em 1999, do relatorio do Institute of Medicine dos Estados Unidos, To Err is Huma(1). No Brasil, o Ministerio da Saude instituiu, em abril deste ano, o Programa Nacional de Seguranca do Paciente, em ressonância com o apelo individual e/ou coletivo dos profissionais da saude e da populacao em geral por uma atencao segura, livre de incidentes que posam gerar danos a saude da pessoa. Na enfermagem, profissionais vinculados ao ensino, assistencia, pesquisa e estudantes de graduacao/pos- -graduacao vem se mobilizando voluntariamente desde 2008 para criar e desenvolver a Rede Brasileira de Enfermagem e Seguranca do Paciente (REBRAENSP). Quase todos os estados do pais tem polos e nucleos da REBRAENSP, criando espacos valiosos de debates com repercussao para as praticas assistenciais, de ensino e de pesquisa. Para que o cuidado seja seguro, e necessario construir uma cultura de seguranca, definida pelo Programa Nacional de Seguranca do Paciente(2) como: cultura na qual todos os trabalhadores, incluindo profissionais envolvidos no cuidado e gestores, assumem responsabilidade pela sua propria seguranca, pela seguranca de seus colegas, pacientes e familiares; cultura que prioriza a seguranca acima de metas financeiras e operacionais; cultura que encoraja e recompensa a identificacao, a notificacao e a resolucao dos problemas relacionados a seguranca; cultura que, a partir da ocorrencia de incidentes, promove o aprendizado organizacional; e cultura que proporciona recursos, estrutura e responsabilizacao para a manutencao efetiva da seguranca. Como se pode ver, os desafios para o desenvolvimento da cultura de seguranca do paciente sao imensos, mas nao intransponiveis, e englobam a necessidade de estabelecimento de estrategias efetivas em tres âmbitos: formacao de profissionais da saude, assistencia em todos os niveis de atencao a saude e pesquisa. No ensino o tema da seguranca do paciente deve perpassar todo o curriculo e enfocar especificidades de riscos e medidas preventivas de dano nos variados cenarios de assistencia a saude. Deve ser desenvolvido por meio de acoes de ensino-aprendizagem em que o aluno e o educador experienciem praticas significativas, que repercutam em uma atuacao segura ao longo da formacao e que se sustentem tambem na atuacao profissional. Para tanto, os educadores precisam manter estrategias de educacao permanente/continuada e os projetos pedagogicos dos cursos de graduacao/pos-graduacao e tecnicos precisam de alinhamentos claros, para que este aspecto nao seja minimizado dentre outros tao importantes no ensino em saude.