Mara Ambrosina de Oliveira Vargas

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

Objective: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. Methods: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). Results: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. Conclusions: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.

Responsabilidade no cuidar: do tempo que nos toca viver como enfermeiros/as intensivistas

Investigacao qualitativa, balizada na analitica foucaultiana, com enfase na nocao de governabilidade, constituiu como objetivos: analisar a articulacao da tecnobiomedicina e bioetica, como discursos da contemporaneidade implicados na producao da subjetividade do/a enfermeiro/a no contexto da Unidade de Terapia Intensiva (UTI); e abordar a responsabilidade no cuidar como um dos desdobramentos estrategicos e tecnologicos de diferentes discursos, gerando determinados modos de conceber e intervir do sujeito enfermeiro/a na UTI. Nessa perspectiva, dos multiplos vieses que poderiam emergir ao se fazer uma leitura critica dos textos analisados e das entrevistas com os/as enfermeiros/as, a tematica da responsabilidade do cuidar foi desdobrada em categorias que expressaram a responsabilidade diante das novas linguagens e da enfermagem como guardia de certos atributos da UTI.

Crença religiosa e doação de órgãos e tecidos: revisão integrativa da literatura

This study aims to analyzing whether religion interfere in the decision for donors and/or their family to consent to both organ donation and the process of organ collection and transplantation. This integrating literature review has been carried out through searches in SciELO, MEDLINE and LILACS databases, from 1995 to 2010, using the following words: organ donation, organ transplantation, ethics, religion, and religious belief. Nineteen papers have been selected. We have concluded that spiritual beliefs have influence on decision-making. No religion has been completely contrary to donation, but the belief of death being related to heart failure, and the rituals associated with the dead body hinder the possibilities of adhering to donation and, ultimately, to transplantation

Iatrogenesis in Intensive Care Units: dramatization of Contemporary Bio/Ethical Problems

This qualitative investigation, based in Foucauldian analysis with approximations to the post-structuralism theoretical framework, explores iatrogenesis as one of the tensions in the nursing to do/to know which can be discursively articulated to bioethics and to technobiomedicine. The documentary sources and intensive interviews with nurses, permitted the activation of a reflection on the act of the nurse in a context permeated by the ever-present possibility of failure in both the procedure and in the conduct and, from this possibility, they should meet their obligation to correct this failure not so much or not only in knowledge, not so much or not only in law but in practice itself.Esta e uma investigacao qualitativa, balizada na analitica foucaultiana com aproximacoes ao referencial teorico pos-estruturalista, explora as iatrogenias como uma das tensoes no fazer/saber enfermagem que podem ser discursivamente articuladas a bioetica e a tecnobiomedicina. As fontes documentais e de entrevistas com enfermeiros(as) intensivistas permitiram ativar reflexao sobre o agir do(a) enfermeiro(a) em contexto permeado pela possibilidade, sempre latente, de falhar tanto no procedimento como na conduta, e, a partir dessa possibilidade, ele(a) encontra sua obrigacao de corrigir essa falha nao tanto ou nao apenas no conhecimento, nao tanto ou nao apenas na lei, mas na pratica de si mesmo.

Iatrogenias nas unidades de terapia intensiva: dramaticidade dos problemas bio/éticos contemporâneos

This qualitative investigation, based in Foucauldian analysis with approximations to the post-structuralism theoretical framework, explores iatrogenesis as one of the tensions in the nursing to do/to know which can be discursively articulated to bioethics and to technobiomedicine. The documentary sources and intensive interviews with nurses, permitted the activation of a reflection on the act of the nurse in a context permeated by the ever-present possibility of failure in both the procedure and in the conduct and, from this possibility, they should meet their obligation to correct this failure not so much or not only in knowledge, not so much or not only in law but in practice itself.Esta e uma investigacao qualitativa, balizada na analitica foucaultiana com aproximacoes ao referencial teorico pos-estruturalista, explora as iatrogenias como uma das tensoes no fazer/saber enfermagem que podem ser discursivamente articuladas a bioetica e a tecnobiomedicina. As fontes documentais e de entrevistas com enfermeiros(as) intensivistas permitiram ativar reflexao sobre o agir do(a) enfermeiro(a) em contexto permeado pela possibilidade, sempre latente, de falhar tanto no procedimento como na conduta, e, a partir dessa possibilidade, ele(a) encontra sua obrigacao de corrigir essa falha nao tanto ou nao apenas no conhecimento, nao tanto ou nao apenas na lei, mas na pratica de si mesmo.

A closer look at women who underwent colostomy surgery: a qualitative exploratory-descriptive study

A qualitative exploratory-descriptive study on adult women who had undergone intestinal colostomy surgery at least 2 years before was carried out. The research aimed at looking closer at how these women lived with their condition. The research field was a recognized ambulatory service for colostomy surgery patients in a Public Health Institution in the city of Porto Alegre, Southern Brazil. The group studied was made up of adult women with intestinal ostomy, who had been to the above mentioned institution in the period of January and February 2004 in order to get their devices (colostomy pouch, irrigation system and colostomy plug). The following inclusion criteria were adopted in the study: to be 20 years old or up, to be a female and to have intestinal ostomy. Twelve women, who ranged from 34 to 79 years old, were interviewed. Concerning education, one was illiterate, two had unfinished elementary school, four had completed elementary school, another had unfinished high school, two others had completed high school, and two of them had a college degree. Concerning their occupation, six of them were retired, five were homemakers, and one was both a plastic artist and writer. Thematic analysis was used, including the following categories: lack of knowledge about the surgery, everyday difficulties, sexuality and their own body image, concern with their families, intestinal ostomy as an alternative to stay alive, and hope to stay alive as a means of overcoming difficulties. This kind of study is expected to contribute for the nurse’s planning to look after colostomy surgery female patients, both during the pre-operative care and in the ambulatory and home care, especially to help them overcome difficulties. Key words: Ostomy. Colostomy. Intestinal neoplasias. Women’s Health. Nursing care.

A textualização de corpos doentes através de imagens: uma das lições da UTI contemporânea

This paper belongs to a dissertation in which, what we have call “nursing worker cyborgizing” in intensive therapy is discussed. In order to carry out this discussion we based our work on cultural theorizing, as well as on Donna Haraway understanding of cyborg. For the corpses analysis manuals and assistance protocols were used. The methodological approach used in this work is the cultural analysis, as it has been used in the Poststructuralist Cultural Studies, in order to describe and analyze the production of images of sick bodies and its decoding process through a complex monitoring system in which sick bodies, machines and nursing practitioners, connect in different ways and effects. We have concluded that it is useful and relevant to consider and discuss these instances of production and diffusion of meanings attributed to the body, life, and the Nursing care. Descriptors: Cultural studies and education; body/machine; Intensive Therapy in Nursing; technologies in nursing. Title: Sick bodies textualized through images: what contemporary intensive therapy unit can teach us

Las iatrogenias en las unidades de terapia intensiva: lo dramático de los problemas bioéticos contemporáneos

This qualitative investigation, based in Foucauldian analysis with approximations to the post-structuralism theoretical framework, explores iatrogenesis as one of the tensions in the nursing to do/to know which can be discursively articulated to bioethics and to technobiomedicine. The documentary sources and intensive interviews with nurses, permitted the activation of a reflection on the act of the nurse in a context permeated by the ever-present possibility of failure in both the procedure and in the conduct and, from this possibility, they should meet their obligation to correct this failure not so much or not only in knowledge, not so much or not only in law but in practice itself.Esta e uma investigacao qualitativa, balizada na analitica foucaultiana com aproximacoes ao referencial teorico pos-estruturalista, explora as iatrogenias como uma das tensoes no fazer/saber enfermagem que podem ser discursivamente articuladas a bioetica e a tecnobiomedicina. As fontes documentais e de entrevistas com enfermeiros(as) intensivistas permitiram ativar reflexao sobre o agir do(a) enfermeiro(a) em contexto permeado pela possibilidade, sempre latente, de falhar tanto no procedimento como na conduta, e, a partir dessa possibilidade, ele(a) encontra sua obrigacao de corrigir essa falha nao tanto ou nao apenas no conhecimento, nao tanto ou nao apenas na lei, mas na pratica de si mesmo.

Sick bodies textualized through images: what contemporary intensive therapy unit can teach us

This paper belongs to a dissertation in which, what we have call “nursing worker cyborgizing” in intensive therapy is discussed. In order to carry out this discussion we based our work on cultural theorizing, as well as on Donna Haraway understanding of cyborg. For the corpses analysis manuals and assistance protocols were used. The methodological approach used in this work is the cultural analysis, as it has been used in the Poststructuralist Cultural Studies, in order to describe and analyze the production of images of sick bodies and its decoding process through a complex monitoring system in which sick bodies, machines and nursing practitioners, connect in different ways and effects. We have concluded that it is useful and relevant to consider and discuss these instances of production and diffusion of meanings attributed to the body, life, and the Nursing care. Descriptors: Cultural studies and education; body/machine; Intensive Therapy in Nursing; technologies in nursing. Title: Sick bodies textualized through images: what contemporary intensive therapy unit can teach us

SERVIÇO DE TRANSPLANTE HEPÁTICO EM UM HOSPITAL UNIVERSITÁRIO: OLHAR DA BIOÉTICA SOCIAL

Objetivo: analisar os aspectos bioeticos intrinsecos de um servico especializado no atendimento em transplante hepatico em um hospital universitario da regiao Sul do Brasil. Metodo: pesquisa qualitativa exploratoria, analitica, com coleta de dados realizada por entrevista semiestruturada com profissionais da equipe multiprofissional. A analise de dados deu-se por analise tematica. Resultados: constatado que o paciente inserido no servico de transplante hepatico recebe atendimento diferenciado quando comparado aos demais pacientes atendidos na instituicao. Conclusoes: os atendimentos embasados na consolidada politica publica dos transplantes de orgaos e os atrativos repasses financeiros aos procedimentos disparam a qualidade da assistencia, em comparacao aos atendimentos alicercados em outras referencias de remuneracao. Descritores: Liver Transplantation. Bioethics; Public Health Practice LIVER TRANSPLANT SERVICE AT A UNIVERSITY HOSPITAL: LOOK SOCIAL BIOET HICS Objective: to analyze the intrinsic bioethical aspects of a service specializing in care in liver transplant at a university hospital in southern Brazil. Method: qualitative research, analytical, with data collection performed by semi-structured interviews with professionals of the multidisciplinary team. Data analysis occurred by thematic analysis. Results: Found that the patient entered in the liver transplant service receives differentiated service compared to the other patients treated at the institution. Conclusions: the care grounded in the consolidated public policy of organ transplants and attractive financial transfers to the procedures, trigger the quality of care compared to grounded calls in other compensation references. Descriptors: HIV; Women’s rights; Breastfeeding; Full assistance to women’s health. SERVICIO DE TRASPLANTE DE HIGADO EN UN HOSPITAL UNIVERSITARIO: MIRAR BIO ETICA SOCIALES Objetivo: analizar los aspectos bioeticos intrinsecas de un servicio especializado en el cuidado de trasplante de higado en un hospital universitario en el sur de Brasil. Metodo: investigacion cualitativa, analitica, con la recogida de datos se realiza por medio de entrevistas semiestructuradas con los profesionales del equipo multidisciplinario. El analisis de datos se produjo mediante el analisis tematico. Resultados: encontrado que el paciente ingreso en el servicio de trasplante de higado recibe servicio diferenciado en comparacion con el resto de los pacientes tratados en la institucion. Conclusiones: la atencion basada en la politica publica consolidada de los trasplantes de organos y transferencias financieras atractivas a los procedimientos, desencadenar la calidad de la atencion en comparacion con las llamadas a tierra en otras referencias de compensacion. Descriptores: Trasplante de Higado; Bioetica; Politicas Publicas de Salud.