Maria Gaby Rivero de Gutiérrez

Construção do conhecimento e do fazer enfermagem e os modelos assistenciais

Artigo de reflexao que enfoca as origens e as principais caracteris-ticas dos modelos clinico e epide-miologico, seus nexos com os mo-delos assistenciais vigentes no sis-]tema de saude brasileiro, e a cons-trucao do conhecimento da enfer-magem nesse contexto. Nessa perspectiva, as autoras propoem um repensar acerca do saber/fazer da enfermagem, apontando possibilidades de expansao do seu campo de atuacao, bem como dos limites e desafios a serem venci-dos pelos profissionais da area.This is a reflective paper focused on the origins and main characteristics of the epidemiological and clinical models, their connections with the health care models currently adopted in Brazil, and the construction of Nursing knowledge in this context. From this perspective, the authors propose a re-thinking of Nursing knowledge and practice, pointing out possibilities for expanding the Nursing field, as well as the boundaries and challenges to be overcome by the area professionals.

Nursing Interventions in the Clinical Practice of an Intensive Care Unit

Este e estudo descritivo, transversal, realizado em um hospital universitario com os objetivos de descrever as intervencoes de enfermagem mais utilizadas na pratica clinica de uma unidade de terapia intensiva, com base nas prescricoes de enfermagem, e analisar a sua similaridade com a Nursing Interventions Classification (NIC). A amostra constou de 991 internacoes de pacientes. Os dados foram coletados, retrospectivamente, em base informatizada, e analisados pela estatistica descritiva e mapeamento cruzado. Identificaram-se 57 diferentes intervencoes/NIC, frequentemente utilizadas na unidade, sendo a maioria no dominio fisiologico complexo (42%) e fisiologico basico (37%), nas classes de controle respiratorio e facilitacao do autocuidado. Em 97,2% dos casos houve similaridade entre as prescricoes de enfermagem da unidade e as intervencoes/NIC. Conclui-se que as intervencoes/NIC, utilizadas na pratica clinica da unidade de terapia intensiva, refletem o nivel de complexidade do cuidado de enfermagem nessa unidade, destinando-se, principalmente, a regulacao do funcionamento fisico e homeostatico do organismo.

Pós-graduação Stricto Sensu em Enfermagem no Brasil: avanços e perspectivas

La Enfermeria es un campo especifico de conocimiento y practica social que se consolida y fortalece como ciencia. En Brasil, se ha desarrollado debido al aumento y cualificacion de los programas de postgrado stricto sensu. Este estudio tiene como objetivo presentar una revision historica del Postgrado Stricto Sensu en Enfermeria en Brasil y reflexionar sobre su evolucion, progresos, desafios y perspectivas futuras. Se explora la creacion de cursos de postgrado stricto sensu, destacando el movimiento para construirse una cultura de posgrado academico y profesional en Enfermeria. Se presenta la trayectoria historica de su consolidacion, expansion, conquista de la excelencia y visibilidad internacional a lo largo de cuatro decadas, y se senalan los desafios y perspectivas futuras. Se constato que el postgrado en la area ha contribuido para el avance y consolidacion del conocimiento cientifico, tecnologico y de innovacion en Enfermeria y salud, y teniendo como filosofia el respecto a la diversidad y el libre debate de ideas, el aumento de la calidad de vida y salud y la efectuacion del ejercicio de la ciudadania.Nursing is a specific field of knowledge and social practice that has been consolidated and strengthened as science. In Brazil, it has been developed due to the increase and qualification of strict sense post-graduate programs. This study aims to present a historical review of the strict sense post-graduate nursing courses in Brazil and to reflect on their evolution, progress, challenges and future perspectives. It explores the creation of strict sense post-graduate courses, highlighting the movement to build a culture of academic and professional post-graduation in nursing. The historical path of their consolidation, expansion, conquest of excellence and international visibility over four decades, and the challenges and future perspectives are showed. It is found that the post-graduate programs in the field has contributed to the advancement and consolidation of scientific, technological knowledge and innovation in nursing and health care, having as philosophy the respect for diversity and the free exchange of ideas, the improvement of quality of life and health, and the effectiveness of citizenship.

Os múltiplos problemas pesquisados e a pesquisar na enfermagem

The present study aims at analyzing topics of masters thesis and doctoral dissertations submitted to nursing graduate programs in Brazil from 1998 to 2000. The sample comprised abstracts of 337 thesis and 153 dissertations that were analyzed based on scheme category proposed by Carvalho (2000) to group nursing graduate scientific production. Results evidenced that research carried out addressed a great range of themes, comprehending all research lines of the three areas of the referred scheme. The Assistance and Organizational fields concentrated most of the production (45.0% and 38.8% respectively) and the Professional field relied on 16.2% of the studies. Based on the results, authors emphasize the need to bind together thematic-affinity projects in order to deepen studies and to move forward in the process of nursing knowledge construction.The present study aims at analyzing topics of masters thesis and doctoral dissertations submitted to nursing graduate programs in Brazil from 1998 to 2000. The sample comprised abstracts of 337 thesis and 153 dissertations that were analyzed based on scheme category proposed by Carvalho (2000) to group nursing graduate scientific production. Results evidenced that research carried out addressed a great range of themes, comprehending all research lines of the three areas of the referred scheme. The Assistance and Organizational fields concentrated most of the production (45.0% and 38.8% respectively) and the Professional field relied on 16.2% of the studies. Based on the results, authors emphasize the need to bind together thematic-affinity projects in order to deepen studies and to move forward in the process of nursing knowledge construction.

Metodologia da pesquisa para enfermeiras de um hospital universitário

This article discusses a descriptive-analytic study on research methodology education practices directed at nurse clinicians who work at a university hospital and aimed at acquiring scientific research competencies on the basis of discovery learning, tutorials and humanistic teaching strategies. Study participants were eighty-six nurses, 70 of whom concluded their projects. 28 of these resulted in scientific studies, most of which were experience reports, descriptive and exploratory investigations. According to the nurses, the program allowed them to acquire and apply their research know-how. They pointed out the lack of mastering scientific methodology and the limitations of administrative and work conditions at the institution as the main difficulties. Among the facilitators, they highlighted the importance of research to modify clinical practice, the publication of results and the collaboration for the maintenance of a research center. The study showed the need for a flexible planning of educational activities, permanent guidance and respect for the particularities of each nurse.Este artigo trata de pesquisa descritivo-analitica sobre praticas educativas em metodologia de pesquisa dirigidas a enfermeiras assistenciais de um hospital universitario, visando a aquisicao de competencias em investigacao cientifica, tendo como base a aprendizagem por descoberta, tutoramento e estrategias do ensino humanista. Participaram do programa 86 enfermeiras, das quais 70 concluiram seus projetos. Desses, 28 resultaram em trabalhos cientificos, em sua maioria relatos de experiencia, pesquisas descritivas e exploratorias. Segundo as enfermeiras, o programa proporcionou-lhes a aquisicao e aplicacao de conhecimentos em pesquisa. Apontaram, como principais dificuldades, a falta de dominio da metodologia cientifica e as limitacoes nas condicoes administrativas e de trabalho na instituicao. Entre os aspectos facilitadores destacaram a importância da pesquisa para modificacao da pratica, a divulgacao dos resultados e a colaboracao para manutencao de um centro de pesquisas. O estudo revelou a necessidade de flexibilizacao do planejamento das atividades educativas, orientacao continua e respeito as particularidades de cada enfermeira.

Intervenções de enfermagem para o diagnóstico de enfermagem Desobstrução ineficaz de vias aéreas

Este estudo teve como objetivos identificar as acoes de enfermagem prescritas pelas enfermeiras do Instituto Dante Pazzanese de Cardiologia (IDPC) para pacientes com o diagnostico de enfermagem Desobstrucao Ineficaz de Vias Aereas e compara-las com as contidas na Classificacao das Intervencoes de Enfermagem (NIC), visando ao aprimoramento da prescricao de enfermagem para este diagnostico. Trata-se de um estudo retrospectivo, cuja fonte de dados foram 435 prontuarios de pacientes internados no periodo de julho a dezembro de 2000, analisados apos aprovacao do Comite de Etica em Pesquisa do IDPC. As acoes de enfermagem prescritas pelas enfermeiras foram: fazer inalacao, estimular deambulacao, sentar paciente em poltrona, estimular a tosse, estimular a ingestao hidrica, aspirar a cânula endotraqueal, observar padrao respiratorio, a saturacao de oxigenio, a presenca de cianose de extremidades e fazer ausculta pulmonar. Foram identificadas algumas convergencias com a NIC, tais como: facilitar a remocao de secrecao por meio de hidratacao, mobilizacao do paciente, estimulo da tosse, aspiracao de secrecao e controle/monitorizacao da condicao respiratoria. Considera-se que as acoes prescritas pelas enfermeiras sao pertinentes, porem faltam-lhes detalhamento para melhor direcionar sua execucao.

Pressure ulcers in surgery patients: incidence and associated factors

Pressure ulcers are an important perioperatory care quality indicator This is a longitudinal case series study, performed with the following objectives: to estimate the incidence of pressure ulcers in patients submitted to medium and large surgeries; rate them according to the stage and location; verify the association with the variables: gender, age, body mass index (BMI), co-morbidities, surgical position, duration of surgery, anesthesia type and use of positioning devices, with presence or absence of pressure ulcers. Data collection took place in 2007 in São Paulo, with 199 patients, 20.6% of which presented pressure ulcers, and most (98.6%) in stages I and II, and the main location was the trunk (35.1%). The variables: position, surgery time, general anesthesia, and device use had a statistically significant association. In conclusion, there is a high incidence of pressure ulcers among surgical patients, requiring actions aimed at reducing this type of injury.As ulceras por pressao constituem um dos principais indicadores da qualidade do cuidado na assistencia perioperatoria. Este e um estudo longitudinal, do tipo serie de casos, com o objetivo de estimar a incidencia de ulceras por pressao em pacientes submetidos a cirurgias de medio e grande portes; classifica-las segundo estagio e localizacao, verificar a associacao das variaveis sexo, idade, indice de massa corporea, comorbidades, posicao cirurgica, tempo cirurgico, anestesia e uso de dispositivos de posicionamento com a presenca ou ausencia de ulceras por pressao. Os dados foram coletados em 2007, em Sao Paulo, com 199 pacientes, dos quais 20,6% apresentaram ulceras por pressao, 98,6% nos estagios I e II, com localizacao predominante no tronco frontal (35,1%). As variaveis: posicao, tempo cirurgico, anestesia geral e uso de dispositivos apresentaram associacao estatistica significativa. Concluiu-se que a incidencia de ulceras por pressao em pacientes cirurgicos e elevada, demandando acoes que visem a reducao desse tipo de lesao.

Ambiente virtual de aprendizagem na educação continuada em enfermagem

This study is a report of a learning experience that had as objective to describe how was structured the virtual learning environment Moodle for training at work. This is a semi-distance education project for controlling a surgical site infection, oriented to the nurses of a university hospital. The study was organized having as a base the interactionist Skopos Model and on humanist principles. The activities were organized on topics aimed at: informing and updating the central aspects of the topic; generating problematization of situations and extend the individual and collective discussion; promoting integration; and encouraging a joint development of a proposal for action. The Moodle resources helped to select the teaching strategies to update knowledge, to generate ideas, and to promote the integration and collective construction of propositions.This study is a report of a learning experience that had as objective to describe how was structured the virtual learning environment Moodle for training at work. This is a semi-distance education project for controlling a surgical site infection, oriented to the nurses of a university hospital. The study was organized having as a base the interactionist Skopos Model and on humanist principles. The activities were organized on topics aimed at: informing and updating the central aspects of the topic; generating problematization of situations and extend the individual and collective discussion; promoting integration; and encouraging a joint development of a proposal for action. The Moodle resources helped to select the teaching strategies to update knowledge, to generate ideas, and to promote the integration and collective construction of propositions.

Natureza e classificação das intervenções de enfermagem em ambulatório de quimioterapia de adultos

Este estudo descritivo objetivou identificar, por meio da analise retrospectiva de registro, a natureza das intervencoes de enfermagem e estabelecer a correspondencia entre estas e os problemas levantados. A populacao abrangeu 184 prontuarios de pacientes atendidos na primeira consulta de enfermagem no Ambulatorio de Quimioterapia de Adultos do Hospital Sao Paulo, no periodo de janeiro a junho de 1997, selecionando-se uma amostra aleatoria de 37 prontuarios, sendo 19 de pacientes do sexo masculino e 18 do feminino. Os principais resultados mostraram o predominio das intervencoes centradas no atendimento das necessidades psicobiologicas, sendo que das psicossociais, as intervencoes educativas foram as mais frequentes. A correspondencia entre problemas identificados e intervencoes propostas, foi mais evidente no atendimento das necessidades psicobiologicas.

Validação de instrumento para identificar ações de rastreamento e detecção de neoplasia de mama

Objective: To develop and validate a questionnaire to identify the actions performed in screening and detection of breast cancer in Brazil, and to determine its applicability. Methods: A methodological study, with the participation of three experts and a pilot test with 85 users of four primary health care services, with a descriptive data analysis. Results: Of the 132 questions formulated and organized in the structure and process dimensions undergoing validation, there was a 96.7% and 78.8% agreement of the evaluators in the first and second rounds, respectively. Most of the questions were understood by those involved in the investigation. The absence of the medical record resulted in the exclusion of 40 questions, resulting in 83 questions in the final version. Conclusion: The content of the instrument was adequate to evaluate actions to control breast cancer in primary care. The pilot test confirmed its applicability, and the need for improvements in documenting information.