Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Student experiences of a return to practice programme: a qualitative study.

BACKGROUND: Nurses, midwives and other health professionals who return to practice come from a range of backgrounds and return for a variety of reasons. Much of the research on return to practice concerns programme provision rather than returnee experience. AIM: This qualitative study focused on the experiences of nursing, midwifery and allied health students undertaking a return to practice programme at a higher education institute. It interpreted the perceptions of the student experience of returning to clinical practice following a lapse in professional registration. METHODS: Data collection methods were qualitative and involved focus groups. Findings were analysed using thematic analysis. FINDINGS: Several themes and subthemes emerged from the data, including 'the importance of returnee identity' and 'challenges and barriers'. Findings demonstrated different approaches to and influences on returnees' learning journeys. CONCLUSION: Previous knowledge, skills and experience were often hidden from view and hard to explain although crucial to returnee success.

A multifactorial conceptual model of peripheral neuromusculoskeletal predisposing factors in task-specific focal hand dystonia in musicians: etiologic and therapeutic implications.

A model is presented showing how peripheral factors may cause a process of movement adaptation that leads to task-specific focal hand dystonia in musicians (FHDM). To acquire a playing technique, the hand must find effective and physiologically sustainable movements within a complex set of functional demands and anatomic, ergonomic, and physiological constraints. In doing so, individually discriminating constraints may become effective, such as limited anatomic independence of finger muscles/tendons, limited joint ranges of motion, or (subclinical) neuromusculoskeletal defects. These factors may, depending on the instrument-specific playing requirements, compromise or exclude functional playing movements. The controller (i.e., the brain) then needs to develop alternative motions to execute the task, which is called compensation. We hypothesize that, if this compensation process does not converge to physiologically sustainable muscle activation patterns that satisfy all constraints, compensation could increase indefinitely under the pressure of practice. Dystonic symptoms would become manifest when overcompensation occurs, resulting in motor patterns that fail in proper task execution. The model presented in this paper only concerns the compensatory processes preceding such overcompensations and does not aim to explain the nature of the dystonic motions themselves. While the model considers normal learning processes in the development of compensations, neurological predispositions could facilitate developing overcompensations or further abnormal motor programs. The model predicts that if peripheral factors are involved, FHDM symptoms would be preceded by long-term gradual changes in playing movements, which could be validated by prospective studies. Furthermore, the model implies that treatment success might be enhanced by addressing the conflict between peripheral factors and playing tasks before decompensating/retraining the affected movements.

A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians.

UNLABELLED: Focal hand dystonia (FHD) in musicians is a painless task-specific motor disorder characterized by an involuntary loss of control of individual finger movements. The aim of this study was to investigate the effects of an innovative behavioural therapy intervention, aimed at normalising movement patterns, in musicians affected by FHD. METHODS: Eight musicians volunteered to take part in this retraining protocol. Intensive constraint-induced therapy and motor control retraining at slow speed were the interventions. Video recordings of the subjects playing two pieces were used for data analysis. The Frequency of Abnormal Movements scale (FAM), the change in metronome speed achieved during motor control retraining, and two ordinal dystonia evaluation scales were chosen as outcome measures. It was hypothesised that there would be significant differences in the FAM scores and metronome speeds over a 12-month period. RESULTS: For the main outcome measure, the FAM scale scores, the two-factor repeated measures ANOVA revealed a very significant decrease in the number of abnormal movements per second of instrumental playing over the 12-month period (F = 6.32, df = 7, p < 0.001). Tukey's post-hoc tests carried out for the FAM scores revealed that significant changes occurred after 8 months of therapy. DISCUSSION: These results suggest that a combination of constraint-induced therapy and specific motor control retraining may be a successful strategy for the treatment of musicians' FHD. Furthermore, the results suggest that retraining strategies may need to be carried out for at least 8 months before statistically significant changes are noted.

Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment.

Musician's dystonia is a task-specific movement disorder that manifests itself as a loss of voluntary motor control in extensively trained movements. Approximately 1% of all professional musicians develop musician's dystonia, and in many cases, the disorder terminates the careers of affected musicians. The pathophysiology of the disorder is not completely clarified. Findings include 1) reduced inhibition at different levels of the central nervous system, 2) maladaptive plasticity and altered sensory perception, and 3) alterations in sensorimotor integration. Epidemiological data demonstrate a higher risk for those musicians who play instruments requiring maximal fine-motor skills. For instruments where workload differs across hands, focal dystonia appears more often in the more intensely used hand. In psychological studies, musicians with dystonia have more anxiety and perfectionist tendencies than healthy musicians. These findings strengthen the assumption that behavioral factors may be involved in the etiology of musician's dystonia. Preliminary findings also suggest a genetic contribution to focal task-specific dystonia with phenotypic variations including musician's dystonia. Treatment options include pharmacological interventions, such as trihexyphenidyl or botulinum toxin-A, as well as retraining programs and ergonomic changes in the instrument. Patient-tailored treatment strategies may significantly improve the situation of musicians with focal dystonia. Positive results after retraining and unmonitored technical exercises underline the benefit of an active involvement of patients in the treatment process. Only a minority of musicians, however, return to normal motor control using the currently available therapies.

Actividades de Evaluación en Farmacognosia / Evaluation Activities in Pharmacognosy

La implantación del EEES comporta un nuevo sistema educativo enfocado al aprendizaje basado en el trabajo del estudiante, el cual deja de ser un sujeto pasivo que adquiere y memoriza conocimientos para convertirse en un sujeto activo de su desarrollo competencial y ser capaz de gestionar sus conocimientos eficientemente, bajo la tutela del profesor. Esto implica modificar no sólo la docencia sino también la evaluación, que como parte esencial del proceso educativo, asegura cubrir necesidades de aprendizaje y actualizar contenidos, proporciona retroalimentación, reflexión y análisis de la propia práctica y permite corregir deficiencias y mejorar metodologías.En Farmacognosia, actualmente en segundo curso de la Licenciatura de Farmacia, se han introducido estrategias de evaluación coherentes con los resultados de aprendizaje descritos, a considerar cuando se inicie el desarrollo de sus competencias en tercer curso de Grado. Inicialmente, se ha realizado una prueba de conocimientos previos. Se han aplicado dos tipos de pruebas, unas que enfatizan en la adquisición y comprensión de conocimientos y otras que abarcan competencias disciplinarias y transversales. Entre las primeras se han incluido: tests en aula virtual, que permiten discriminar información y dar una retroalimentación rápida; pruebas de respuesta abierta para comprobar capacidad de expresión, organización de ideas y razonamiento; y resolución de problemas para ver capacidad de gestionar información. Entre las segundas, después de realizar prácticas de laboratorio, se plantea una prueba de ejecución para una droga problema y se elabora un informe que demuestre el desarrollo de la ejecución, búsqueda y selección de información, observación e interpretación de resultados, y posterior exposición oral para valorar capacidad de comunicación(AU)

The implantation of the European Higher Education Area (EHEA) requires an educational system rooted in a competency-based learning approach in which, under professorial supervision, the students become active agents in order to reach a sufficient level of competence, retain more knowledge, and manage and apply this knowledge more efficiently. It implies modifying not only our teaching practices, but also our methods of evaluation, which, as an essential part of the education process, guarantees the acquisition of an ample range of skills and keeps course material up to date while providing students and educators with feed-back, reflection and analysis of the whole process. This, in turn, facilitates the correction of deficiencies and improvement of methodologies.In Pharmacognosy, which is currently taught in the second year of the Pharmacy program and in which ca. 200 students are enrolled, various evaluation strategies coherent with the established learning objectives were introduced to two groups of students. We first administered a questionnaire to ascertain the range of knowledge the students already had in related subjects. Then, two types of test were given: one type emphasizing the acquisition and understanding of knowledge and the other type focussing on more generic, interdisciplinary competence. The former type included: on-line multiple choice questionnaires, which allow for discernment of information and quick feed-back; open answertests to determine the students’ ability to reason, organize their thoughts and express their ideas; and the resolution of problems to see how the students handle information. The latter type of exercise was given to pairs of students who, upon completing the laboratory component of the class, were given a proposal for solving a problem relating to a crude drug(AU)

The students then had to draft a scientific paper-like document describing the experimental protocol along with their observations, analysis of the results, and how they searched for and selected information. Finally, the students gave an oral presentation of the protocol and their findings, thus allowing the professor to evaluate their oral communication skills(AU)

Opening new doors: RN to BSN students' experiences in a holistic nursing course.

A phenomenological study was conducted to investigate RN to BSN students' experiences in a holistic nursing course. A purposive sample of 19 RN to BSN graduates participated. Five theme clusters emerged when the formulated meanings were organized into categories: (1) uncertain beginnings, (2) shifting perspectives and power, (3) ripples of caring, (4) seeing the body, mind, spirit connection, and (5) from everyday practice to caring praxis. Findings provide evidence of the power of holistic nursing education to facilitate personal development and enhance professional practice.

Curriculum design to promote the critical thinking of accelerated bachelor's degree nursing students.

This project describes the curriculum design of an accelerated bachelor's degree nursing program intended to promote the critical thinking of its students. Course objectives and teaching-learning strategies are described. Rogers' unitary view of human beings supports critical thinking as a developing process that should be measured in the context of nursing practice. Pre- and post-program critical thinking test scores indicated significant growth for the 38 graduates in the first 4 consecutive classes tested.

Investigating spiritual care perceptions and practice patterns in Hong Kong nurses: results of a cluster analysis.

AIM: Nurses' spiritual care perceptions and practices are explored by identifying profiles of nurses studying in a part-time baccalaureate course in a local Hong Kong university. Relationships between nurses' spiritual care perceptions and their practices are explored. RESEARCH METHOD: Hundred and ninety three nurses completed a structured questionnaire. OUTCOME MEASURES: Spiritual care perceptions and practices. RESULTS: Two-step cluster analysis yielded three clusters. Clusters A, B, and C consisted of 15.0% (n = 29), 44.6% (n = 86), and 40.4% (n = 78), respectively. Cluster A nurses were characterized by relatively negative spiritual care perceptions and practices. Cluster C nurses reported positive perceptions, but negative practices; they mainly chose 'uncertain' for most items on both scales. Cluster B was a large group of nurses holding both positive spiritual care perceptions and practices. Significant differences towards spiritual care were found among clusters. Nurses' perceptions were significant positively correlated with practices (r = 0.62). High positive correlations were found between the two scales (r = 0.83) for nurses in Cluster A, for nurses in Clusters B and C, low positive correlations (r = 0.37) were found. CONCLUSION: Three clusters of Hong Kong nurses were differentiated. They showed differences in the level of their spiritual care perceptions and practices. Despite their level of spiritual care perceptions, nurses seldom incorporated spiritual care practices into their daily nursing care, and the level of spiritual care awareness of some nurses was low. Findings may be used to improve support of nurses, to ensure sensitive spiritual care in their daily practices, and to enhance nursing curricula.

[Rehabilitation and integration management]. / Rehabilitations- und Eingliederungs- management.

At the core of a high-quality and efficient rehabilitation management, there is always a sophisticated analysis of each specific case and situation. This analysis is performed from a professional, medical and psychological point of view. It is set in the context of a case situation with regard to elements of civil law and social security regulations. The analysis explicitly takes the overall situation of the client into account. The success of the rehabilitation plan - and the amount of the overall costs--depend very much on the level of accuracy with which this analysis is conducted. Highly competent medical and job-specific knowledge, as well as psychological know-how, is required. Rehabilitation management does not refer to a fixed set of certain measures, but has to be applied to the specific healing plan and resources of the client.

Case management: entry-level practice for occupational therapists?

As American businesses have sought means to control employee health benefits, managed care has evolved. This evolution has brought greater demand for case management. Case management is not a profession but a practice area within one's own profession. Case managers come from a variety of disciplines and work in a variety of practice settings, which include medical, psychosocial, educational, vocational, and rehabilitation.

Rethinking midwifery refresher programs as a recruitment strategy.

This paper presents a case study on an innovative Midwifery Refresher Program in the context of current midwifery workforce issues. The refresher program was developed specifically as a recruitment strategy to address a staffing crisis at the Mater Misericordiae Mothers' Hospital, a busy tertiary maternity hospital in Brisbane, Australia. Features of the program that contributed to its success include collaboration with an industry partner, high levels of clinical support for participants, flexibility for women with family responsibilities and low financial costs for all stakeholders. This type of recruitment strategy may be useful for health care services experiencing staff shortages.

Overcoming the undersupply--supporting midwives' return to practice.

UNLABELLED: The current critical shortage of midwives is a worldwide phenomenon that has created the need for educational programs that prepare midwives, who have previously left midwifery practice, for return to the contemporary clinical workforce. This paper focuses on the support requirements of midwives involved in a refresher program as determined by a research project conducted at The Northern Hospital in Melbourne during 2001. The project was a small-scale case study involving eight program participants. Questionnaires and semi-structured interviews were used to generate data. Analysis of the data revealed that the concept of support must be considered from personal and professional perspectives, if successful outcomes are to be achieved. INTRODUCTION: The response of the Federal Government to the dire shortage of midwives currently working in public healthcare facilities has been to allocate funding to the states and territories for education and re-skilling programs, with the aim of enticing midwives back to clinical practice (Walsh 2001). In Victoria, refresher programs have been developed to meet the needs of midwives whose level of expertise has diminished due to lack of clinical experience, but who have fulfilled the necessary requirements.

The development of National ACMI Standards for the accreditation of three-year Bachelor of Midwifery programs.

Prior to 2002 Australians who wished to become midwives were expected to complete and undergraduate nursing degree and then apply for admission to a university-based post-nursing program in midwifery, usually requiring an additional year of study. Graduates were, therefore, qualified to practice in either profession. Many organisations, coalitions and individuals have contributed to the arduous struggle to ensure that midwives are educated in ways that allow them to confidently and competently fulfill their role as the World Health Organisation defines it. Indeed, in some states, universities and Nurses Boards recognising the need for multiple routes of entry to practice have introduced three-year undergraduate midwifery degrees. So far this has taken place in South Australia and Victoria but other states intend to follow this initiative. In this paper the background to the development of the ACMI National Bachelor of Midwifery Taskforce and the midwifery Program Standards will be discussed. A brief description of the Program Standards is presented to show how they can be used to ensure that 21st century midwives are capable of competently and confidently responding to the changing needs of maternity service providers and consumers. Finally, the authors argue that it is crucial that employers and clinicians have access to a standardised, objective means to evaluate midwifery programs, and believe that the Standards provide the means to do this.