Workloads in the Family Health Strategy: interfaces with the exhaustion of nursing professionals. / Cargas de trabalho na Estratégia Saúde da Família: interfaces com o desgaste dos profissionais de enfermagem.

OBJECTIVE: To identify the workloads of nursing teams working in the Family Health Strategy in the five regions of Brazil and their interfaces with their feelings of exhaustion. METHOD: Qualitative study with nursing professionals from 20 Family Health Units, from eight cities in the five regions of the country. Data were collected through interviews, observation and analyzed according to the precepts of thematic analysis and the theoretical framework of workloads. RESULTS: A total of 79 professionals participated in the study. Workloads were related to structural and managerial problems. Workloads that stood out were psychological workload, due to excessive demands and staff shortages; physiological workload, due to the overload of activities that generate physical pain and exhaustion; physical and mechanical workload, due to inadequacies in the work environment and equipment; biological workload, due to the presence of microorganisms; and chemical workload, due to exposure to dust and smoke. CONCLUSION: The sources that increase workloads are similar in the five regions, indicating that there is a strong influence of psychological and physiological loads on exhaustion among workers. However, workloads are reduced by dividing and planning team actions and by the affinity with the assistance model.

Cargas de trabalho de enfermeiros: luzes e sombras na Estratégia Saúde da Família / Nurses' workload: lights and shadows in the Family Health Strategy

Resumo Estudo multicêntrico, de abordagem qualitativa, que buscou identificar os elementos que podem aumentar ou reduzir as cargas de trabalho do enfermeiro da Saúde da Família. Foram abordados 40 enfermeiros, de 36 equipes, das cinco Regiões do Brasil, consideradas exitosas segundo o prescrito na Política Nacional da Atenção Básica e com boa avaliação no Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. A coleta de dados foi realizada pela triangulação de instrumentos, utilizando-se entrevista semiestruturada, observação e estudo documental, de 2013 a setembro de 2016. Os achados foram analisados com base na Análise Temática de Conteúdo e categorizados com auxílio do software Atlas.ti. Identificou-se que os elementos que mais influenciam o aumento das cargas são a precariedade e déficits no ambiente de trabalho, materiais e equipamentos, somados ao déficit numérico da força de trabalho e ao excesso de demanda assistencial. Entretanto, o trabalho em equipe, reconhecimento pelo trabalho realizado, vínculo com usuários e bom relacionamento interpessoal contribuem para diminuir as cargas. Ressalta-se a dialética presente nos elementos do processo de trabalho com influência de condições objetivas, do momento e da forma como são manejados.

Abstract This study was multicenter with a qualitative approach, which sought to identify the elements that can increase or reduce the workloads of the Family Health nurse. Forty nurses were interviewed, from 36 teams from five regions of Brazil, considered successful according to the requirements of the National Policy of Primary Care and with good evaluation in the National Program for Improvement in Primary Care Access and Quality. Data collection was performed by instrument triangulation, using a semi-structured interview, observation and documentary study, from 2013 to September 2016. The findings were analyzed based on the Thematic Content Analysis and categorized with the help of Atlas.ti software. It was identified that the elements that most influence the increase of the workloads are the precariousness and deficits in the work environment, materials and equipment, added to the numerical deficit of the workforce and the excess of health care demand. However, teamwork, recognition for the performed work, bonding with users and good interpersonal relationships, all contribute to reduce the workloads. We highlight the dialectic present in the elements of the work process. They can increase or decrease workloads influenced by objective conditions, the moment and way they are handled.

Nurses' workload: lights and shadows in the Family Health Strategy. / Cargas de trabalho de enfermeiros: luzes e sombras na Estratégia Saúde da Família.

This study was multicenter with a qualitative approach, which sought to identify the elements that can increase or reduce the workloads of the Family Health nurse. Forty nurses were interviewed, from 36 teams from five regions of Brazil, considered successful according to the requirements of the National Policy of Primary Care and with good evaluation in the National Program for Improvement in Primary Care Access and Quality. Data collection was performed by instrument triangulation, using a semi-structured interview, observation and documentary study, from 2013 to September 2016. The findings were analyzed based on the Thematic Content Analysis and categorized with the help of Atlas.ti software. It was identified that the elements that most influence the increase of the workloads are the precariousness and deficits in the work environment, materials and equipment, added to the numerical deficit of the workforce and the excess of health care demand. However, teamwork, recognition for the performed work, bonding with users and good interpersonal relationships, all contribute to reduce the workloads. We highlight the dialectic present in the elements of the work process. They can increase or decrease workloads influenced by objective conditions, the moment and way they are handled.

Estudo multicêntrico, de abordagem qualitativa, que buscou identificar os elementos que podem aumentar ou reduzir as cargas de trabalho do enfermeiro da Saúde da Família. Foram abordados 40 enfermeiros, de 36 equipes, das cinco Regiões do Brasil, consideradas exitosas segundo o prescrito na Política Nacional da Atenção Básica e com boa avaliação no Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. A coleta de dados foi realizada pela triangulação de instrumentos, utilizando-se entrevista semiestruturada, observação e estudo documental, de 2013 a setembro de 2016. Os achados foram analisados com base na Análise Temática de Conteúdo e categorizados com auxílio do software Atlas.ti. Identificou-se que os elementos que mais influenciam o aumento das cargas são a precariedade e déficits no ambiente de trabalho, materiais e equipamentos, somados ao déficit numérico da força de trabalho e ao excesso de demanda assistencial. Entretanto, o trabalho em equipe, reconhecimento pelo trabalho realizado, vínculo com usuários e bom relacionamento interpessoal contribuem para diminuir as cargas. Ressalta-se a dialética presente nos elementos do processo de trabalho com influência de condições objetivas, do momento e da forma como são manejados.

Cargas de trabalho na Estratégia Saúde da Família: interfaces com o desgaste dos profissionais de enfermagem / Cargas de trabajo en la Estrategia de Salud Familiar: interfaces con el desgaste de los profesionales de la enfermería / Workloads in the Family Health Strategy: interfaces with the exhaustion of nursing professionals

RESUMO Objetivo Identificar as cargas de trabalho de equipes de enfermagem que atuam na Estratégia Saúde da Família nas cinco regiões do Brasil e as interfaces com o desgaste desses profissionais. Método Estudo qualitativo com profissionais de enfermagem de 20 Unidades de Saúde da Família, de oito munícipios das cinco regiões do país. Os dados foram coletados por meio de entrevistas e observação, sendo analisados segundo preceitos da análise temática e do referencial teórico de cargas de trabalho. Resultados Participaram 79 profissionais. As cargas de trabalho foram relacionadas a problemas estruturais e gerenciais, destacando-se as psíquicas devido ao excesso de demanda e à falta de profissionais, as fisiológicas pela sobrecarga de atividades que geram dores físicas e exaustão, as físicas e mecânicas em função das inadequações no ambiente de trabalho e equipamentos, as biológicas pela presença de micro-organismos e as químicas devido à exposição a poeiras e fumaças. Conclusão As fontes que elevam as cargas de trabalho são semelhantes nas cinco regiões, indicando forte influência das cargas psíquicas e fisiológicas nos padrões de desgaste da enfermagem. Entretanto, divisão e planejamento das ações em equipe e afinidade com o modelo assistencial reduzem as cargas de trabalho.

RESUMEN Objetivo Identificar las cargas de trabajo de los equipos de enfermería de la Estrategia de Salud Familiar en las cinco regiones de Brasil y las interfaces con el desgaste de estos profesionales. Método Se trata de un estudio cualitativo realizado entre 79 profesionales de enfermería de veinte Unidades de Salud Familiar, en ocho municipios de las cinco regiones del país. Los datos se recogieron mediante entrevistas y observación y se analizaron de acuerdo con los preceptos del análisis temático y de la referencia teórica de las cargas de trabajo. Resultados Las cargas de trabajo estaban relacionadas con problemas estructurales y de gestión, destacándose las psíquicas por el exceso de demanda y la falta de profesionales; las fisiológicas por la sobrecarga de actividades que generan dolor físico y agotamiento; las físicas y mecánicas por las inadecuaciones en el ambiente de trabajo y los equipos; las biológicas por la presencia de microorganismos y las químicas por la exposición al polvo y al humo. Conclusión Las fuentes que aumentan las cargas de trabajo son similares en las cinco regiones, lo que indica una gran influencia de las cargas psíquicas y fisiológicas en los patrones de desgaste de la enfermería. Sin embargo, la división y la planificación de las acciones en equipo y la afinidad con el modelo de atención reducen las cargas de trabajo.

ABSTRACT Objective To identify the workloads of nursing teams working in the Family Health Strategy in the five regions of Brazil and their interfaces with their feelings of exhaustion. Method Qualitative study with nursing professionals from 20 Family Health Units, from eight cities in the five regions of the country. Data were collected through interviews, observation and analyzed according to the precepts of thematic analysis and the theoretical framework of workloads. Results A total of 79 professionals participated in the study. Workloads were related to structural and managerial problems. Workloads that stood out were psychological workload, due to excessive demands and staff shortages; physiological workload, due to the overload of activities that generate physical pain and exhaustion; physical and mechanical workload, due to inadequacies in the work environment and equipment; biological workload, due to the presence of microorganisms; and chemical workload, due to exposure to dust and smoke. Conclusion The sources that increase workloads are similar in the five regions, indicating that there is a strong influence of psychological and physiological loads on exhaustion among workers. However, workloads are reduced by dividing and planning team actions and by the affinity with the assistance model.

The health care model: concepts and challenges for primary health care in Brazil.

This is a theoretical reflection aiming to highlight the conceptual debate about the health care model and the challenges for primay health care in Brazil. The study characterizes different concepts and terminologies relating to the expression 'care model' and shows that the Family Health Strategy has improved access to health care, and also including user reception and humanization perspectives in health practices. However, one still sees: a centralizing attitude in the treatment of pathologies, and care focused on the biological body; difficulties in implementing comprehensive care; and deficits in training of teams, and in working conditions and relations. The study concludes that the term 'care model' is interpreted as polysemic and that, although there are structuring proposals and policies for a model that can make progress in relation to the biomedical paradigm, the difficulties for its implementation are significant.

Modelo assistencial em saúde: conceitos e desafios para a atenção básica brasileira / The health care model: concepts and challenges for primary health care in Brazil

Trata de uma reflexão teórica com objetivo de resgatar o debate conceitual sobre modelo assistencial em saúde e os desafios para a atenção básica no Brasil. O estudo caracteriza diferentes conceitos e terminologias relativas à expressão modelo assistencial e mostra que a saúde da família promoveu ampliação do acesso e incorporação do acolhimento e humanização das práticas. No entanto, verifica-se a persistência da centralidade do tratamento de patologias e dos cuidados ao corpo biológico, as dificuldades na implantação da integralidade e déficits na formação das equipes e nas condições e relações de trabalho. Concluiu que o termo modelo assistencial é polissêmico e que, embora existam propostas e políticas estruturantes de um modelo que avance em relação ao paradigma biomédico, as dificuldades para sua implementação são significativas.

This is a theoretical reflection aiming to highlight the conceptual debate about the health care model and the challenges for primay health care in Brazil. The study characterizes different concepts and terminologies relating to the expression ‘care model’ and shows that the Family Health Strategy has improved access to health care, and also including user reception and humanization perspectives in health practices. However, one still sees: a centralizing attitude in the treatment of pathologies, and care focused on the biological body; difficulties in implementing comprehensive care; and deficits in training of teams, and in working conditions and relations. The study concludes that the term ‘care model’ is interpreted as polysemic and that, although there are structuring proposals and policies for a model that can make progress in relation to the biomedical paradigm, the difficulties for its implementation are significant.

Correlation of acute phase inflammatory and oxidative markers with long-term cognitive impairment in sepsis survivors rats.

Oxidative damage and inflammation occur early in the brain after sepsis and are resolved when long-term cognitive impairment occurs. There is no information of a direct relation between acute levels of brain inflammation and oxidative damage and long-term cognitive deficits. We hypothesized that higher levels of early oxidative damage and inflammation are followed by long-term cognitive deficits, and this is related to a decrease in the levels of brain-derived neurotropic factor (BDNF). Wistar rats were subjected to sham operation or cecal ligation and perforation and the cerebrospinal fluid (CSF) was obtained 6 and 24 h after the determination of thiobarbituric acid-reactive species, interleukin 1 (IL-1), IL-10, and tumor necrosis factor α (TNF-α). Animals were followed until 30 days after surgery and were subjected to the step-down inhibitory avoidance (IA) task, and the hippocampus levels of BDNF were determined. At 6 h, higher CSF levels of thiobarbituric acid-reactive species and TNF-α were observed in septic animals that had a better performance in the IA task and presented higher BDNF levels in the hippocampus. At 24 h, higher CSF levels of IL-1ß and TNF-α were observed in septic animals that had a worse performance in the IA task, and this was associated with lower BDNF levels. The persistence of brain inflammation during the acute phase of sepsis is associated with long-term hippocampus levels of BDNF and memory impairment in sepsis survivors.

Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes.

PURPOSE: Delirium is a frequent and serious problem in the intensive care unit (ICU) that is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The main objective of the present study was to compare and assess the agreement between the diagnosis of delirium obtained by the Confusion Assessment Method for the ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in patients admitted to the ICU and their association with outcomes. METHODS: Adult patients admitted to the ICU for more than 24 hours between May and November 2008 were included. Patients with a Richmond Agitation-Sedation Scale score of -4 to -5 for more than 3 days were excluded. Delirium was evaluated twice a day by the ICDSC and CAM-ICU. Patients were followed-up until ICU discharge or for a maximum of 28 days. RESULTS: During the study period, 383 patients were admitted to the ICU and 162 (42%) were evaluated; delirium was identified in 26.5% of patients by CAM-ICU and in 34.6% by ICDSC. There was agreement in diagnosing delirium diagnosis between the 2 methods in 42 (27.8%) patients and in excluding delirium in 105 (64.8%) patients. The ICDSC was positive in 14 (8.6%) patients in whom CAM-ICU was negative. Delirium, diagnosed either by ICDSC or CAM-ICU assessments, was associated with both significantly increased hospital LOS (14.8 ± 8.3 vs 9.8 ± 6.4, P < .001; 15.3 ± 8.7 vs 10.5 ± 7.1, P < .001, respectively), mortality in the ICU (11.1% vs 5.8%, P < .001; 12.5% vs 2.5%, P = .022), and in the hospital (10.7% vs 5.6%, P < .001; 23.2% vs 10.9%, P = .047). In addition, patients with positive ICDSC presenting with negative CAM-ICU had similar outcomes as compared with those without delirium. CONCLUSION: The findings of our study suggest that the CAM-ICU is better predictor of outcome when compared with ICDSC.

The effects of N-acetylcysteine and deferoxamine on plasma cytokine and oxidative damage parameters in critically ill patients with prolonged hypotension: a randomized controlled trial.

Reactive oxygen species and inflammation have been implicated in renal tubule cell injury. However, there is some controversy concerning whether antioxidants might attenuate oxidative damage and inflammation in humans after hypotension in the setting of critical illness. This study was a prospective, randomized, double-blinded, placebo-controlled study that included patients with hypotension. Patients were randomized to receive either N-acetylcysteine (NAC; 50 mg/kg by 4 hours followed by 100 mg/kg/d for 48 hours diluted in 5% glucose) and deferoxamine (DFX; at a single dose of 1000 mg diluted in 5% glucose) or placebo. The primary study outcome was the serum levels of markers of oxidative damage and inflammatory response. Secondary outcomes included the incidence of acute renal failure, serum creatinine at hospital discharge, intensive care unit length of stay, and length of hospital stay. Thirty patients were enrolled in the study. The use of NAC plus DFX decreased the oxidative damage parameters but not plasma interleukin-6 levels. In contrast, plasma nitrite levels increased 24 hours after NAC plus DFX administration. On analysis of secondary outcomes, it was observed that creatinine levels at hospital discharge were lower in patients receiving NAC plus DFX when compared with placebo. NAC plus DFX administration was able to decrease plasma markers of oxidative damage and creatinine levels at hospital discharge.