Experiences of Providers and Immigrants/Refugees with Health Care: A Meta-Synthesis of the Latin American Context.

INTRODUCTION: The experiences of providers and immigrants/refugees related to healthcare in the Latin American context have not yet been aggregated. This study aimed to synthesize the qualitative evidence on this theme. METHOD: A systematic review of qualitative evidence with meta-synthesis. After identification, eligible studies were evaluated for methodological quality, and information was systematically analyzed. RESULTS: The sample comprised 26 articles. The meta-theme shows that the experiences of providers and immigrants/refugees are determined by multilevel factors. In a macro-context, these factors involve the vulnerabilities of immigrants/refugees and the healthcare system/model, and in a closer context, they involve the lack of professional training in cultural skills and communication; language barriers; and prejudice/xenophobia. Within healthcare, the relationship is mostly conflictual, asymmetric, and unable to solve problems, leading to negative repercussions for both. CONCLUSIONS: Managers involved in developing public policies and providers must consider improving the interrelationship between healthcare services and the migrant population.

Evaluation of Clinical Communication in Pharmacy Undergraduates in Brazil: A Multicentric Study.

OBJECTIVE: To assess the clinical communication characteristics of pharmacy undergraduates, estimate differences in this specific competency, and produce recommendations for further education and training. METHODS: Analysis of communication competence between 110 pharmacy students in the last graduation year from each of the 5 Brazilian regions and a simulated patient with complaints of mild allergic rhinitis passive of resolution with non-prescription medicines. The simulated appointment was recorded, and the video was analyzed using the 2 main elements: biomedical/task-focused and socio-emotional exchange of the Roter Interaction Analysis System. RESULTS: The total of utterances/speech from the pharmacist to the patient was 183.4; there was a statistically significant difference according to the Brazilian region. In the consultation, the frequency with which pharmacy students returned to the segment was evaluated, with a total mean clinical history segment 2 of mean 5.60; in segment 4, which is the counseling phase, an average of 4.80. In the task codes and the socio-emotional codes, there was a statistically significant difference between the codes when compared by region. We compare by sex because it is said that women talk more than men. There was a statistically significant difference in socio-emotional code and biomedical/focused and task being higher for women. CONCLUSION: The level of communication competence of students should be that desired for graduation, in all regions. There seems to be a difference between training and level of competence. Considering gender, although the consultation time is similar, it appears that the quality of communication is higher for women.

"Existe o espaço, mas ao mesmo tempo não existe": análise do processo de cuidado no tratamento psicofarmacológico na saúde mental / "Existe el espacio, pero al mismo tiempo no existe": análisis del proceso de cuidado en el tratamiento psicofarmacéutico en la salud mental / "There is space, but at the same time there isn't": the care process analysis in psychopharmacological treatment in mental health

Considerando os desafios à reabilitação psicossocial, objetivou-se compreender a perspectiva de usuários e trabalhadores no tratamento psicofarmacológico. Trata-se de um estudo qualitativo que entrevistou seis profissionais e dez usuários do Centro de Atenção Psicossocial de um município da região norte de Minas Gerais. As transcrições foram tratadas em Ciclos de Codificação e examinadas pela Análise de Discurso. Definiram-se três categorias relativas à dimensão micropolítica do cuidado: o fluxograma institucional, os espaços intercessores e a produção subjetiva dos agentes. Revelaram-se dissonâncias entre enunciados alusivos à política da atenção psicossocial, com a concorrência de concepções e tecnologias de cuidado emancipatórias e restritivas. Constatou-se a importância da análise micropolítica do cuidado no tratamento psicofarmacológico, favorecendo os processos de contratualidade, protagonismo e autonomia do usuário.(AU)

Considerando los desafíos para la rehabilitación psicosocial, el objetivo fue comprender la perspectiva de usuarios y trabajadores en el tratamiento psicofarmacéutico. Se trata de un estudio cualitativo que entrevistó a seis profesionales y a diez usuarios del Centro de Atención Psicosocial de un municipio de la región norte de Minas Gerais. Las transcripciones fueron tratadas en Ciclos de Codificación y examinadas por el Análisis del Discurso. Se definieron tres categorías relativas a la dimensión micropolítica del cuidado: el diagrama de flujo institucional, los espacios intercesores y la producción subjetiva de los agentes. Se revelaron disonancias entre enunciados alusivos a la política de la atención psicosocial, con la concurrencia de concepciones y tecnologías de cuidado emancipatorias y restrictivas. Se constató la importancia del análisis micropolítico del cuidado en el tratamiento psicofarmacéutico, favoreciendo los procesos de contractualidad, protagonismo y autonomía del usuario.(AU)

Considering the challenges to psychosocial rehabilitation, this study was aimed at understanding the perspective of users and workers regarding psychopharmacological treatment. This is a qualitative study, which interviewed six providers and ten users of the Psychosocial Care Center of a municipality in the north of Minas Gerais. The transcripts were treated in Coding Cycles and examined by Discourse Analysis. Three categories related to the micropolitical dimension of care were defined: the institutional flowchart; the intercessory spaces; and the subjective production of the agents. Dissonances were revealed between statements alluding to the psychosocial care policy, with the competition of emancipatory and restrictive conceptions and technologies of care. The importance of the micropolitical analysis of care in psychopharmacological treatment was verified, favoring the processes of contractuality, protagonism, and user autonomy.(AU)

Physical therapists' perspectives of patient values and their place in clinical practice: a qualitative study.

BACKGROUND: In physical therapy practice patients and therapists exchange their perspectives on musculoskeletal health problems and their meaning for both of them. However, literature indicates that physical therapists find it difficult to enquire about the patients' values during clinical encounters. OBJECTIVES: The aim of this study was to gain deeper insight into the perspectives of physical therapists about patient values. DESIGN: Explorative qualitative focus group study. METHOD: Twenty-three physical therapists were interviewed in the Netherlands from March to May 2021. Two researchers analyzed the interviews and derived relevant codes. After an iterative process of comparing, analyzing, conceptualizing and discussing the codes, themes were identified through a thematic framework, illustrated with meaningful quotes. RESULTS: Three major themes were identified: Humane, Tacit, and Responsive. It appeared that patient values play unconsciously a major role in daily practice and are associated with humanity, not technical or procedural aspects of the encounter. Responsive denotes that all values require interaction in which aligning with the individual patient forms the basis of treatment. Barriers for being responsive are identified as subthemes: Choices, Trust, Diverseness, and Boundaries. CONCLUSION: The concept of patient values appeared to be implicit. The professional intuitively attunes as a fellow human being to values and expectations of the individual patient. This study contributes to finding a balance and mutual reinforcement of implicit and explicit knowledge. With all found experiences and insights the concept of patient values became more explicit in physical therapy to create a framework for education and research in the future.

Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study

Abstract Background: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client's perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. Methods: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. Results: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain. Conclusion: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care.

Perceptions of the Brazilian obstetrics physicians about the term obstetric violence: a cross-sectional study

SUMMARY INTRODUCTION: We observe a growing global discussion about the practices considered "obstetric violence" against women during pregnancy and childbirth. Otherwise, the indiscriminate subjective and lay interpretation of the term "obstetric violence" can lead to a misunderstanding among medical professionals. OBJECTIVE: This study aimed to describe the obstetrician's perceptions about the term "obstetric violence" and the medical groups affected negatively by the topic. METHODS: A cross-sectional study applied to Brazilian obstetrics physicians regarding their perceptions of "obstetric violence." RESULTS: From January to April 2022, we sent about 14,000 direct mail nationwide. A total of 506 participants responded. We observed that 374 (73.9%) participants consider the term obstetric violence nocive or harmful to professional practice. Furthermore, after Poisson regression, we described that the respondents who graduated before 2000 and from a private institution were significant and independent groups for the full or partial agreement that the term is nocive for the obstetricians in Brazil. CONCLUSION: We observed that almost three in four obstetrician participants consider the term "obstetric violence" nocive or harmful to professional practice, particularly in those who graduated before 2000 and from a private institution. The findings are relevant to propose further debates and strategies to mitigate the possible harms caused to the obstetrician team by the indiscriminate use of the term obstetric violence.

Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study.

BACKGROUND: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client's perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. METHODS: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. RESULTS: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain. CONCLUSION: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care.

Linguagem, interação e vulnerabilidade comunicativa na relação de cuidado ao paciente: um estudo sobre a percepção de estudantes de Enfermagem, Fonoaudiologia e Medicina / Language, interaction and communicative vulnerability to patient care: a study on the perception of Nursing, Speech-Language Pathology and medicine students / Comunicación y Vulnerabilidad Comunicativa en la relación de cuidado del paciente: un estudio sobre la percepción de estudiantes de Enfermería, Fonoaudiología y Medicina

Introdução: A linguagem entre os homens evoluiu ao longo da história. Comprometimentos de fala e linguagem podem acarretar em situação de vulnerabilidade comunicativa, influenciando na participação da pessoa no processo terapêutico e tomada de decisões clínicas. Objetivo: Investigar a percepção de futuros profissionais de medicina, fonoaudiologia e enfermagem quanto à comunicação com o paciente a partir de vivências nos campos de estágios. Método: Estudo transversal, descritivo e quantitativo, com amostra de 85 alunos. Para a coleta de dados utilizou-se questionário online. Resultados: Todos participantes consideraram importante, ou muito importante, a comunicação com o paciente. Para a maioria dos participantes de fonoaudiologia (84,8%) e de medicina (65,6%) a comunicação com os pacientes é efetiva, enquanto que os de enfermagem (55%) referiram certa dificuldade. 35% dos alunos de enfermagem e 28,1% dos de medicina informaram que não tiveram contato com pacientes não oralizados; 33,3% dos alunos de Fonoaudiologia responderam que, nesses casos, a comunicação é efetiva, pois eles utilizavam outras formas de comunicação. Todos consideraram que o não falar coloca o paciente em situação de vulnerabilidade. Conclusão: Os resultados evidenciam que a comunicação paciente-futuro profissional de saúde é considerada importante para todos os participantes. Os achados reiteram a importância da temática na graduação e da comunicação na relação paciente-profissional para o bem-estar de vida e saúde da pessoa, sendo essa questão responsabilidade da equipe e não apenas do fonoaudiólogo, tendo em vista uma formação e atenção integrada e humanizada.

Introduction: Communication between men has evolved throughout history. Speech and language impairments can lead to situations of communicative vulnerability, influencing the person's participation in the therapeutic process and making decisions. Objective: To investigate the perception of future professionals in medicine, speech-language pathology and nursing regarding communication with the patient from experiences in the internship fields. Methods: Cross-sectional, descriptive and quantitative study, with a sample of 85 students. .An online questionnaire was used for data collection. Results: For most students of speech-language pathology (84.8%) and medicine (65.6%), communication was effective, while nursing students (55%) claimed to feel some difficulty. 35% of nursing students and 28.1% of medical students reported that they had no contact with patients who do not speak, and speech-language pathology students (33.3%) answered that, in these cases, communication is effective, as they used other forms of communication. All considered that not speaking puts the patient in a situation of vulnerability. Conclusion: The results show that communication between patient and future health professional is considered important for all participants. The findings reiterate the importance of the theme in graduation and communication in the patient-professional relationship for the well-being and health of the person, this issue being the responsibility of the team and not only of the speech-language therapist, in view of an integrated and humanized care.

Introduccion: La comunicación entre los hombres ha evolucionado a lo largo de la historia. Los fallos y compromisos lingüísticos pueden conducir a una situación de vulnerabilidad comunicativa, influyendo en la participación de las personas en el proceso terapéutico y en la toma de decisiones. Objetivo: Investigar la percepción de los futuros profesionales de la patología del habla y el lenguaje sobre la comunicación con el paciente a partir de experiencias en los campos de prácticas. Metodos: Estudio transversal, descriptivo y cuantitativo, con una muestra de 85 estudiantes, aprobado por el CEP. Para la recolección de datos se utilizó un cuestionario en línea. Resultados: La mayoría de los estudiantes de fonoaudiología (84,8%) y medicina (65,6%) la comunicación fue eficaz, mientras que en enfermería afirmaron sentirse un poco difíciles (55%). 35% de los estudiantes de enfermería y 28,1% de los estudiantes de medicina refirieron no tener contacto con pacientes que no hablan y en fonoaudiología 33,3% respondió que la comunicación efectiva, ya que la ven como otras posibles formas de comunicación. Todos los académicos son evaluados como importantes o pacientes para comunicarse. Conclusión: Los resultados muestran que la comunicación entre el paciente y el futuro profesional en fonoaudiología se considera efectiva y debe realizarse de manera ética. Los hallazgos reiteran la importancia de la comunicación en la relación paciente-profesional para el bienestar y la salud de la persona, siendo responsabilidad del equipo y no solo del fonoaudióloga, con miras a una atención integral y humanizada.

A influência dos profissionais de saúde na escolha pelo uso da língua de sinais / The influence of health professionals on the choice to use sign language / La influencia de los profesionales de la salud en la elección de utilizar el lenguaje de signos

RESUMO Objetivo: compreender de que forma a conduta do profissional de saúde influencia (ou não) os pais e/ou responsáveis na escolha pelo uso da língua de sinais após o diagnóstico de surdez. Método: estudo descritivo de abordagem qualitativa realizado com pais/responsáveis de crianças e adolescentes surdos. Coleta de dados mediante entrevistas, realizadas nos meses de outubro e novembro de 2021 na cidade de Maceió/AL - BR, os dados foram analisados conforme Bardin. Resultado: a língua de sinais não é a primeira alternativa sugerida aos pais como forma de comunicação dos filhos surdos, visto que os profissionais priorizam o uso do aparelho auditivo e o implante coclear, embora em muitas vezes sua eficácia seja questionada. Conclusão: o estudo contribui para a literatura sobre o tema que ainda é escassa, possibilitando discutir o papel privilegiado que o profissional de saúde possui para influenciar positivamente na vida de indivíduos surdos e suas famílias.

ABSTRACT Objective: to understand how the conduct of health professional's influences (or does not influence) parents and/or guardians in choosing the use of sign language after the diagnosis of deafness. Method: descriptive study of qualitative approach carried out with parents/guardians of deaf children and adolescents. Data were collected through interviews, conducted in October and November 2021 in the city of Maceió/AL - BR, data were analyzed according to Bardin. Results: sign language is not the first alternative suggested to parents as a form of communication with deaf children, since professionals prioritize the use of hearing aids and cochlear implant, although often its effectiveness is questioned. Conclusion: the study contributes to expand the literature on the theme, which is still scarce, making it possible to discuss the privileged role that the health professional must positively influence the lives of deaf individuals and their families.

RESUMEN Objetivo: comprender de qué manera la conducta del profesional de la salud influye (o no influye) en los países y/o responsables en la elección del uso de la lengua de signos tras el diagnóstico de la sordera. Método: estudio descriptivo de enfoque cualitativo realizado con padres/tutores de niños y adolescentes sordos. Recogida de datos a través de entrevistas, realizadas en octubre y noviembre de 2021 en la ciudad de Maceió/AL - BR, los datos fueron analizados según Bardin. Resultados: la lengua de signos no es la primera alternativa que se sugiere a los países como forma de comunicación con los niños mayores, dado que los profesionales priorizan el uso del aparato auditivo y el implante coclear, aunque, muchas veces, su eficacia se pone en duda. Conclusión: el estudio contribuye a ampliar la literatura sobre el tema que aún es escasa, permitiendo discutir el papel privilegiado que el profesional de la salud posee para influir positivamente en la vida de los individuos de sordos y sus familias.

Uso del yo como herramienta terapéutica: una experiencia formativa de terapia ocupacional en pregrado / Uso de si como ferramenta terapêutica: uma experiência formativa na graduação em terapia ocupacional / Use of the self as a therapeutic tool: a formative experience of occupational therapy in an undergraduate course

Resumen Introducción El uso del yo como herramienta terapéutica es una práctica centrada en el cliente y el pilar disciplinar con menor evidencia pedagógica en terapia ocupacional. En Chile, surgen asignaturas vivenciales, ligadas a métodos artísticos/lúdicos que buscan incidir en competencias del estudiante de pregrado para su desarrollo. Objetivo Analizar la experiencia de las estudiantes en relación a los aprendizajes, características y contribuciones de las asignaturas que aportan a la formación del uso del yo como herramienta terapéutica, en carreras de terapia ocupacional de universidades al sur de Chile. Método Investigación cualitativa, con diseño en teoría fundamentada de alcance exploratorio. El muestreo fue no probabilístico, intencionado, por criterio, conformado por quince estudiantes en etapa de internado profesional. La recolección de datos fue mediante dos grupos focales, previa firma de consentimiento informado. El análisis se realizó por método de comparación constante de Glaser y Strauss, utilizando el programa Atlas Ti para sistematizar la información. La rigurosidad científica fue cautelada por los criterios de Guba y Lincoln. Resultados Se identifican 530 unidades de significado, 30 códigos abiertos descriptivos, agrupados en ocho categorías axiales, emergiendo dos núcleos temáticos que abordan el "Proceso de enseñanza aprendizaje en la formación del Uso del Yo" y el "Desarrollo profesional para el Uso del Yo". Conclusión Para los estudiantes las metodologías utilizadas contribuyen de manera relevante al desarrollo del autoconocimiento y competencias genéricas clave para el "Uso del Yo". Esta pedagogía se podría complementar con otras estrategias activas para asegurar la centralidad del usuario en la terapia ocupacional.

Resumo Introdução O uso de si como ferramenta terapêutica é uma prática centrada no cliente e o pilar disciplinar com menor evidência pedagógica em terapia ocupacional. No Chile, surgem disciplinas vivenciais, vinculadas a métodos artísticos/lúdicos que buscam contribuir as habilidades do aluno de graduação para seu desenvolvimento. Objetivo Analisar a experiência dos alunos em relação à aprendizagem, características e contribuições das disciplinas que auxiliam para a formação do uso de si como ferramenta terapêutica, nos cursos de terapia ocupacional em universidades ao sul do Chile. Método Pesquisa qualitativa, com delineamento da teoria fundamentada de alcance exploratório. A amostragem foi não probabilística, intencional, por critério, composta por quinze alunos em etapa de estágio profissional. A coleta de dados se deu por meio de dois grupos focais, após assinatura do consentimento informado. A análise foi realizada pelo método de comparação constante de Glaser e Strauss, utilizando o programa Atlas Ti para sistematizar as informações. O rigor científico foi resguardado pelos critérios de Guba e Lincoln. Resultados Foram identificadas 530 unidades de sentido, 30 códigos abertos descritivos, agrupados em oito categorias axiais, emergindo dois núcleos temáticos que abordam o "Processo de ensino-aprendizagem na formação do Uso de Si" e o "Desenvolvimento profissional para o uso de Si". Conclusão Para os alunos, as metodologias utilizadas contribuem de forma relevante para o desenvolvimento do autoconhecimento e das competências genéricas chave para o "Uso de Si". Essa pedagogia poderia ser complementada com outras estratégias ativas para garantir a centralidade do usuário na terapia ocupacional.

Abstract Introduction The use of the self as a therapeutic tool is a client-centered practice with the least evidence in the pedagogy of occupational therapy. In Chile, experiential subjects arise, linked to artistic/playful methods that seek to influence the skills of the undergraduate student for their development. Objective To analyze the experience of the students in relation to the learning, characteristics, and contributions of the subjects that contribute to the development of the use of the self as a therapeutic tool, in occupational therapy careers at universities in the south of Chile. Method Qualitative research, exploratory with a grounded theory design. The sampling was non-probabilistic, intentional, by criteria, of fifteen students in the professional internship stage. Data collection was through two focus groups, after signing informed consent. The analysis was carried out using the constant comparison method of Glaser and Strauss, using the Atlas Ti program to systematize the information. Scientific rigor was guarded by the criteria of Guba and Lincoln. Results 530 units of meaning are identified, 30 descriptive open codes, grouped into eight axial categories, emerging two thematic nuclei that address the "Teaching-learning process in the formation of the Use of the Self" and the "Professional Development for the Use of the Self". Conclusion For the students, the methodologies used to contribute in a relevant way to the development of self-knowledge and key generic competences for the "Use of the Self". This pedagogy could be complemented with other active strategies to ensure the centrality of the user in occupational therapy.

Nursing staff's instrument for change-of-shift reporting - SBAR (Situation-Background-Assessment-Recommendation): validation and application / Instrumento del pasaje de plantón del grupo de enfermería - SBAR (Situation-Background-Assessment-Recommendation): validación y aplicación / Instrumento de passagem de plantão da equipe de enfermagem - SBAR (Situation-Background-Assessment-Recommendation): validação e aplicação

ABSTRACT Objectives: to validate and apply a change-of-shift instrument using the SBAR (Situation-Background-Assessment-Recommendation) tool. Methods: methodological study for the validation of an instrument. It was validated by ten judges from the area of nursing teaching and care and applied in a surgical gastroenterology ward by 11 nursing technicians in February 2019. The analyses considered descriptive statistics. Results: the judges analyzed the instrument with a content validity index of 91.7% and made suggestions, which led to the second version of the instrument. The participants reported that the predominant modality of shift handover is oral, in the nursing room, lasting six to ten minutes. Most pay attention during shift change, mention that delays and early departures interfere in the activity and believe that the instrument provides the necessary information and is viable. Conclusions: the instrument built was validated, and its application proved relevant, as it was considered necessary and feasible.

RESUMEN Objetivos: validar y aplicar instrumento del pasaje de plantón utilizando la herramienta SBAR (Situation-Background-Assessment-Recommendation). Métodos: estudio metodológico para la validación de instrumento. Este fue validado por diez jueces del área de enseñanza y asistencia de enfermería y aplicado en una enfermería de gastroenterología quirúrgica por 11 técnicos de enfermería en febrero de 2019. Los análisis consideraron la estadística descriptiva. Resultados: los jueces analizaron el instrumento con índice de validez de contenido de 91,7%, hicieron sugestiones generando la segunda versión del instrumento. Los participantes refirieron que la modalidad del pasaje de plantón predominante es oral, en la sala de enfermería, de seis a diez minutos. La mayoría presta atención en el pasaje de plantón, refiere que retrasos y salidas anticipadas interfieren, creen que el instrumento posee informaciones necesarias y es viable. Conclusiones: el instrumento construido fue validado, y su aplicación evidenció la relevancia, pues es considerado necesario y viable.

RESUMO Objetivos: validar e aplicar instrumento de passagem de plantão utilizando a ferramenta SBAR (Situation-Background-Assessment-Recommendation). Métodos: estudo metodológico para a validação de instrumento. O instrumento foi validado por dez juízes da área de ensino e assistência de enfermagem e aplicado em uma enfermaria de gastroenterologia cirúrgica por 11 técnicos de enfermagem no mês de fevereiro de 2019. As análises consideraram a estatística descritiva. Resultados: os juízes analisaram o instrumento com índice de validade de conteúdo de 91,7%, fizeram sugestões gerando a segunda versão do instrumento. Os participantes referiram que a modalidade de passagem de plantão predominante é oral, na sala de enfermagem, de 6 a 10 minutos. A maioria presta atenção na passagem de plantão, refere que atrasos e saídas antecipadas interferem, acreditam que o instrumento possui informações necessárias e é viável. Conclusões: o instrumento construído foi validado e sua aplicação evidenciou a relevância, pois considera-se o instrumento necessário e viável.

Reclamos contra la conducta ética en el ejercicio de la medicina. Análisis de las causas ingresadas a un Tribunal de Ética del Colegio Médico de Chile / Analysis of the cases admitted to a regional ethics court of the Chilean medical association

BACKGROUND: The Ethics Committees of medical associations define standards of conduct to avoid improper professional behavior. AIM: To identify the areas of professional behavior with most allegations of misconduct. MATERIAL AND METHODS: Analysis of all ethical claims received at the Regional Ethics Court of the Chilean Medical Association between 2016 and 2021. RESULTS: Of 323 cases analyzed, 17% of complaints argued a failure in achieving a satisfactory standard of medical care, 15% unprofessional behavior, 14% disruptive interaction among physicians, 12% failure to fulfill therapeutic expectations, 6% poor quality of care, 6% fraud, 6% complains against institutions, 6% sexual misconduct, 6% inappropriate billing, 3% diagnostic errors, 3% inappropriate social behaviors, 1% refusal to provide a sick leave and 1% illegal practice. Only 41.5% of complaints were filed against registered physicians, thus limiting the capabilities of the medical ethical board. CONCLUSIONS: The most common complaints observed were professional misconduct and relationship problems between physicians.

[Paideia Education in primary care: an analysis of institutional democracy and power relations in health sector work practices]. / Formación Paideia en atención primaria: análisis de la democracia institucional y las relaciones de poder en las prácticas laborales en salud.

This article looks at two pedagogical initiatives based on "Paideia Education" in order to analyze their contributions to the production of democratic relations and the co-production of care in primary health care. The first of these initiatives was a seminar on matrix support (2015-2016) that trained 94 specialists, and the second was a seminar on family care (2018-2020) that trained 149 professionals. The 243 participating health professionals came from five different municipalities in Brazil. The results obtained through questionnaires and field diaries kept during the seminars indicate that "Paideia Education" has the ability to motivate professionals to incorporate notions such as the expanded clinic and matrix support into primary health care, and fosters the sharing of care and the co-construction of autonomy with users. However, authoritarian management practices are still frequently directed towards professionals, practiced among professionals themselves, and directed towards patients, and therefore it is necessary to invest in a greater democratization of services beyond training.

Este artículo parte de dos iniciativas pedagógicas de "formación Paideia" con el propósito de analizar sus contribuciones en la producción de relaciones democráticas y en la coproducción del cuidado en atención primaria de la salud. La primera iniciativa realizó una capacitación en apoyo matricial (2015-2016) que reunió a 94 especialistas y, la segunda, una capacitación en salud familiar (2018-2020), que reunió a 149 profesionales. Los 243 profesionales de la salud participantes provenían de cinco municipios brasileños. Los resultados obtenidos a través de cuestionarios y diarios de campo elaborados durante los cursos señalan que la formación Paideia motiva a los profesionales a incorporar una clínica ampliada y el apoyo matricial en atención primaria de la salud, y propicia compartir el cuidado y la co-construcción de la autonomía junto a los usuarios. Sin embargo, aún son frecuentes las prácticas autoritarias de la gestión hacia las y los profesionales, entre profesionales, y desde las y los profesionales hacia las personas usuarias, de modo que es necesario invertir, más allá de la formación, en una mayor democratización de los servicios.

Formación Paideia en atención primaria: análisis de la democracia institucional y las relaciones de poder en las prácticas laborales en salud / Paideia Education in primary care: an analysis of institutional democracy and power relations in health sector work practices

RESUMEN Este artículo parte de dos iniciativas pedagógicas de "formación Paideia" con el propósito de analizar sus contribuciones en la producción de relaciones democráticas y en la coproducción del cuidado en atención primaria de la salud. La primera iniciativa realizó una capacitación en apoyo matricial (2015-2016) que reunió a 94 especialistas y, la segunda, una capacitación en salud familiar (2018-2020), que reunió a 149 profesionales. Los 243 profesionales de la salud participantes provenían de cinco municipios brasileños. Los resultados obtenidos a través de cuestionarios y diarios de campo elaborados durante los cursos señalan que la formación Paideia motiva a los profesionales a incorporar una clínica ampliada y el apoyo matricial en atención primaria de la salud, y propicia compartir el cuidado y la co-construcción de la autonomía junto a los usuarios. Sin embargo, aún son frecuentes las prácticas autoritarias de la gestión hacia las y los profesionales, entre profesionales, y desde las y los profesionales hacia las personas usuarias, de modo que es necesario invertir, más allá de la formación, en una mayor democratización de los servicios.

ABSTRACT This article looks at two pedagogical initiatives based on "Paideia Education" in order to analyze their contributions to the production of democratic relations and the co-production of care in primary health care. The first of these initiatives was a seminar on matrix support (2015-2016) that trained 94 specialists, and the second was a seminar on family care (2018-2020) that trained 149 professionals. The 243 participating health professionals came from five different municipalities in Brazil. The results obtained through questionnaires and field diaries kept during the seminars indicate that "Paideia Education" has the ability to motivate professionals to incorporate notions such as the expanded clinic and matrix support into primary health care, and fosters the sharing of care and the co-construction of autonomy with users. However, authoritarian management practices are still frequently directed towards professionals, practiced among professionals themselves, and directed towards patients, and therefore it is necessary to invest in a greater democratization of services beyond training.

Humanization of the hospital: participatory construction of knowledge and practices on care and ambience / Humanización de hospitales: construcción colectiva de saberes y prácticas de acogida y ambientación / Humanização hospitalar: construção coletiva de saberes e práticas de acolhimento e ambiência

ABSTRACT Objective: To identify and implement care and ambience strategies, with a view to hospital humanization. Method: Action-research study, whose investigation process occurred between January and March 2019, with the participation of employees in strategic functions of a medium-sized hospital, through a focus group and strategic focal analysis. The implementation of care and ambience strategies started in May 2019 and remains in progress, with the responsible and multiplying participation of professionals and patients. Results: 18 employees participated in the study. It was found that investigative processes accompanied by practical interventions, especially those related to the promotion of interactive, inclusive, care spaces and the creation of a ludic, attractive and interactive environment favor multi-professional actions, mobilize innovative knowledge and practices, and contribute to the (re)signification of the being and doing of the health professional. Conclusion: Care and ambience, with a view to hospital humanization, include the implementation of strategies designed with the responsible and multiplying participation of all actors (professionals and users) of the hospital. It is important that, in this process, everyone feels they are protagonists of new ways of being, living and doing in health.

RESUMEN Objetivo: Identificar e implementar estrategias de acogida y ambientación, con miras a la humanización hospitalaria. Método: Se trata de una investigación-acción, cuyo proceso transcurrió entre enero y marzo de 2019 con la participación de colaboradores, de funciones estratégicas en un hospital de porte mediano, mediante grupo focal y análisis focal estratégico. El proceso de implantación de las estrategias de acogida y ambientación comenzó en mayo de 2019 y sigue en marcha con la participación responsable y multiplicadora de profesionales y pacientes. Resultados: Participaron 18 colaboradores. Es evidente que los procesos de investigación, acompañados de intervenciones prácticas, principalmente las relacionadas con la promoción de espacios interactivos, inclusivos y acogedores y la creación de un ambiente lúdico, atractivo y asociativo, favorecen el desempeño multiprofesional, movilizan saberes y prácticas innovadoras y contribuyen al (re)significado del ser y del hacer del profesional en salud. Conclusión: La acogida y la ambientación enfocadas en la humanización del hospital, pasan por la aplicación de estrategias concebidas con la participación responsable y multiplicadora de todos los actores (profesionales y usuarios) del hospital. En este proceso, es importante que todos se sientan protagonistas de nuevas formas de ser, vivir y hacer en salud.

RESUMO Objetivo: Identificar e implementar estratégias de acolhimento e ambiência, com vistas à humanização hospitalar. Método: Pesquisaação, cujo processo de investigação ocorreu entre janeiro e março de 2019, com a participação de colaboradores, advindos de funções estratégicas de um hospital de médio porte, mediante grupo focal e análise focal estratégica. O processo de implementação das estratégias de acolhimento e ambiência ocorreu a partir de maio de 2019 e permanece em andamento com a participação responsável e multiplicadora de profissionais e pacientes. Resultados: Participaram 18 colaboradores. Demostra-se que processos investigativos acompanhados de intervenções práticas, especialmente os relacionados à promoção de espaços interativos, inclusivos, acolhedores, e a criação de ambiência lúdica, atraente e associativa favorecem a atuação multiprofissional, mobilizam saberes e práticas inovadoras e contribuem para a (re)significação do ser e fazer profissional em saúde. Conclusão: O acolhimento e a ambiência, com vistas à humanização hospitalar, perpassam pela implementação de estratégias concebidas com a participação responsável e multiplicadora de todos os atores (profissionais e usuários) do hospital. É importante, nesse processo, que todos se sintam protagonistas de novos modos de ser, conviver e fazer em saúde.

A situação da atenção farmacêutica: revolução ou penumbra paradigmática? / The situation of pharmaceutical care: revolution or paradigmatic twilight?

RESUMO Com o propósito de compreender a situação da atenção farmacêutica em um sistema municipal de saúde, tomou-se como ponto de partida o estudo do grau de adesão e incorporação do paradigma profissional que orienta essa prática. Com um desenho qualitativo e de abordagem etnográfica, os critérios que orientaram essa investigação buscaram tipificar a variedade de cenários, motivações e procedimentos que se associam a esse exercício profissional. Esse recorte permitiu examinar se os movimentos que operam a atenção farmacêutica ainda constituem uma área de penumbra ou se já foi alcançada a concretude de um novo modelo de cuidado para a farmácia. Os resultados informam uma variedade de arranjos, desenhos construtivos e estrutura conceitual. Não há congruência nem na delimitação de seus componentes estruturantes. Todo esse cenário revela que ainda se está em uma fase de penumbra ou 'crise paradigmática', na qual o antigo paradigma ainda não foi totalmente abandonado ante a superioridade do novo. Isso se observa na ausência de uma interpretação padronizada capaz de revelar elementos recorrentes e compartilhados. Desse modo, o reconhecimento de uma realização exemplar, capaz de consolidar a maturidade e transição paradigmática da atenção farmacêutica, não foi encontrado.

ABSTRACT In order to understand the situation of pharmaceutical care in a municipal health system, we took as a starting point the study of the degree of adherence and incorporation of the professional paradigm that guides this practice. With a qualitative design and an ethnographic approach, the criteria that guided this investigation sought to typify the variety of scenarios, motivations and procedures that are associated with this professional exercise. This cutout allowed us to examine whether the movements that operate pharmaceutical care are still an area of darkness or the concreteness of a new care model for Pharmacy has already been achieved. The results inform a variety of arrangements, constructive designs, and a conceptual framework. There is no congruence or delimitation of its structuring components. The entire scenario reveals that we are still in a phase of twilight or ‘paradigmatic crisis’, in which the old paradigm has not yet been totally abandoned in the face of the superiority of the new one. This is observed in the absence of a standardized interpretation capable of revealing recurrent and shared elements. Thus, the recognition of an exemplary achievement, capable of consolidating the maturity and paradigmatic transition of pharmaceutical care, was not found.

Acesso e continuidade assistencial na busca por cuidado em saúde: tecendo a rede entre encontros e entrelaços / Access and continuity of care in the search for health care: weaving the network between encounters and entanglements

Resumo Este artigo busca analisar o acesso e a continuidade do cuidado em trajetórias assistenciais de mulheres através da identificação dos principais pontos de apoio na rede de atenção à saúde. Trata-se de uma pesquisa qualitativa, realizada em uma região de saúde do Rio de Janeiro, a partir de entrevista semiestruturada com 21 mulheres para produção de suas trajetórias assistenciais. Os dados foram tratados por meio de análise de conteúdo e categorizados em quatro unidades temáticas: os agentes comunitários de saúde, identificados como o primeiro contato e facilitadores do acesso à rede; os profissionais de enfermagem, com quem se estabeleceram os mais fortes vínculos longitudinais e alguma possibilidade de continuidade do cuidado; o médico, que representava a expectativa de cura, mas onde os laços e a comunicação com as usuárias foram mais frágeis; e outros pontos de apoio, representados por atores intermediários (amigos, familiares, figuras políticas e outros) presentes ora como apoio, ora como facilitadores do acesso ao cuidado oportuno. O mosaico de trajetórias produzidas pelas mulheres na rede de atenção à saúde indicou fragilidades para garantia de acesso e continuidade do cuidado, mas também potências para a produção de intervenções e práticas que respondam a desejos e necessidades em saúde.

Abstract This article seeks to analyze the access and continuity of care in women's care trajectories through the identification of the main points of support in the health care network. This is a qualitative research, carried out in a health region of Rio de Janeiro, based on a semi-structured interview with 21 women to produce their care trajectories. The data were treated through content analysis and categorized into four thematic units: community health agents, identified as the first contact and facilitators of access to the network; nursing professionals, with whom the strongest longitudinal bonds and some possibility of continuity of care were established; the doctor, who represented the expectation of a cure, but where ties and communication with users were more fragile; and other points of support, represented by intermediate actors (friends, family, political figures and others) present at times as support, at times as facilitators of access to timely care. The mosaic of trajectories produced by women in the health care network indicated weaknesses to guarantee access and continuity of care, but also potencies to produce interventions and practices that respond to health wants and needs.

Skills and practices of pharmacy staff for dispensing of drugs with fiscalized substances in drugstores and pharmacies

ABSTRACT OBJETIVE To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.

Patient Satisfaction Towards Dentist-Patient Interaction Among Patients Attending Outpatient Dental Clinic Hospital Universiti Sains Malaysia

ABSTRACT Objective: To determine the satisfaction with the dentist-patient interaction and factors associated with patient satisfaction among patients attending the outpatient dental clinic Hospital Universiti Sains Malaysia (HUSM). Material and Methods: This cross-sectional study involved 229 patients who attended outpatient dental clinic Hospital USM that located in the East Coast region of Malaysia. A self-administered Skala Kepuasan Interaksi Perubatan - 11 (SKIP-11) questionnaire was used to assess the satisfaction towards dentist-patient interaction. Systematic random sampling was applied in this study. The data were analyzed using simple logistic regression analysis to determine the factors associated with patient satisfaction with dentist-patient interaction. Results: The mean age of patients was 32.6 ± 13.9 years, 71.6% of them study up to tertiary level, 31.5% came to for dental check up and 23.6% of them had tooth decay. More than half (64.6%) of the patients were satisfactory with dentist-patient interaction. The satisfaction percentage in the distress relief domain was 60.7%, 56.8% in the rapport domain, and 53.7% in the interaction outcome domain. Satisfaction with dentist-patient interaction was significantly associated with the dentists' characteristics such as age (OR = 0.583, 95%CI 0.44-0.76, p=0.001), gender (OR = 0.386, 95% CI 0.22-0.69, p=0.001) and years of service (OR = 0.294, 95% CI 0.15-0.57, p=0.001). Conclusion: The result showed that slightly more than half of the patients who attended the outpatient dental clinic HUSM were satisfied with the dentist-patient interaction, which was found to be influenced by the characteristics of the dentists. Efforts to improve patient-dentist interaction are recommended to ensure delivery of good quality oral health care.

Enhancing citizenship through nursing care in Brazil: Patients' struggle against austerity policies.

Interpersonal relations play a critical role in both the conception and dynamics of Brazilian citizenship. Under the influence of neoliberalism, patients must build strategies to access high-quality health care services. This study aimed to analyze the role of interpersonal relations involved in the access to and delivery of health care services in Brazil amid the influence of austerity policies and the role of nurses in enhancing citizenship through nursing care. Thirty-one patients in a public hospital in Rio de Janeiro, Brazil, participated in qualitative interviews. A lexical analysis was conducted to analyze the interview data using Alceste® software, version 2012. The results were interpreted in light of both theoretical constructs of the Brazilian citizenship and biological subcitizenship propositions. Two lexical classes revealed contents about strategies used by patients to access high-quality health care. In the context of budget cuts due to austerity policies, cultural aspects of Brazilian citizenship have influenced access to high-quality health care services by creating two distinct conditions. Some patients acted as super-citizens, while others acted as subcitizens. Nurses across the globe must spearhead the struggle for universal and equitable health care access at all levels, without losing sight of wider sociocultural aspects.