Nurses' perception of the nursing process and its relationship with leadership.

OBJECTIVES: to describe Nurses' perception of the Nursing Process and its relationship with leadership. METHODS: action research conducted between September/2021 and April/2022 with nurses from a medium-sized hospital in southern Brazil. The data investigated, one of the stages of the method, was collected using the Focus Group technique and submitted to Strategic Focus Analysis. RESULTS: three categories emerged from the organized and analyzed data, namely: Nursing Process: a tool that qualifies nursing care; Conditions that weaken the Nursing Process; and Strategies that enhance the Systematization of Nursing Care. FINAL CONSIDERATIONS: the perception of the Nursing Process and its relationship with leadership are not always understood as complementary themes. Although they recognize that the Nursing Process is sometimes imposed as normative, nurses do not perceive the importance of the role of the leader, who is considered a key player in conducting and boosting the Systematization of Nursing Care.

"Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes.

BACKGROUND: A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?" METHODS: A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway. RESULTS: Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes. CONCLUSIONS: Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

Children and youth mental health from the perspective of workers in a health network / Saúde mental infantojuvenil na perspectiva de trabalhadores de uma rede de saúde / La salud mental infantil y juvenol desde la perspectiva de los trabajadores de una red sanitaria

The objective was to understand the difficulties and potential of a Mental Health (MH) network aimed at children and adolescents, identifying how professionals understand and operationalize the principles of the policy of SM for children and adolescents. Five Focus Groups were held, with the participation of 43 workers. We used lexical analysis through the Iramuteq software, originating four classes: "What is being a child and adolescent?"; "What do children and adolescents suffer from?"; "On the relationship between services" and "Potentials and challenges of the Mental Health Network". Difficulties in sharing care were identified, articulating the network outside of oneself. Capsij is perceived as a priority for user embracement, and there is still difficulty in providing care in MH in Primary Care (AB). It is concluded that the complexity of care in MS for children and adolescents imposes the need to continue strategies to strengthen the AB and intersectoral actions aimed at an expanded clinic. (AU)

Objetivou-se conhecer as dificuldades e potencialidades de uma rede de Saúde Mental (SM) voltada a crianças e adolescentes, identificando como profissionais compreendem e operacionalizam os princípios da política de SM infantojuvenil. Foram realizados cinco Grupos Focais, com participação de 43 trabalhadores. Utilizou-se da análise lexical por meio do software Iramuteq, originando quatro classes: "O que é ser criança e adolescente?"; "Do que sofrem as crianças e adolescentes?"; "Sobre a relação entre os serviços" e "Potencialidades e desafios da Rede de Saúde Mental". Identificou-se dificuldades em compartilhar o cuidado, articulando a rede para fora de si. O Capsij é percebido como prioritário para o acolhimento, havendo, ainda, dificuldade em efetivar os cuidados em SM na Atenção Básica (AB). Conclui-se que a complexidade da atenção em SM para crianças e adolescentes impõe a necessidade de continuidade de estratégias de fortalecimento da AB e de ações intersetoriais visando uma clínica ampliada. (AU)

El objetivo fue comprender las dificultades y potencialidades de una red de Salud Mental (SM) para niños y adolescentes, identificando cómo los profesionales entienden y operacionalizan los principios de la política de SM para la niñez y adolescencia. Se realizaron cinco Grupos Focales, en los que participaron 43 trabajadores. Se utilizó el análisis léxico a través del software Iramuteq, originando cuatro clases: "¿Qué es ser niño y adolescente?"; "¿Qué padecen los niños y adolescentes?"; "Sobre la relación entre servicios" y "Potencialidades y desafíos de la Red de Salud Mental". Se identificaron dificultades a la hora de compartir los cuidados, articulando la red para fuera de sí. El Capsij se percibe como una prioridad para la acogida, existiendo aún dificultades para implementar los cuidados en SM en Atención Primaria (AP). Se concluye que la complejidad de la atención en SM para niños y adolescentes impone la necesidad de continuidad de las estrategias de fortalecimiento de la AP y de acciones intersectoriales, visando una clínica ampliada. (AU)

Concepções de idosos com hipertensão e/ou diabetes sobre qualidade de vida / Concepciones de las personas mayores con hipertensión y/o diabetes sobre la calidad de vida / Conceptions of elderly people with hypertension and/or diabetes about quality of life

RESUMO O objetivo deste estudo foi compreender as concepções de qualidade de vida de idosos portadores de hipertensão arterial sistêmica e diabetes mellitus tipo II. Trata-se de um estudo exploratório-descritivo de abordagem qualitativa, e a estratégia de coleta de dados foi a técnica de Grupo Focal. Os dados foram analisados usando o programa de análise qualitativa - QDA miner e interpretados através da análise de conteúdo, proposta por Bardin. Os dados revelaram duas categorias: 'Concepções de Qualidade de Vida', que aponta para os elementos que atravessam a compreensão que os idosos têm da qualidade de vida e 'Relação entre Qualidade de vida e doença crônica', como a vivência da doença crônica está associada à qualidade de vida. Os dados indicam que as concepções de qualidade de vida de idosos com hipertensão arterial e diabetes mellitus passam pelo processo de convivência com a doença crônica, enfatizando a importância de fatores subjetivos, especialmente os recursos psicológicos e sociais dos idosos, que auxiliam no enfrentamento dos efeitos negativos das condições crônicas que interferem na qualidade de vida.

RESUMEN El objetivo de este estudio fue comprender las concepciones de cualidad de vida de ancianos con hipertensión arterial y diabetes mellitus. Se trata de un estudio exploratorio-descriptivo de enfoque cual itativo y la estrategia para la recolección de datos fue la técnica de Grupo Focal. Los datos se analizaron usando el programa de análisis cualitativo-QDA miner e interpretados a través del análisis de contenidos propuesta por Bardin. Los datos revelaron dos categorías: "'concepciones de calidad de vida", ', que señala los elementos que pasan por la comprensión que los ancianos tienen de calidad de vida y "'la relación calidad de vida y enfermedad crónica" ' - cómo la experiencia de la enfermedad crónicas se asocia con la calidad de vida. Los datos indicaron que las concepciones de cualidad de vida de ancianos con hipertensión arterial y diabetes mellitus pasan por el proceso de convivencia con la enfermedad crónica enfatizando la importancia de factores subjetivos especialmente los recursos psicológicos y sociales de los ancianos que ayudan en el enfrentamiento de los efectos negativos de las condiciones crónicas que interfieren en la cualidad de vida.

ABSTRACT The aim of this study was to understand the quality of life concepts in elderly people who suffers from arterial hypertension and diabetes mellitus. It is a descriptive and exploratory study with qualitative approach, the data collection strategy was Focus Group Interviews. The software QDA Miner was used for qualitative data analysis and the Content Analysis Method proposed by Bardin was used for data interpretation. The data had disclosed two categories: 'concepts of quality of life', pointing to the elements that go through the understanding that the elderly have of the quality of life, and 'relation between quality of life andchronic illness' - how the experience of chronic disease is associated with quality of life. Data had indicated that the quality of life concepts in this population are related to the way they live with the chronic illness. The subjective factors are very important concerning the elderly people life with the chronic illness, mainly their psychological and social resources, that help them to fight the negative effects of chronic illness conditions in the quality of life.

Conception of workers in a municipal health network about the service-management relationship / Concepção dos Trabalhadores de uma Rede Municipal de Saúde sobre a Relação Serviço-Gestão / Concepción de los trabajadores de una red de salud municipal sobre la relación servicio-gestión

The objective of this work was to understand the conceptions of health professionals about the relationship between management and the different services that constitute the public health network of a municipality in the southeastern region of Brazil. It used the Focus Group (FG) technique for data collection. Three FG were held with an average of 12 participants per meeting, totaling 38 participants. The Lexical Descending Hierarchical Classification analysis was applied with the support of the Iramuteq software. The results outlined four classes: Management-Service Relationship; Daily challenges of services; Sustainability of work in the territory and Prioritization of the user. The relationship between health services and management was marked by hierarchical practices. However, it was possible to verify that there are expectations regarding the establishment of a transversal relationship. Collective spaces and user participation in care management are considered as important elements for co-management. (AU)

Objetivou-se compreender as concepções de profissionais de saúde sobre a relação de uma gerência com os diversos serviços que compõem a rede de saúde pública de um município da região sudeste do Brasil. Utilizou-se da técnica do Grupo Focal (GF) para a coleta de dados. Foram realizados três GF com a composição média de 12 participantes por encontro, totalizando 38 participantes. Seguiu-se com a análise lexical do tipo Classificação Hierárquica Descendente com o auxílio do software Iramuteq. Os resultados delinearam quatro classes: "Relação Gestão-Serviço"; "Desafios cotidianos dos serviços"; "Sustentação do trabalho no território" e "Priorização do usuário". O estudo indica que a relação serviços-gestão é marcada por práticas hierarquizadas. Contudo, foi possível verificar que existem expectativas em torno da instauração de uma relação transversalizada. Pondera-se os espaços coletivos e a participação dos usuários na gestão do cuidado como elementos importantes para a cogestão. (AU)

El objetivo de este trabajo fue comprender las concepciones de los profesionales de la salud sobre la relación entre la gestión y los diferentes servicios que componen la red pública de salud de un municipio de la región sudeste de Brasil. Se utilizó la técnica de Grupo Focal (GF) para la recolección de datos. Se realizaron tres GF con un promedio de 12 participantes por reunión, totalizando 38 participantes. Un análisis léxico de Clasificación Jerárquica Descendente fue aplicado con el apoyo del software Iramuteq. Los resultados distinguieron cuatro clases: "Relación Gestión-Servicio"; "Retos cotidianos del servicio"; "Sostenibilidad del trabajo en el territorio" y "Priorización de usuario". El estudio indicó que la relación entre los servicios de salud y la gestión está marcada por prácticas jerárquicas. Sin embargo, se pudo constatar que existen expectativas en cuanto al establecimiento de una relación transversal. Los espacios colectivos y la participación de los usuarios en la gestión de la atención se consideran elementos importantes para la cogestión. (AU)

Nutrition education incorporation into mainstream primary school curriculum in Ghana: Stakeholders' sources of nutrition information and perceived barriers.

INTRODUCTION: Nutrition literacy has been cited as a crucial life skill. Nutrition education as a primary school subject has been treated inconsequentially when compared to other subjects. We investigated an aspect of the current state of nutrition education in Ghana by engaging stakeholders about their sources of nutrition information and the perceived barriers in implementing nutrition education in mainstream primary schools. METHODS: Three hundred and fifty one (351) primary school children, 121 homebased caregivers, six schoolteachers, two headteachers, two Ghana Education Service (GES) officials, and six school cooks were involved in the study. Surveys were used to collect data on nutrition information acquisition behaviors and to record perceived barriers. Key Informant Interviews were conducted among GES officials, headteachers, schoolteachers and school cooks, while Focus Group Discussions were used among homebased caregivers and children to gather qualitative information. RESULTS: Only 36.3% of the primary school children had heard about nutrition, and 71% of those got nutrition information from their family members. About 70% of homebased caregivers had heard or seen nutrition messages, and their source of nutrition information was predominantly traditional media. Schoolteachers mostly received their nutrition information from non-governmental organizations and the Internet, while most of the school cooks stated their main source of nutrition information was hospital visits. Perceived barriers included schoolteachers' knowledge insufficiency, and lack of resources to adequately deliver nutrition education. Lack of a clear policy appeared to be an additional barrier. CONCLUSION: The barriers to the implementation of nutrition education in the mainstream curriculum at the primary school level that were identified in this study can be resolved by: providing schoolteachers with learning opportunities and adequate nutrition education resources for practical delivery, having specific national policy framework, and including family members and school cooks in the nutrition education knowledge and information dissemination process.

Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

O olhar de usuários, residentes e trabalhadores sobre uma intervenção em saúde bucal de abordagem comunitária na ESFdo campo / Perspective of users, residents and workers on a community-based oral health intervention in the rural FHS

Objetivou-se analisar uma intervenção de cuidado integral em saúde bucal de abordagem comunitária protagonizada por residentes de Odontologia em Saúde da Família inseridos em duas unidades de saúde do campo de Caruaru/PE, segundo o olhar de profissionais, residentes e usuários. A intervenção englobou diagnóstico e levantamento das necessidades odontológicas, ações coletivas em saúde bucal e ações assistenciais para cárie com tratamento restaurador atraumático. Os grupos-alvo formam escolares e moradores de áreas mais remotas nas unidades de Lagoa de Pedra e de Xicuru. O estudo qualitativo utilizou técnica do grupo focal para coleta dos dados. Três grupos foram constituídos: nove profissionais, seis residentes e oito usuários. As entrevistas seguiram um roteiro com perguntas abertas sobre o cuidado e as tecnologias em saúde bucal empregadas no contexto das populações campesinas e acesso/acessibilidade às unidades de saúde. Os dados foram submetidos à análise de conteúdo. Emergiram duas categorias temáticas: dificuldades de acesso aos cuidados em saúde bucal e satisfação com as ações implementadas. Os participantes dos três grupos avaliaram positivamente a iniciativa de estabelecer relação educativa/assistencial participativa abrindo-se a espaços comunitários e valorizaram o enfoque adotado pela intervenção de saúde bucal no enfrentamento dos problemas limitadores do acesso aos serviços odontológicos e às ações coletivas que relataram. Contudo, desinteresse na continuidade das ações realizadas e contrários às práticas comunitárias em saúde bucal foram relatadas no grupo focal dos profissionais. Considera-se persistir fatores profissionais e de estrutura limitadores à garantia dos direitos de acesso à saúde aos usuários de áreas mais remotas às unidades de saúde (AU).

The aimof this study was to analyze a comprehensivecommunity-basedoral health care intervention carried out by residents of Dentistry in Family Health inserted in two health units in the rural area of the municipalityof Caruaru/PE, according to the perspective of professionals, residents and users. The intervention included diagnosis and assessment of dental needs, collective actions in oral health and actions for caries treatment with atraumatic restorative treatment. Target groupswere composed of schoolchildren and users frommore remote areas included in the health units of Lagoa de Pedra and Xicuru. The qualitative study used the focus group technique for data collection. Three groups were formed: nine professionals, six residents and eight users. Interviews followed a script with open questions about oral health care and technologies used in the context of ruralpopulations and access/accessibility to health units. Data were submitted to content analysis. Two thematic categories emerged: difficulties in accessing oral health care and satisfaction with implemented actions. Participants in the three groups positively evaluated the initiative ofestablishinga participatory educational/care relationship by opening up to community spaces and valued the approach adopted by the oral health intervention in dealing with problems that limit access to dental services and the reported collective actions. However, lack of interest in the continuity of actions carried out and contrary to community practices in oral health were reported in the focus group of professionals. There ispersistent presence of professional and structural factors that limit the guarantee of access to health ofusers frommore remote areas included inhealth units.

A vivência do medo por estudantes universitários durante a pandemia de Covid-19 / La vivencia del miedo por estudiantes universitarios durante la pandemia de Covid-19 / The experience of fear by university students during the Covid-19 pandemic

RESUMO Objetivo: compreender a vivência do medo por estudantes universitários durante a pandemia de COVID-19. Métodos: estudo exploratório, qualitativo, realizado com 16 estudantes matriculados em instituições de ensino superior brasileiras. Os dados foram coletados em junho de 2020, através de grupo focal realizado virtualmente, utilizando-se um roteiro semiestruturado com questões norteadoras. A partir da análise de conteúdo, modalidade temática, emergiram as categorias: Medo do desconhecido e suas repercussões na vida de estudantes universitários e viver daqui por diante: desafios impostos pela pandemia e semelhanças com experiências anteriores. Resultados: a pandemia de COVID-19 simbolizava o novo, evidenciado pelo sentimento de medo dos participantes frente ao imprevisível, à solidão, ao sofrimento e à finitude humana. As narrativas mostraram mudanças no viver dos estudantes universitários. Conclusão: apesar de seu ineditismo, a vivência da pandemia encontrou semelhanças em experiências pregressas de eventos estressores que possibilitaram aos participantes aprender e desenvolver sua capacidade de resiliência.

RESUMEN Objetivo: comprender la vivencia del miedo por estudiantes universitarios durante la pandemia de COVID-19. Métodos: estudio exploratorio, cualitativo, realizado con 16 estudiantes inscriptos en instituciones de enseñanza superior brasileñas. Los datos fueron recolectados en junio de 2020, a través de un grupo focal realizado virtualmente, utilizando una guion semiestructurado con cuestiones orientadoras. A partir del análisis de contenido, modalidad temática, surgieron las categorías: Miedo a lo desconocido y sus repercusiones en la vida de estudiantes universitários y Vivir de aquí en adelante: desafíos impuestos por la pandemia y semejanzas con experiencias anteriores. Resultados: la pandemia de COVID-19 simbolizaba lo nuevo, evidenciado por el sentimiento de miedo de los participantes frente a lo impredecible, a la soledad, al sufrimiento y a la finitud humana. Los relatos mostraron cambios en el vivir de los estudiantes universitarios. Conclusión: pese su carácter inédito, la vivencia de la pandemia encontró similitudes en experiencias anteriores de eventos estresantes que permitieron a los participantes aprender y desarrollar su capacidad de resiliencia.

ABSTRACT Objective: aprehending the experience of fear by university students during the Covid-19 pandemic. Methods: an exploratory, qualitative study conducted with 16 students enrolled in Brazilian higher education institutions. Data were collected in June 2020 through a virtually performed focus group using a semi-structured script with north-section questions. From the content analysis, thematic modality, the following categories emerged: Fear of the unknown and its repercussions on the lives of university students and Living going forward: challenges imposed by the pandemic and similarities with previous experiences. Results: the Covid-19 pandemic symbolized the new, evidenced by the participants' feeling of fear in the face of the unpredictable, loneliness, suffering and human finitude. The narratives showed changes in the lives of university students. Conclusion: despite its originality, the experience of the pandemic found similarities in previous experiences of stressful events that allowed participants to learn and develop their resilience.

O significado do uso de telas entre adolescentes: causas e consequências / El significado del uso de pantallas entre adolescentes: causas y consecuencias / The signification of the use of screens among adolescents: causes and consequences

RESUMO Objetivo: compreender o significado do uso de telas atribuído pelos adolescentes. Métodos: o presente estudo foi descritivo exploratório, com abordagem qualitativa e referencial teórico-metodológico do interacionismo simbólico. Participaram adolescentes de uma escola pública mineira. Os dados foram coletados através de entrevistas e grupos focais realizados de forma online e analisados conforme a análise temática no período deagosto a dezembro de 2020. Resultados: participaram oito adolescentescom idades entre 14 e 17 anos, que cursavam o ensino médioe relataram que a tela mais usada foi o celular. Os significados atribuídos ao uso de telas estiveram relacionados à possibilidade de interação e praticidade por possibilitar a realização de várias atividades. Houve o reconhecimento que, diante do uso excessivo, é preciso ter momento distante da tela. Após a análise foram desveladas três categorias: 1. Tela é diversidade 2. Tela é interação, 3. É bom parar um pouco. Considerações finais: a pesquisa mostrou que distanciar-se das telas é difícil e que a presença de profissionais da saúde, particularmente relacionados à saúde do adolescente, pode ajudá-los a encontrar alternativas para usar as telas com redução das consequências negativas.

RESUMEN Objetivo: comprender el significado del uso de pantallas asignado por los adolescentes. Métodos: el presente estudio fue descriptivo exploratorio, con abordaje cualitativo y referencial teórico-metodológico del interaccionismo simbólico. Participaron adolescentes de una escuela pública de Minas Gerais-Brasil. Los datos fueron recolectados a través de entrevistas y grupos focales realizados en forma online y analizados conforme el análisis temático en el período de agosto a diciembre de 2020. Resultados: participaron ocho adolescentes con edades entre 14 y 17 años, que cursaban la enseñanza secundaria y relataron que la pantalla más usada fue el celular. Los significados atribuidos al uso de pantallas estuvieron relacionados a la posibilidad de interacción y practicidad por posibilitar la realización de varias actividades. Hubo el reconocimiento de que, ante el uso excesivo, es necesario tener momento alejado de la pantalla. Después del análisis surgieron tres categorías: 1. La pantalla es diversidad; 2. La pantalla es interacción; 3. Es bueno detenerse un poco. Consideraciones finales: la investigación ha demostrado que distanciarse de las pantallas es difícil y que la presencia de profesionales de la salud, particularmente involucrados con la salud del adolescente, puede ayudarles a encontrar alternativas para usar las pantallas con reducción de las consecuencias negativas.

ABSTRACT Objective: to understand the signification of the use of screens attributed by adolescents. Methods: the current study was descriptive and exploratory, with a qualitative approach and theoretical-methodological framework of symbolic interactionism. Adolescents from a public school in Minas Gerais participated in it. Data were collected through interviews and focus groups carried out online and analyzed according to thematic analysis in the period from August to December 2020. Results: it had the participation of eight adolescents aged between 14 and 17 years, who attended high school and reported that the most used screen was the cell phone. The significations attributed to the use of screens were related to the possibility of interaction and practicality for allowing the performance of various activities. There was recognition that, in the face of excessive use, it is necessary to have a moment away from the screen. After the analysis, three categories were revealed: 1. Screen is diversity 2. Screen is interaction, 3. It is good to stop for a while. Final considerations: research has shown that distance from screens is difficult and the presence of health professionals, particularly related to adolescent health, can help them to find alternatives to use screens with reduced negative consequences.

Construção de fluxograma e protocolo de enfermagem para manejo da sífilis na atenção primária em saúde / Construcción de flujograma y protocolo de enfermería para el manejo de la sífilis en la atención primaria de salud / Construction of a nursing flowchart and protocol for syphilis management in primary health care

RESUMO Introdução: a sífilis é uma doença facilmente tratável, porém, no Brasil, ainda é um problema de saúde pública. Objetivo: construir um fluxograma e um protocolo para manejo da sífilis em adultos na Atenção Primária à Saúde. Método: pesquisa quanti-qualitativa, desenvolvida em 2019, realizada com 42 enfermeiros da Atenção Primária à Saúde de um município no oeste catarinense. Para a etapa quantitativa aplicou-se um questionário autoaplicado, embasado nos protocolos vigentes do Ministério da Saúde. A etapa qualitativa ocorreu por meio de uma pesquisa participativa do tipo pesquisa-ação com oito dos 42 enfermeiros. Estes, em dois grupos focais, produziram coletivamente um fluxograma e um protocolo de manejo da sífilis em adultos e, posteriormente, após análise do material construído, validaram os documentos, por meio de análise de conteúdo, resultando em 100% de concordância. Resultados: os produtos construídos representam a descrição das melhores práticas profissionais a serem seguidas. O fluxograma apresenta as etapas no manejo, e o protocolo descreve as atividades que envolvem o atendimento relacionado à doença nos adultos atendidos na Atenção Primária à Saúde do município. Considerações finais: a construção do fluxograma e do protocolo atenderam as necessidades dos profissionais da saúde, na qualificação do atendimento às pessoas com sífilis no município.

RESUMEN Introducción: la sífilis es una enfermedad fácilmente tratable, sin embargo, en Brasil, todavía es un problema de salud pública. Objetivo: construir un flujograma y un protocolo para el manejo de la sífilis en adultos en la Atención Primaria de Salud. Método: investigación cuanti-cualitativa, desarrollada en 2019, realizada con 42 enfermeros de la Atención Primaria de Salud de un municipio en el oeste catarinense, Brasil. Para la etapa cuantitativa se aplicó un cuestionario autoaplicado, basado en los protocolos vigentes del Ministerio de Salud. La etapa cualitativa ocurrió por medio de una investigación del tipo acción participativa con ocho de los 42 enfermeros. Estos, en dos grupos focales, produjeron colectivamente un flujograma y un protocolo de manejo de la sífilis en adultos y, posteriormente, tras el análisis del material construido, validaron los documentos, por medio de análisis de contenido, resultando en un 100% de concordancia. Resultados: los productos construidos representan la descripción de las mejores prácticas profesionales a seguir. El flujograma presenta las etapas en el manejo, y el protocolo describe las actividades que involucran la atención relacionada con la enfermedad en los adultos atendidos en la Atención Primaria de Salud del municipio. Consideraciones finales: la construcción del flujograma y del protocolo atendieron las necesidades de los profesionales de la salud, en la calificación de la atención a las personas con sífilis en el municipio.

ABSTRACT Introduction: syphilis is an easily treatable disease, even though it is still a public health problem in Brazil. Objective: to build a flowchart and a protocol for syphilis management in adults in Primary Health Care. Method: quantitative-qualitative study of 42 Primary Health Care nurses from a municipality in western Santa Catarina performed in 2019. In the quantitative stage, a self-administered questionnaire based on the current protocols of the Ministry of Health was applied. The qualitative stage was performed through participatory action research with eight out of 42 nurses. In two focus groups, they collectively produced a flowchart and a protocol for the management of syphilis in adults. After analyzing the constructed material, they validated the documents through content analysis, resulting in 100% agreement. Results: the products built describe the best professional practices to be followed. The flowchart presents the steps in the management, and the protocol describes the activities involving the care related to the disease in adults treated in Primary Health Care of the municipality. Final considerations: the construction of the flowchart and the protocol met the needs of health professionals in the qualification of care for people with syphilis in the municipality.

Educação permanente em saúde como prática possível: uma experiência na atenção primária / Educación permanente en salud como práctica posible: experiencia en atención primaria / Permanent health education as a possible practice: an experience in primary care

RESUMO Objetivo: descrever o processo de análise de necessidades, execução e avaliação de um programa educativo na Atenção Primária à Saúde, na lógica da Educação Permanente em Saúde (EPS). Método: pesquisa-ação com abordagem mista, desenvolvida entre 2014 e 2016, com trabalhadores da saúde. A coleta de dados ocorreu nos encontros de grupo focal, oficinas do programa educativo e aplicação de questionários. Os dados qualitativos foram submetidos à análise de discurso do sujeito coletivo, e os dados quantitativos, à análise estatística descritiva. Resultados: a necessidade priorizada foi a comunicação prejudicada no ambiente de trabalho; e, durante a execução do programa educativo, os participantes pactuaram acordos para superação dos problemas identificados, a exemplo da criação de espaços de diálogo e fluxos definidos de comunicação. Sentiram-se satisfeitos em participar, e percebeu-se que o programa educativo causou impacto positivo no trabalho. Considerações finais: o objetivo de descrever todo processo da EPS foi alcançado. Houve maior estímulo para um movimento de transformação no processo de trabalho, em referência ao aprimoramento da comunicação na dimensão profissional da gestão do cuidado, a partir de um paradigma dialógico e crítico, capaz de ressignificar o processo de ensino-aprendizagem no trabalho. Como produto, tem-se um modo mais efetivo de operar a EPS.

RESUMEN Objetivo: describir el proceso de análisis de necesidades, ejecución y evaluación de un programa educativo en la Atención Primaria de Salud, en la lógica de la Educación Permanente en Salud (EPS). Método: investigación-acción con enfoque mixto, desarrollada entre 2014 y 2016, con trabajadores de la salud. La recolección de datos tuvo lugar en los encuentros de grupo focal, talleres del programa educativo y aplicación de cuestionarios. Los datos cualitativos fueron sometidos al análisis de discurso del sujeto colectivo, y los datos cuantitativos, al análisis estadístico descriptivo. Resultados: la necesidad priorizada fue la comunicación perjudicada en el ambiente de trabajo; y, durante la ejecución del programa educativo, los participantes pactaron acuerdos para superar los problemas identificados, a ejemplo de la creación de espacios de diálogo y flujos definidos de comunicación. Se sintieron satisfechos de participar, y se percibió que el programa educativo causó impacto positivo en el trabajo. Consideraciones finales: el objetivo de describir todo el proceso de EPS fue alcanzado. Hubo mayor estímulo para un movimiento de transformación en el proceso de trabajo, en referencia al perfeccionamiento de la comunicación en la dimensión profesional de la gestión del cuidado, a partir de un paradigma dialógico y crítico, capaz de resignificar el proceso de enseñanza-aprendizaje en el trabajo. Como producto, se tiene un modo más efectivo de operar la EPS.

ABSTRACT Objective: to describe the process of needs analysis, execution and evaluation of an educational program in Primary Health Care, in the logic of Permanent Health Education (PHE). Method: action research with mixed approach, developed between 2014 and 2016, with health workers. Data collection occurred in focus group meetings, educational program workshops and questionnaire application. The qualitative data were submitted to discourse analysis of the collective subject, and quantitative data were submitted to descriptive statistical analysis. Results: the prioritized need was impaired communication in the work environment; and, during the implementation of the educational programme, participants agreed agreements to overcome the identified problems, such as the creation of dialogue spaces and defined communication flows. They were satisfied to participate, and it was noticed that the educational program had a positive impact on the work. Final considerations: the objective of describing the entire Process of PHE was achieved. There was a greater stimulus for a movement of transformation in the work process, in reference to the improvement of communication in the professional dimension of care management, from a dialogical and critical paradigm, capable of resignifying the teaching-learning process at work. As a product, there is a more effective way to operate PHE.

Motivations for entering a physical education teacher training program in Chile / Motivações para incursão em um curso superior de educação física no Chile

ABSTRACT Physical education teacher training programs in Chile have a high demand for enrollment and is recognized as one of the attractive professions for young people. The purpouse of this study is to know the reasons that lead young Chileans to choose the physical education teacher training program at a regional university, in the Maule region, Chile. The research was a mixed sequential one, since it was characterized by a first stage, where quantitative data were collected and analyzed, followed by another, where qualitative data were collected and interpreted. At the quantitative part of the study 146 students (54 female and 89 male) answered a questionnaire, and at the qualitative part 6 students (3 men and 3 women) participated in a focus group interview. Previous participation in sport, interest related to a physically active lifestile, and the pleasure of teaching are shown in the results. As conclusions, the students choose to enroll in a physical education teaching program motivated by previous sports and physical activity experiences, and the desire to teach values through sport.

RESUMO Os programas de formação de professores de educação física no Chile têm uma grande demanda por matrículas, e a profissão é reconhecida como uma das mais atrativas para os jovens. A proposta deste estudo é conhecer os motivos que levam jovens chilenos a escolherem o programa de formação de professores de educação física em uma universidade regional, na região de Maule, Chile. A pesquisa foi sequencial mista, pois se caracterizou por uma primeira etapa, onde foram coletados e analisados dados quantitativos, seguida de outra, onde os dados qualitativos foram coletados e interpretados. Na etapa quantitativa do estudo 146 alunos (54 mulheres e 89 homens) responderam a um questionário e na etapa qualitativa 6 alunos (3 homens e 3 mulheres) participaram de uma entrevista de grupo focal. A participação anterior em esportes, o interesse relacionado ao estilo de vida fisicamente ativo e o prazer de ensinar são mostrados nos resultados. Como conclusões, os alunos optam por se matricular em um programa de ensino de educação física motivados por experiências anteriores de esportes e atividades físicas, e o desejo de ensinar valores por meio do esporte..

Con dos que se quieran. Un programa televisivo en la formación de estudiantes de medicina / With two who love each other A television program in the training of medical students

La formación médica amerita una educación que estimule el conocimiento científico, en la cual el cine y sus muchos materiales audiovisuales concebidos para la televisión se vinculan como un ente facilitador al docente para elevar la cultura del estudiante y con ello incidir en la pertinencia de su gestión como futuro profesional de la salud pública, comprometido con la ética de su praxis y en particular con las investigaciones que implican ensayos en humanos. En este sentido sobresalen programas como la entrevista al Dr. Jorge Berlanga Acosta, eminente investigador en el espacio televisivo «Con dos que se quieran», empleado mediante el debate con los estudiantes de Medicina. (AU)

Medical training deserves an education that stimulates scientific knowledge, in which the cinema and the many audiovisual materials conceived for television are linked as a facilitating entity to the teacher to elevate the student's culture and thus influence the relevance of his management as a future public health professional, committed to the ethics of his practice and in particular to research involving trials. In this sense, programs such as the interview with Dr. Jorge Berlanga Acosta, an eminent researcher in the television space ¨Con dos que se quieran¨, used through debate with medical students, stand out. (AU)

Use of collaborative learning as atool to evaluate syndromic craniofacial anomalies / Uso da aprendizagem colaborativa como ferramenta para avaliar anomalias craniofaciais sindrômicas

Almost 30% of oral cleftsare associated with other structural abnormalities.However, little is known on orofacial characteristics related tothese cases since they are not systematically reported. To close this gap, we developed a collaborative learning approach supported by an interprofessional team aiming to systematicallydescribe oral findings and impactthe training of future professionals that hopefully will incorporate these descriptionsintotheir clinical practice. The methodological proposal consisted of small group sessions focusing on a particular syndrome or group of syndromes followed by examiningpatients with those conditions. Twenty cases were examined and studied over one semester andaset of conditions to be identified in the orofacial regionwasdefined. Here, we present a guideline that we suggest that dentists and dental institutions use. We also present the advantages of using collaborative learning as a tool in the training of the clinician (AU).

Quase 30% das fissuras orais estão associadas a outras anormalidades estruturais. No entanto, pouco se sabe sobre as características orofaciais relacionadas a esses casos, uma vez que não são relatados de forma sistemática. Para fechar essa lacuna, desenvolvemos uma abordagem de aprendizagem colaborativa apoiada por uma equipe interprofissional com o objetivo de descrever sistematicamente os achados orais e impactar o treinamento de futuros profissionais que, esperançosamente, irão incorporar essas descrições em sua prática clínica. A proposta metodológica consistia em sessões de pequenos grupos enfocando uma determinada síndrome ou grupo de síndromes seguidas de exame de pacientes com essas condições. Vinte casos foram examinados e estudados ao longo de um semestre e foi definido um conjunto de condições a serem identificadas na região orofacial. Aqui, apresentamos uma diretriz que sugerimos que os dentistas e instituições odontológicas utilizem. Também apresentamos as vantagens de usar a aprendizagem colaborativa como uma ferramenta no treinamento do clínico (AU).

Gulf War Era Veterans' perspectives on research: a qualitative study.

AIMS: Many veterans of the 1990-1991 Gulf War Era (GWE) have experienced poorly understood health issues. In response to challenges recruiting this population for research, we conducted focus groups and semi-structured phone interviews with GWE veterans and subject matter experts (SMEs) to explore GWE veterans' perceptions about research. MAIN METHODS: Transcribed discussions were content-analyzed. Participants discussed research-related motivators and barriers identified among other populations, and nuances that may be specific to GWE veterans. KEY FINDINGS: Examples of motivating factors included: seeking answers about causes of and treatment for health issues; helping oneself; and helping other veterans. Examples of barriers included: distrust and dissatisfaction with federal entities; lack of research follow-through; and concerns about privacy and confidentiality. SIGNIFICANCE: Researchers can use this information to better address GWE veterans' concerns and motivate them to participate in research. Inclusion of GWE veterans in research will allow researchers and clinicians to better understand and address health issues affecting this population.

Encouraging Mammograms Using Behavioral Economics: A Randomized Controlled Trial in Chile.

OBJECTIVES: This article illustrates the effect of a direct mail campaign that used insights from behavioral economics and psychology to increase the number of free mammograms in Chilean women aged 50 years or older. METHODS: We hypothesized 4 barriers in obtaining a mammogram based on previous literature and focus group analysis. A behavioral economic approach providing incentives was used to help overcome these barriers. We accessed a unique data set, which comprised 12 000 women 50 years old or older, with private health insurance who have not had a mammogram for 24 or more months. We conducted a randomized controlled trial with 8 treatments, each involving a specific combination of messages. RESULTS: The intervention overall led to a 167% increase in the use of free mammograms, a 1.13% to 3.03% average increase from the control to treatment groups, respectively. Regarding barriers, we found that all messages were effective, with a slightly larger and persistent effect for the less complex ones in terms of information. This finding illustrates the benefits of keeping the message simple. CONCLUSIONS: Finally, these results suggest a successful public policy for increasing use of free mammography programs. Moreover, they are potentially transferable because the study considered decision-making heuristics that are not specific to one culture or social context.

Why is there variation in test ordering practices for patients presenting to the emergency department with undifferentiated chest pain? A qualitative study.

INTRODUCTION: Up to one-third of laboratory tests ordered in the ED for adults presenting with undifferentiated chest pain are generally not indicated by current Australian guidelines. This study set out to undertake a qualitative investigation of clinician perceptions to identify the reasons for variations in pathology requesting. METHODS: For this study, we draw on data from semistructured interviews (n=38) conducted in the EDs and laboratories across three hospitals as part of a larger study on the test result management process from test request to result follow-up. Thematic analysis was conducted to determine what aspects of the clinical routines and environment might contribute to variations in pathology requesting. Informed by the findings from the analysis, targeted questions were developed and further focus groups (n=5) were held with clinicians, hospital management and electronic medical record (eMR) analysts to investigate in more detail the reasons for requesting outside of guidelines. RESULTS: Participants cited four main reasons for ordering outside of guidelines. Clinicians requested tests outside of guidelines and the ED scope of practice to facilitate the patient journey along the broader continuum of care, including admission to hospital or transfer to another site. Clinicians were also faced with multiple and inconsistent guidelines regarding appropriate test selection. Limited access to in-house specialty and diagnostic services also influenced ordering patterns in smaller non-referral hospitals. Finally, certain features of the current electronic ordering framework within the eMR facilitated overordering and failed to impose any real restrictions on ordering inappropriately or outside of scope of practice. CONCLUSION: Beyond the standardisation of pathology requesting advice across electronic decision support, order sets and guidelines, attempts to address issues related to the appropriateness and variation of laboratory test ordering should consider local and systemic factors which also shape the ordering process.

Galeria ilustrada da classificação internacional de funcionalidade e incapacidade em saúde: relato de experiência / Illustrated gallery of the international classification of functionality and disability in health: experience report / Galería ilustrada de la clasificación internacional de funcionalidad y discapacidad en salud: informe de experiencia

Introdução: A Síndrome Congênita do Zika constitui uma nova condição de saúde, advinda do surto do vírus Zika no Brasil no início do ano 2015. É caracterizada por um conjunto de anormalidades que envolve a desproporção craniofacial, irritabilidade, espasticidade, convulsões, dificuldades alimentares, anormalidades oculares e perda auditiva. Objetivo:Relatar a experiência do uso da Galeria Ilustrada da Classificação Internacional de Funcionalidade, Incapacidade e Saúde como auxílio para coleta de dados em pesquisa sobre funcionalidade e incapacidade em crianças com Síndrome congênita do Zika. Metodologia: Foram construídos 3 instrumentos visuais baseados na versão resumida da Classificação Internacional de Incapacidade e Funcionalidade em Saúde e aplicados com 32 pais de crianças com diagnóstico confirmado da Síndrome congênita do Zika. Foram capturadas as imagens da galeria ilustrada nos domínios de atividade e participação, funções do corpo e fatores ambientais, de modo a facilitar a elaboração de respostas das entrevistas. Resultados: O instrumento visual permitiu aos participantes da pesquisa um processo de entrevista dinâmico, compreensível e espontâneo através de uma melhor compreensão dos conceitosda Classificação Internacional de Incapacidade e Funcionalidade em Saúde, e desse modo permitiu aos pesquisadores obter suas percepções a respeito da condição de saúde dos filhos dos entrevistados. Conclusões: Ferramentas visuais envolvendo a galeria ilustrada podem ser utilizadas como auxílio na coleta de dados em pesquisas qualitativas que envolvem a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (AU).

Introduction:Congenital Zika Syndrome is a new health condition, arising from the Zika virus outbreak in Brazil in early 2015. It is characterized by a set of abnormalities involving craniofacial disproportion, irritability, spasticity, seizures, eating difficulties, eye abnormalities and hearing loss.Objective:To report the experience of using the Illustrated Gallery of the International Classification of Functioning, Disability and Health as an aid to data collection in research on functionality and disability in children with congenital Zika Syndrome.Methodology:Three visual instruments were builtbased on the abridged version of the International Classification of Disability and Functioning in Health and applied to 32 parents of children with a confirmed diagnosis of congenital Zika Syndrome. Images from the illustrated gallery were captured in the domains of activity and participation, body functions and environmental factors, in order to facilitate the elaboration of interview responses. Results:The visual instrument allowed research participants a dynamic, understandable and spontaneous interview process through a better understanding of the concepts of the International Classification of Disability and Functioning in Health, and thus allowed the researchers to obtain their perceptions about the condition of your children's health. Conclusions:Visual tools involving the illustrated gallery can be used as an aid in data collection in qualitative research involving the International Classification of Functioning, Disability and Health (AU).

Introducción:El síndrome de Zika congénito es una nueva condición de salud, que surge del brote del virus del Zika en Brasil a principios de 2015. Se caracteriza por un conjunto de anomalías que involucran desproporción craneofacial, irritabilidad, espasticidad, convulsiones, dificultades para comer, anomalías oculares y auditivas. pérdida. Objetivo:Informar la experiencia de utilizar la Galería Ilustrada de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud como ayuda para la recopilación de datos en la investigación sobre la funcionalidad y la discapacidad en niños con síndrome congénito del Zika. Metodología:Se construyeron tres instrumentos visuales basados en la versión abreviada de la Clasificación Internacional de Discapacidad y Funcionamiento en Salud y se aplicaron a 32 padres de niños con diagnóstico confirmado de síndrome congénito del Zika. Se capturaron imágenes de la galería ilustrada en los dominios de actividad y participación, funciones corporales y factores ambientales, con el fin de facilitar la elaboración de las respuestas de la entrevista. Resultados:El instrumento visual permitió a los participantes de la investigación un proceso de entrevista dinámico, comprensible y espontáneo a través de una mejor comprensión de los conceptos de la Clasificación Internacional de Discapacidad y Funcionamiento en Salud, y así permitió a los investigadores obtener sus percepciones sobre elestado de salud de sus hijos. Conclusiones:Las herramientas visuales que involucran la galería ilustrada se pueden utilizar para ayudar en la recopilación de datos en la investigación cualitativa que involucra la Clasificación Internacional de Funcionamiento, Discapacidad y Salud (AU).

The lived experiences of graduate nurses transitioning to professional practice during a pandemic.

BACKGROUND: Graduate nurses face challenges during their transition to professional practice. Understanding these experiences during a pandemic has not been explored. PURPOSE: The purpose of this study is to describe the lived experiences of graduate nurses transitioning to practice during a pandemic. METHODS: Using a hermeneutic phenomenological approach, focus groups were conducted with fifteen nurses who were at three different stages of transition and participating in a 12-month Graduate Nurse Residency Program. FINDINGS: Seven themes emerged: 1) being new is overwhelming, even more so during COVID-19, 2) need to be flexible, 3) pandemic knowledge and practice disconnect, 4) communication barriers worsened with masks, 5) being a "COVID nurse," 6) no self-care, and 7) gratitude: still glad to be a nurse. DISCUSSION: Findings emphasize the important focus on graduate nurse support and educational foundation for role transition into professional practice, especially during a pandemic. Participants expressed lack of preparedness for practice but remain excited about being a nurse.