RCAAP Repository

ABSTRACT Objective: To propose a reflection on the labor practice in a psychiatric hospital, emphasizing Brazil. Method: A theoretical-reflexive study with an analogy between work in a psychiatric hospital and the literary work “Alice in Wonderland.” Results: The complex movement of the psychiatric hospital’s history induces a discordant work process and demands from the worker a personified performance of a world of “wonders.” Final considerations: This manuscript contributed to the equalization of knowledge about the work in the psychiatric hospital, aiming to minimize the conceptual distortions identified and expose the worker’s real situation in these institutions.

ABSTRACT Objective: to report the experience of a nursing student with mental health care during a clinical internship. Method: an experience report based on data from a Singular Therapeutic Project developed by a nursing student during 16 days of practice in a Day Hospital as part of an undergraduate course. The findings were analyzed based on the theory of interpersonal relationships and psychosocial rehabilitation. Results: the care process was organized between the weeks and phases of the relationship in: 1) from the unknown to relationship of trust; 2) reflections and reframing as a care proposal; 3) from limitation to leading role; 4) from care resolution to mutual transformations. Final considerations: it was concluded that despite the limitations of the practice context, the student was able to conduct psychosocial interventions in mental health in line with the expected goals and produce meanings in both involved.

ABSTRACT Objective: Identify factors associated with the knowledge and attitude regarding male condom use in school adolescents. Methods: Cross-sectional, quantitative, Knowledge, Attitude, and Practice survey, conducted with 114 adolescents from a public state high school from August to October 2017, in Fortaleza, Ceará, Brazil. Results: The assumption of having sufficient knowledge regarding safe sex, not having a casual/dating partner, and having had three or more sexual partners in the last three months affected adequate knowledge. Higher education of the mother and not talking to the mother about sex were factors that influenced the inappropriate attitude of the participants. Conclusion: The knowledge and attitude of adolescents are influenced both by their previous sexual relations and by their relationship with their mother and the level of her schooling. Thus, it is essential that health institutions promote actions aimed at sex education, with support from schools and health professionals in general.

ABSTRACT Objective: to understand humanization practices in the parturitive course from the point of view of purperae and nurse-midwives. Methods: an exploratory, descriptive, qualitative research carried out in a maternity hospital in Bahia State. Semi-structured interviews were carried out, with a structured script applied to 11 mothers and 5 nurse-midwives from March to June 2019. Analysis followed Bardin’s content structure. Results: this study unveiled the importance of using soft care technologies, respect for female role, active participation and women’s autonomy as a positive impact on the parturition process. Final considerations: nurse-midwives are qualified professionals to assist women in labor and birth. They can favor the implantation and implementation of care with humanization practices, respect for women’s choices and incentive to the normal way of delivery with an expanded view of individual and multidisciplinary needs.

ABSTRACT Objective: To analyze the epidemiological profile of HIV infections in pregnant women. Methods: Analytical study with a quantitative approach. Results: The HIV rate in pregnant women increased from 1.5/1000 babies born alive, in 2010, to 3.3/1000 in 2017. There was a significant association between the prenatal and the variables educational level (p<0.0001), occupation (p=0.0105), gestational age (p < 0.0001), and type of delivery (p < 0.0001). The mean rate of adherence to the antiretroviral treatment in the prenatal was 68.8% (DP = ± 3.7). Conclusion: The high rates of HIV detection in pregnant women suggest the need to intensify the health care to women during the prenatal, guaranteeing an integral care, early diagnoses, and enhancing the strategies to improve the adherence to the antiretroviral treatment, aiming to achieve the viral suppression of the mother by the time of childbirth, thus diminishing the risk of a vertical transmission.

ABSTRACT Objective: To analyze the experiences of families in the exercise of the rights of children with chronic conditions in public health, education and social assistance institutions. Method: ethnographic multiple case study, with qualitative approach, following the theoretical approach of Boaventura Santos. Experiences of the families of these children in a city were studied through interviews with family members, managers and professionals from social institutions (35), participant observations in social spaces (13) and creation of eco-maps (3). Critical Discourse Analysis was performed. Results: the offer of services is lower than the demand, and exclusion processes persist. Given the hegemony of neoliberal and normality ideologies, meetings between family members and professionals revealed obstacles to civil rights; however, when these ideologies were challenged, the realization of their rights was enhanced. Final considerations: the care to promote civil rights requires family members, managers and professionals to develop subjectivities that overcome neoliberal and normality ideologies, recognizing these children as subjects of law.

ABSTRACT Objective: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. Method: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. Results: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. Conclusion: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

ABSTRACT Objective: to analyze skin-to-skin contact practice in full-term newborns after birth. Method: a cross-sectional study carried out in São Paulo-SP with 78 mother-child binomials. Data were obtained from medical records and by non-participant observation. Maternal, neonatal and care conditions, length of skin-to-skin contact and breastfeeding attachment were analyzed. Results: skin-to-skin contact was performed in 94.9% of births, with a mean length of 29 minutes. Births with intact perineum took longer, neonates with Apgar 10, without upper airway aspiration, assisted by a nurse-midwife and with neonatal assistance by a resident in pediatrics. The variables that favor breastfeeding attachment were perineal integrity, newborn with good vitality, without upper airway aspiration and who received professional assistance for breastfeeding attachment. Conclusion: skin-to-skin contact was performed in almost all births, but with less time than recommended as best practice.

ABSTRACT Objective: To build and validate the content of a good practice tool in the newborn bath. Method: Methodological study, developed from December 2018 to January 2019, in a Joint Neonatal Housing Unit of a teaching hospital, in three stages: bibliographic survey, construction of the instrument and content validation by nine judges. The content validity index was used above 80% and general analysis with ten requirements. Results: The instrument was organized in three domains: before bathing, during bathing and after bathing, with a total of 20 items. Two rounds of validation were carried out to adjust the suggestions; the second presented a percentage of agreement between the judges, equal to or above 0.82. Conclusion: The instrument “Good practices in the newborn’s bath” was considered representative and valid in terms of content.

ABSTRACT Objective: to describe the health promotion competency domains, performed by nurses, for adolescents, according to the Galway Consensus. Method: a qualitative study based on the Galway Consensus theoretical methodological framework. Fifteen nurses from northeastern Brazil participated. Data were collected between April and May 2017 through pre-structured interviews, submitted to the content analysis technique and analyzed according to the Galway Consensus dimensions. Results: the following competency areas were found: catalyzing changes, leadership, needs assessment, planning, implementation, and partnerships. These competencies were contemplated from embracement of adolescents at health unit, guidance, teamwork, educational activities and lectures, as well as active search. Conclusion: most health promotion domains were observed; however, it is still suggested that there are challenges to an effective performance of health promotion among adolescents because some competency domains in health promotion have not been evidenced.

ABSTRACT Objective: to analyze the association of skin-to-skin contact and social determinants of health. Methods: this is a cross-sectional study with 187 medical records of newborns from a reference rooming in in northeastern Brazil. An instrument with maternal and neonatal data was used. Analysis was descriptive and inferential statistics. For the associations, a chi-square test was used to measure strength, an Odds Ratio was calculated, with a 95% confidence interval. Results: 62% of newborns who made skin-to-skin contact at birth were eutrophic, full-term, Apgar > 7, mothers with prenatal care and without abortion. The determinants associated with non-skin-to-skin contact were preterm (CR=3.2;95%CI: 2.72-18.98); 1st minute Apgar < 7 (CR:2.9;95%CI: 2.38-3.06), cesarean section (CR:8.4;95%CI: 4.29-16.57), and unhealthy NB (CR 12.7;95%CI: 4.9-32.67). We used STROBE guidelines. Conclusion: skin-to-skin contact was influenced by gestational age, Apgar, delivery, and newborn health.

ABSTRACT Objectives: to estimate the incidence and the risk factors for severe acute postoperative pain self-reported on the first day after hospital discharge. Methods: cohort study with 279 children from both sexes (5-12 years old), indicated for ambulatory surgery in two Brazilian hospitals. Children were assessed at the pre-surgery, immediate postoperative and first postoperative day. Faces Pain Scale-Revised and Yale Preoperative Anxiety Scale Modified were used. Severe postoperative pain was defined as score ≥6. Cox regression analyses were used. Results: the incidence of severe postoperative pain was 15.8% (95%CI:10.7%-20.4%) on the first postoperative day. Preoperative anxiety (HR=2.23; p=0.049), severe preoperative pain (HR=2.78; p=0.031) and having undergone two surgical procedures (HR=2.91; p=0.002) were associated with severe postoperative pain. Conclusions the incidence of severe postoperative pain self-reported after hospital discharge was high. Anxiety and severe preoperative pain, in addition to performing two surgical procedures at the same time were confirmed as risk factors.

ABSTRACT Objective: to understand the intentionality of women's autonomous actions in labor. Methods: a study in Alfred Schütz's social phenomenology, developed with 15 puerperal women admitted to a university hospital in southern Brazil. Data were collected through phenomenological interviews and analyzed according to the adopted framework and the comparison with scientific productions. Results: the actions intended to receive physical and emotional support from their companions, from pregnancy, for a peaceful delivery with less pain, fast and without interventions. The intention was to do the right things for the child's well-being and, after delivery, to be painless and active to take care of their children. Final considerations: women's actions have intentionality arising from their knowledge, which is guided by the social relationships established in the world of life.

ABSTRACT Objective: to verify the validity of indicators’ content referring to the instrument for data collection in children aged 0 to 5 years hospitalized in a pediatric clinic. Method: a cross-sectional methodological study was carried out with 11 experts between January and May 2018. For data collection, the steps for validating the instrument’s content were respected. For data analysis, Content Validity Index and Kappa agreement analysis were used. Results: after content analysis, a Content Validity Index of 0.94 and Kappa 0.71 was issued according to the experts’ suggestions 81.9%. Therefore, the instrument was suitable for applicability. Conclusion: the instrument proved to be valid in terms of content for pediatric care, contributing significantly to improving care for hospitalized children aged 0 to 5 years.

ABSTRACT Objective: to analyze the association between individual characteristics and housing context with smoking and alcohol consumption during pregnancy. Methods: a cross-sectional study with a probabilistic sample of 3,580 pregnant women who underwent prenatal care in the Unified Health System in 2019. The outcomes were firsthand, secondhand smoke and alcohol consumption during pregnancy. Individual characteristics and the living environment were used as exploratory variables. Results: living in a neighborhood with episodes of violence, without social cohesion and without urban elements that encourage physical activity was associated with smoking. Alcohol consumption during pregnancy was associated with living in environments that do not encourage physical activity. Smoking was also associated with lower income and education. Conclusions: individual characteristics and the living environment are associated with smoking, secondhand smoke and alcohol consumption during pregnancy.

ABSTRACT Objective: To analyze the temporal trends in the fertility rate, proportion of antenatal consultations and caesarean sections in Brazilian adolescents aged 15 to 19, between 2000 and 2015. Methods: The fertility rate, proportion of prenatal consultations and proportion of routes of birth were calculated using data from DATASUS. The trend analysis was performed using the Prais-Winsten regression model and the annual percentage change. Results: There was a trend of reduction of 3.5% per year in the fertility rate among adolescents (p<0.05), in addition to an increasing trend of 6% per year in the proportion of more than six antenatal consultations (p <0.0001) and an increasing trend of 6.8% per year in the proportion of caesarean sections (p<0.0001). Conclusion: Despite the decreasing trend in fertility rates among Brazilian adolescents, they remain high. Also noteworthy is the growing trend for caesarean sections, even with improved access to antenatal care.

ABSTRACT Objective: to assess breastfeeding support practices for preterm infants at two Baby-Friendly hospitals in southeastern Brazil, comparing the effect of implementing the guidelines for Baby-Friendly Hospital Initiative for Neonatal wards. Methods: a quasi-experimental study, pre- and post-intervention with control. Implementation of this initiative in the intervention hospital using Knowledge Translation. Data collection on compliance with the adapted Ten Steps, Three Guiding Principles and the Code before and after the intervention was carried out via interviews with mothers of preterm babies and professionals, unit observation and documentary analysis in the intervention and control hospitals. Intra-intergroup comparison was performed. Results: increases in global compliance with the Three Principles, Ten Steps, the Code, partial compliance with each Principle and in most Steps was greater in the intervention hospital. Conclusion: this initiative improved practices related to breastfeeding in the intervention hospital, demonstrating the potential to improve care and breastfeeding in neonatal wards.

ABSTRACT Objectives: to identify the reasons for the prevalence of the technocratic model in obstetric care from the perspective of health professionals. Methods: Grounded Theory. Study approved by two Research Ethics Committees and conducted by theoretical sampling, from July 2015 to June 2017. Twenty-nine interviews were conducted with health professionals from two maternity hospitals in the Southern Region of Brazil. Data collection and analysis was performed alternately; and analysis by open, axial, and selective coding/integration. Results: the technocratic model still persists because the assistance is performed in a mechanized way, centered on the professionals. There is a lack of systematization of care, and under-dimensioning of the nursing staff. Final Considerations: obstetric nurses need to review their performance in obstetric centers, the internal organization, the dimensioning of nursing professionals, and become protagonists of care. Investment in academic training/updating the knowledge of midwifery professionals, based on scientific evidence and user-centered care is necessary.

ABSTRACT Objectives: to validate the content and appearance of the booklet “Going home after a child’s cardiac surgery” and assess family members’ cognitive learning regarding its use. Methods: a methodological and quasi-experimental study of before and after type, with semi-structured interview, pre-test and reading of the booklet in a hospital; post-test and validation occurred after hospital discharge. Wilcoxon non-parametric statistics were used. Results: nineteen family members of children with heart disease participated. The average of correct answers increased 14 percentage points from pre- to post-test; most were medication errors. There was a significant difference (p <0.0001) in the comparison between cognitive knowledge prior to using the booklet and learning acquired from its use. All items received a positive rating, except font size. Conclusions: the booklet helps family members to understand a child’s needs after cardiac surgery, and can be used to prevent unwanted occurrences and enable safe care at home.

ABSTRACT Objectives: to describe the contribution of pregnant women to the construction and evaluation of educational technology. Methods: a participatory study developed in three stages, which occurred between March 2018 and June 2019 for identifying the content, construction, and evaluation of the comic. Non-directive interviews were conducted in educational groups with 34 pregnant women. After the comic was built by a team, including a designer, an instrument was applied to 41 pregnant women to evaluate the items Objectives, Organization, Writing style, Appearance, and Motivation. Results: the comic contains 40 pages of contents, illustrations, and quizzes (word search, cross-puzzle, seven mistakes, etc). The pregnant women evaluated it as easy to understand, self-explanatory, aesthetically attractive, and capable of motivating good care practices during pregnancy, obtaining a minimum agreement of 92.1%. Final Considerations: the innovation of the educational technology consisted of incorporating the voices of pregnant women in prenatal care, with the potential to stimulate reflections and the learning process of this target audience.