Supervisão de futuros enfermeiros no ensino clínico no serviço de cirurgia

Este estudo insere-se no contexto da supervisão de futuros enfermeiros no ensino clínico, no serviço de cirurgia de uma unidade hospitalar, e teve como principais objetivos, entre outros: i) analisar a evolução das aprendizagens realizadas por alunos de enfermagem durante o estágio; ii) identificar as opiniões dos alunos sobre o processo de supervisão. Neste estudo de natureza qualitativa, os dados foram recolhidos durante o processo de supervisão de seis alunos, através de observação participante e diários de sessões, elaborados pela supervisora, bem como através de semanários, portefólios da terapêutica e das patologias, estudo de caso, reflexão crítica no final do ensino clínico e grelhas de avaliação intercalar e final dos estagiários. Os resultados obtidos mostraram que durante o ensino clínico os alunos foram interiorizando as orientações, reajustando os seus comportamentos e progredindo gradualmente no seu desempenho e desenvolvimento de competências. Também se observou que a relação supervisiva assentou num clima afetivo-relacional e cultural de entreajuda, abertura, cordialidade, empatia, autenticidade e motivação. Os resultados desta investigação mostraram que a prática e investigação sobre a supervisão, deverão ser aprofundadas no futuro para se promover um ensino clínico mais eficaz.Instituto de Educação, Centro de Investigação em Educação (CIEd

Supervisão no ensino clínico em enfermagem: um estudo com alunos do 3º ano de enfermagem no serviço de cirurgia

Relatório de estágio de mestrado em Educação (área de especialização em Mediação Educacional e Supervisão na Formação)Fazer supervisão em clínica em enfermagem é (re) pensar as práticas e o processo formativo, de modo a aprofundar no aluno, futuro enfermeiro, não só o cariz científico da profissão, como também o desenvolvimento das suas capacidades de análise crítica e reflexiva que contribuem para o seu desenvolvimento pessoal e profissional ao longo da vida. Assim, este estágio retratou o meu percurso supervisivo numa unidade hospitalar com base nos seguintes objectivos: analisar a percepção da supervisora sobre as características da reflexão desenvolvida por alunos de enfermagem durante o estágio no ensino clínico; descrever as características principais dos níveis de reflexão nuclear de alunos de enfermagem no final desse estágio; identificar as opiniões dos alunos de enfermagem sobre o processo de supervisão durante o estágio e as características de um bom supervisor. Para a consecução desses objectivos foi utilizada uma metodologia de investigação qualitativa em que a recolha de dados foi feita durante o processo de supervisão no ensino clínico através da observação participante e com recurso a estratégias de supervisão como diários de sessões, semanários reflexivos dos estagiários, portefólios da terapêutica e das patologias, estudos de caso, reflexões críticas no final do ensino clínico e grelhas de avaliação intercalar e final do ensino clínico. Finalmente, procedeu-se a uma entrevista semi-estruturada de reflexão nuclear sobre o estágio e as competências desejáveis no supervisor. A reflexão desenvolvida por alunos de enfermagem durante o estágio no ensino clínico mostrou que: à medida que o ensino clínico decorria, estes, iam interiorizando as orientações, reajustavam comportamentos e posturas e progrediam gradualmente no seu desempenho e na aquisição de competências; nas situações de maior ansiedade, o papel da supervisora foi fundamental; a relação supervisiva assentou num clima afectivo-relacional e cultural, de entreajuda, abertura, cordialidade, empatia, autenticidade e motivação; o semanário foi considerado uma estratégia importante no relato e expressão dos factos e opiniões, publicamente difíceis de revelar, mas os alunos sentiram algum constrangimento na sua redacção; o estudo de caso foi valorizado por possibilitar uma reflexão sobre a prática; a reflexão crítica no final do estágio mostrou que os alunos confrontam o “eu” pessoal com o “eu” do futuro enfermeiro ao analisar criticamente o seu percurso; o facto de a supervisora pertencer à instituição onde está a ser realizado o estágio é uma mais-valia, embora existam outras características necessárias a um bom supervisor. Os resultados desta investigação mostraram que a prática e investigação sobre as estratégias supervisivas acima descritas, deverão ser aprofundadas no futuro para se promover um ensino clínico que seja mais eficaz no desenvolvimento pessoal e profissional dos alunos futuros enfermeiros.Faire la supervision de l'enseignement clinique en soins infirmiers c’est (re) penser les pratiques et le processus formatif, de manière à approfondir chez l’élève, futur infirmier, non seulement le caractère scientifique de la profession, comme aussi le développement de ses capacités d’analise critique et réflexive qui contribuent à son développement personnel et profissionnel au long de la vie. Ainsi, ce stage a décrit mon parcours supervisif dans un service hospitalier reposant sur les objectifs suivants: analiser la perception de la superviseuse sur les caractéristiques de la réflexion développée par les élèves infirmiers durant le stage en soins cliniques; décrire les principales caractéristiques des niveaux de réflexion nucléaire des élèves infirmiers en final de stage; identifier les opinions des élèves infirmiers sur le processus de supervision durant le stage et les caractéristiques d’un bon superviseur. Pour la réalisation de ces objectifs il a été utilisée une méthodologie d’investigation qualitative où le relevé des données s’est fait pendant le processus de supervision en soins cliniques au travers d’une observation participante et utilisant des stratégies de supervision comme les carnets de bords, les hebdomadaires reflexifs des stagiaires, les portefolios de la therapêutique et des pathologies, les études de cas, les réflexions critiques en fin de soins cliniques et les grilles d’évaluation intercalaires et finales des soins cliniques. Finalement, il a été réalizée une entrevue semi-structurée de reflexion nucléaire sur le stage et les compétences souhaitables chez le superviseur. La réflexion développée par les élèves infirmiers durant le stage en soins cliniques a démontrée que: à mesure que le stage en soins cliniques decourrait, les élèves infirmiers, interiorisaient les orientations, réajustaient leurs comportements et leurs postures et progressaient peu à peu au niveau de leurs performances et aquisition de compétences; face aux situations de grande anxiété, le rôle de la superviseuse s’est révélé fondamental; la relation supervisive c’est basée sur un climat afectivo-relationnel et culturel, d’entraide, d’ouverture, de cordialité, d’empathie, d’authenticité et de motivation; l’hebdomadaire a été considéré une stratégie importante de rapport et d’expression des faits et des opinions, publiquement dificiles de revéler, cependant les élèves ont quand même sentit une certaine contrainte à sa rédaction; l’ étude de cas a été valorisé par la possibilitée qu’il proporcionne de réflechir sur la pratique; la réflexion critique finale a montrée que les élèves confrontent le “moi” personnel avec le “moi” futur infirmier en analisant de façon critique leurs parcours; le fait que la superviseuse fasse partie de l’institution de stage c’est révélé um atout, bien qu’existent d’autres caractéristiques nécessaires à un bon superviseur. Les résultats de cette investigation ont montrés que la pratique et l’investigation au niveau des stratégies supervisives supra-citées, deveront être approfondies dans le futur pour que l’on puisse promouvoir um enseignement clinique qui soit encore plus efficace au développement personnel et profissionnel des éleves, futurs infirmiers

Supervisão no ensino clínico no serviço de cirurgia: um estudo com alunos do 3º ano de enfermagem

A supervisão de estudantes de enfermagem em ensino clínico implica (re)pensar as práticas e aprofundar o processo formativo dos futuros enfermeiros, não só na dimensão científica da profissão, mas também no desenvolvimento de capacidades de análise crítico-reflexivas que contribuem para o seu desenvolvimento pessoal e profissional. Esta investigação sobre o processo supervisivo numa unidade hospitalar visou, entre outros objetivos: analisar as caraterísticas da reflexão desenvolvida por alunos de enfermagem durante o seu estágio no ensino clínico. Para a recolha destes dados foi utilizada a observação participante e instrumentos de supervisão tais como diários de sessões, semanários reflexivos, portefólios, estudos de caso, reflexões críticas no final do estágio e grelhas de avaliação intercalar e final. Os dados recolhidos durante o estágio clínico mostraram que os alunos de enfermagem: foram interiorizando as orientações, reajustaram comportamentos e posturas, progrediram gradualmente no seu desempenho e na aquisição de competências, e nas situações mais ansiogénicas o papel da supervisora foi fundamental. Também se verificou que a relação supervisiva foi baseada num clima afetivo-relacional positivo. Além disso, o semanário foi um instrumento importante no relato e expressão dos factos e opiniões publicamente difíceis de revelar. O estudo de caso foi valorizado por possibilitar uma reflexão sobre a prática enquanto a reflexão crítica final mostrou um confronto entre a identidade atual e as expetativas para a identidade do futuro enfermeiro. Os resultados evidenciaram a necessidade de aprofundar a investigação sobre os instrumentos de supervisão a utilizar no estágio em ensino clínico, para que este se torne eficaz no desenvolvimento pessoal e profissional dos futuros enfermeiros.The supervision of nursing students in clinical internship implies the (re)thinking of practices and a deepening of the training process for future nurses, not only in the scientific dimension of the profession but also in the development of critical-reflective analysis capacities which contribute to their personal and professional development. This research on the supervisory process in a hospital unit aims to accomplish the following aim, among others: to analyze the characteristics of nursing students' reflexions during their internship. Participant observation and supervisory tools such as daily sessions, weekly reflective diaries, portfolios, case studies, critical reflections at the end of the internship and intercalary and final evaluation grids were used for data collection. Data collected during the clinical internship of nursing students showed that: they were internalizing the guidelines, readjusting behaviours and attitudes, gradually they were progressing in their performance and skill acquisition and in anxiogenic situations the supervisor's role was considered essential. Also, the supervisory relationship was based on a positive relational and cultural climate. In addition, the weekly diary was an important tool in the narration and expression of the facts and opinions publicly difficult to reveal. The case study was valuable because it allowed for a reflection on practice while the final critical reflection showed a confrontation between the present and the expectations of the future identity of the nurse. These results highlighted the need for further research on supervisory tools to use in clinical internship in order for it to become effective in the personal and professional development of future nurses

Sexualidade e género no discurso dos media : um projecto de investigação no CIDTFF

Neste poster será apresentado um projecto de investigação em curso no Centro de Investigação Didáctica e Tecnologia na Formação de Formadores – CIDTFF da Universidade de Aveiro, que tem por objectivos: i) analisar o repertório das representações de sexualidade e de género simbolizado no discurso dos media enquanto estratégia de constituição de identidades e subjectividades culturais; ii) integrar nas competências profissionais dos(as) professores(as) a abordagem didáctica de novos suportes, conteúdos e linguagens dos media que as crianças e jovens usam no seu quotidiano; iii) avaliar o impacte de dispositivos metodológicos de questionamento do currículo cultural desenhado pelos media na qualidade da formação inicial e contínua de professores(as)

Meglumine antimoniate and miltefosine combined with allopurinol sustain pro-inflammatory immune environments during canine leishmaniosis treatment

Canine leishmaniosis (CanL) caused by Leishmania infantum is a zoonotic disease of global concern. Antileishmanial drug therapies commonly used to treat sick dogs improve their clinical condition, although when discontinued relapses can occur. Thus, the current study aims to evaluate the effect of CanL treatments in peripheral blood, lymph node, and bone marrow cytokine profile associated with clinical recovery. Two groups of six dogs diagnosed with CanL were treated with miltefosine combined with allopurinol and meglumine antimoniate combined with allopurinol (MT+A and MG+A), respectively. At diagnosis and after treatment, during a 3-month follow-up, clinical signs, hematological and biochemical parameters, urinalysis results and antileishmanial antibody titers were registered. Furthermore, peripheral blood, popliteal lymph node, and bone marrow samples were collected to assess the gene expression of IL-2, IL-4, IL-5, IL-10, IL-12, TNF-α, TGF-β, and IFN-γ by qPCR. In parallel, were also evaluated samples obtained from five healthy dogs. Both treatment protocols promoted the remission of clinical signs as well as normalization of hematological and biochemical parameters and urinalysis values. Antileishmanial antibodies returned to non-significant titers in all dogs. Sick dogs showed a generalized upregulation of IFN-γ and downregulation of IL-2, IL-4, and TGF-β, while gene expression of IL-12, TNF-α, IL-5, and IL-10 varied between groups and according to evaluated tissue. A trend to the normalization of cytokine gene expression was induced by both miltefosine and meglumine antimoniate combined therapies. However, IFN-γ gene expression was still up-regulated in the three evaluated tissues. Furthermore, the effect of treatment in the gene expression of cytokines that were not significantly changed by infection, indicates that miltefosine and meglumine antimoniate combined therapy directly affects cytokine generation. Both combined therapies are effective in CanL treatment, leading to sustained pro-inflammatory immune environments that can compromise parasite survival and favor dogs' clinical cure. In the current study, anti-inflammatory and regulatory cytokines do not seem to play a prominent role in CanL or during clinical recovery.publishersversionpublishe

Meglumine antimoniate and miltefosine combined with allopurinol sustain pro-inflammatory immune environments during canine leishmaniosis treatment

Research Areas: Veterinary SciencesCanine leishmaniosis (CanL) caused by Leishmania infantum is a zoonotic disease of global concern. Antileishmanial drug therapies commonly used to treat sick dogs improve their clinical condition, although when discontinued relapses can occur. Thus, the current study aims to evaluate the effect of CanL treatments in peripheral blood, lymph node, and bone marrow cytokine profile associated with clinical recovery. Two groups of six dogs diagnosed with CanL were treated with miltefosine combined with allopurinol and meglumine antimoniate combined with allopurinol (MT+A and MG+A), respectively. At diagnosis and after treatment, during a 3-month follow-up, clinical signs, hematological and biochemical parameters, urinalysis results and antileishmanial antibody titers were registered. Furthermore, peripheral blood, popliteal lymph node, and bone marrow samples were collected to assess the gene expression of IL-2, IL-4, IL-5, IL-10, IL-12, TNF-alpha, TGF-beta, and IFN-gamma by qPCR. In parallel, were also evaluated samples obtained from five healthy dogs. Both treatment protocols promoted the remission of clinical signs as well as normalization of hematological and biochemical parameters and urinalysis values. Antileishmanial antibodies returned to non-significant titers in all dogs. Sick dogs showed a generalized upregulation of IFN-gamma and downregulation of IL-2, IL-4, and TGF-beta, while gene expression of IL-12, TNF-alpha, IL-5, and IL-10 varied between groups and according to evaluated tissue. A trend to the normalization of cytokine gene expression was induced by both miltefosine and meglumine antimoniate combined therapies. However, IFN-gamma gene expression was still up-regulated in the three evaluated tissues. Furthermore, the effect of treatment in the gene expression of cytokines that were not significantly changed by infection, indicates that miltefosine and meglumine antimoniate combined therapy directly affects cytokine generation. Both combined therapies are effective in CanL treatment, leading to sustained pro-inflammatory immune environments that can compromise parasite survival and favor dogs' clinical cure. In the current study, anti-inflammatory and regulatory cytokines do not seem to play a prominent role in CanL or during clinical recovery.info:eu-repo/semantics/publishedVersio

Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal

URBANTB group: Patrícia Soares (Representative of the consortium), Mário Carreira, Sofia Pereira, Catarina Alves, Filipe Alves, Ana Rodrigues, Ana Moreira, Márcia Cardoso, Sandra Mota, Ana Gomes, Liliana Ferreira, Marta Lopes, Isabel Correia, Juan Rachadell, Maria Gameiro, Ângela Dias, Manuel Pereira, Jorge Gonçalves, Maria Gonçalves, Adriana Taveira, Celene Neves, Lucinda Silva, Maria Mendes, Maria Teixeira, Maria Pereira, Milena Piedade, Antónia Teixeira & Carlos Carvalho.Background: Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. Methods: A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). Results: The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. Conclusions: These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.This work was supported by the Fundação para a Ciência e Tecnologia (FCT, Portugal) [Grant: PTDC/SAU-PUB/31346/2017]. The present publication was funded by Fundação para a Ciência e Tecnologia (FCT, Portugal) national support through Comprehensive Health Research Centre (CHRC) [UIDP/04923/2020].info:eu-repo/semantics/publishedVersio

Influenza severe cases in hospitals, between 2014 and 2016 in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Since 2009, the Portuguese Laboratory Network (PLNID) for Influenza Diagnosis has integrated 15 Laboratories in mainland and Atlantic Islands of Azores and Madeira. This PLNID added an important contribute to the National Influenza Surveillance Program regarding severe and hospitalized influenza cases. The present study aims to describe influenza viruses detected in influenza like illness (ILI) cases: outpatients (Outp), hospitalized (Hosp), and intensive care units (ICU), between 2014 and 2016. Methods: The PLNID performs influenza virus diagnosis by biomolecular methodologies. Weekly reports to the National Influenza Reference Laboratory ILI cases tested for influenza. Reports include data on detecting viruses, hospital assistance, antiviral therapeutics, and information on death outcome. Were reported during two winter seasons 8059 ILI cases,being 3560 cases in 2014/15 (1024 in Outp, 1750 Hosp, and 606 in ICU) and 4499 cases in 2015/2016 (1933 in Outp, 1826 Hosp, and 740 in ICU). Results: The higher percentage of influenza positive cases were detected in Outp in both seasons, 18% during 2014/15 and 20% in 2015/16. In 2014/15,influenza cases were more frequent in individuals older than 65 years old and these required more hospitalizations,even in ICU. In 2015/16,the influenza cases were mainly detected in individuals between 15-64 years old. A higher proportion of influenza positive cases with hospitalization in ICU were observed in adults between 45-64 years old.During the study period,the predominant circulating influenza viruses were different in the two seasons: influenza B and A(H3) co-circulated in 2014/15,and influenza A(H1)pdm09 was predominant during 2015/16. Even when influenza A is notthe dominant virus, A(H3) and A(H1)pdm09 subtypes correlate with higher detection rate in hospitalized cases (Hosp and UCI), with higher frequencies in adults older than 45. Influenza B,detected in higher proportion in outpatients, was frequently relatedwith influenza cases in younger age groups: 0-4 and 5-14 years old. Conclusions: This study highlights the correlation of theinfluenza virus type/subtype that circulates in each season with the possible need for hospitalization and intensive care in special groups of the population. Circulation of influenza A subtypes can cause more frequentdisease in individuals older than 45, with need of hospitalization including intensive care. On the other hand, influenza B is more frequently associated with less severe cases and with infection in children and younger adults. Influenza B circulation might predict lower number of hospitalizations.The identification of influenza type in circulation,byPLNID ineach season, could guide action planning measures in population health care.info:eu-repo/semantics/publishedVersio

CENTR(AR): pulmões em andamento: manual de atividade física domiciliário

Sem resumo disponível.publishe