Ser trabajador de enfermería de la Unidad de Centro de Material: un abordaje fenomenológico

Este estudo buscou compreender a experiência dos trabalhadores de enfermagem da Unidade de Centro de Material (UCM) de um hospital de Londrina, utilizando a pesquisa qualitativa femomenológica. Foram realizadas dez entrevistas. A análise dos discursos permitiu construir quatro categorias: 1. Falando do ingresso na UCM - situa as diferentes formas de ingresso nesta unidade; 2. Falando sobre o trabalho desenvolvido na UCM - discorre sobre a rotatividade, o trabalho concomitante e a predileção por determinadas áreas; o ambiente fechado; a evolução tecnológica e o relacionamento interpessoal; 3. Vivenciando as dificuldades - descreve a rotina diária; o trabalho repetitivo e monótono, o cansaço físico, a falta de materiais e equipamentos; o período de adaptação, o desconhecimento, a desvalorização e a discriminação vivenciada; 4. Superando os obstáculos - revela a tomada de consciência do seu papel na unidade reconhecendo a sua importância.Este estudio buscó comprender la experiencia de los trabajadores de enfermería de la Unidad de Centro de Material (UCM) de un hospital de Londrina, utilizando la pesquisa cualitativa fenomenológica. Fueron realizadas diez entrevistas. La análisis de los discursos permitió construir cuatro categorías: 1. Hablando del ingreso en la UCM - sitúa las diferentes formas de ingreso en esta unidad; 2. Hablando sobre el trabajo desarrollado en la UCM - discurre sobre lo rotativo, el trabajo concomitante y la predilección por determinadas áreas; el ambiente cerrado; la evolución tecnológica y la relación inter-personal; 3. Vivenciando las dificultades - describe la rutina diaria; el trabajo repetitivo y monótono, el cansancio físico, la falta de materiales y equipamientos; el periodo de adaptación, el desconocimiento, la desvaloración y la discriminación vivenciada; 4. Superando los obstáculos - rebela la tomada de consciencia de su papel en la unidad reconociendo a su importancia.This study investigated the experience of nursing workers at the Sterile Processing Department (SPD) of a hospital in Londrina, State of Paraná, using the qualitative phenomenological method. Ten interviews were conducted. The analysis of the discourses made possible to build four categories: 1) How the individual came to be part of the department - describes the various ways one may come to work in the unit; 2) Speaking about the work involved in the SPD - describes the turnover, the multiple simultaneous tasks that must be performed and the preference for certain areas; the closed atmosphere; the technological evolution; and the interpersonal relationships; 3) Dealing with difficulties - describes the daily routine; the repetitive and monotonous work; the physical exhaustion; the lack of supplies and equipment; the adjustment period; and the under-appreciation, discrimination, and ignorance of other health workers about their work; 4) Overcoming the obstacles - reveals that through greater aware-ness of their role in the Department these professionals are able to recognize their importance

Necesidades de cuidados de mujeres infectadas con el virus del papiloma humano: un abordaje comprensivo

This study is founded on the phenomenology of Martin Heidegger, with the objective to understand the care needs of women infected with the human papilloma virus. Participants were fourteen women who had been diagnosed with this infection. The guiding questions were: What is it like to have this diagnosis? Tell me your experience, from when you received your diagnosis until today. What has your health care been like? The questions revealed the theme - seeking care as solicitude - which showed the importance of the support of family and friends. The presence of the infection as the cause of marital conflicts and separation was another highlighted aspect. The statements showed that there was a sense of resignation after an unsuccessful attempt to find accurate and clear information in order to make assertive decisions. Health interventions for infected women must overcome the traditional models of care, including interventions for health promotion and prevention, with trained professionals who are sensitive to the subjective dimension.Investigación fundamentada en fenomenología de Martin Heidegger que objetivó comprender las necesidades de cuidados de mujeres infectadas por el Virus del Papiloma Humano. Participaron 14 mujeres diagnosticadas con esta infección. Las preguntas orientadoras fueron: ¿Cómo es, para usted, estar con este diagnóstico? Cuénteme su experiencia, desde que supo del diagnóstico hasta hoy. ¿Cómo viene siendo la atención recibida? La revelación del tema: "buscando el cuidado como solicitud" mostró la importancia del respaldo familiar y de amigos. La presencia de la infección como razón de conflictos y separación conyugal fue otro aspecto resaltado. Los testimonios evidencian la resignación luego de la tentativa frustrada de búsqueda de informaciones precisas y esclarecedoras para la toma de decisiones asertivas. Las acciones de salud con la mujer infectada necesitan sobrepasar los modelos tradicionales de atención, incluyendo acciones de promoción y prevención de salud, con profesionales capacitados, sensibles a la dimensión subjetiva.Pesquisa fundamentada na fenomenologia de Martin Heidegger que objetivou compreender as necessidades de cuidados das mulheres infectadas pelo Papilomavírus Humanos. Participaram catorze mulheres que haviam recebido o diagnóstico dessa infecção. As questões norteadoras foram: como é, para você, estar com este diagnóstico? Conte-me sua experiência, desde que soube do diagnóstico até hoje. Como está sendo a assistência que você tem recebido? O desvelamento do tema - buscando o cuidado como solicitude - mostrou a importância do suporte dos familiares e de amigos. A presença da infecção como motivo de conflitos e separação conjugal foi outro aspecto ressaltado. Os depoimentos deixam em evidência a resignação após a tentativa frustrada de busca por informações precisas e esclarecedoras para a tomada de decisões assertivas. As ações de saúde à mulher infectada necessitam ultrapassar os modelos tradicionais de cuidado, incluindo ações de promoção e prevenção à saúde, com profissionais capacitados, sensíveis à dimensão subjetiva

Isolation and Characterization of Plant Growth-Promotion Diazotrophic Endophytic Bacteria Associated to Sugarcane (Saccharum officinarum L.) Grown in Paraíba, Brazil

Sugarcane is an important Brazilian commodity, being usually cultivated in soils with low natural fertility. This study aimed to isolate diazotrophic endophytes from sugarcane tissues and evaluate the morphological and physiological characteristics of their colonies as well as their plant growth-promoting (PGP) traits in select diazotrophic endophytic bacteria. Fifty-six bacterial isolates were identified in the sugarcane tissues, and these isolates presented distinct morphological and physiological traits. A total of thirty-five bacterial isolates were biochemically evaluated. Overall, Bacillus was the dominant genus. Isolates of Methylobacterium spp. and Brevibacillus agri were present only in leaves, while Herbaspirillum seropedicae occurred only in stems. Except to IPA-CF45A, all isolates were nitrogenase positive. All endophytes exhibit production of indol 3-acetic acid. Over 50% of endophytes solubilize phosphate, release N-acyl homoserine lactones, and present the activity of 1-aminocyclopropane-1-carboxylic acid deaminase, catalase, lipase and protease. The network analysis showed that isolates belonged to Burkholderia, Herbaspirillum, and Methylobacterium interact with Bacillus. Bacterial endophytes exhibited distinct morphological, physiological, and PGP traits that are useful for sustainable agriculture, highlighting the isolates IPA-CC33, IPA-CF65, IPA-CC9 and IPA-CF27. Further studies on the effects of these diazotrophic endophytes and their potential for providing microbial inoculants for improving sugarcane fields will provide valuable information to maintain the sustainability and environment quality.National Council for Scientific and Technological Development 426655/2018-

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Women nursing professors of a public university: perception with respect to corporality in their professional practice

Por meio do corpo e da corporeidade, podem ser feitas escolhas e interagir com os outros, de maneira verdadeira e autêntica, além de intervir nos fatos relacionados à natureza e aos fenômenos humanos, mudar, criar, compartilhar, ensinar, transformar e ser transformado. Este estudo buscou compreender como a mulher docente de enfermagem percebe seu corpo em sua atuação docente. A pesquisa qualitativa foi usada com a abordagem fenomenológica. Participaram da investigação dez mulheres docentes de enfermagem de uma universidade pública. Seus depoimentos foram coletados por meio de entrevistas com as seguintes questões norteadoras: Como você se vê como mulher e docente de enfermagem? Que significados você atribui ao seu corpo, sendo mulher e docente de enfermagem? Como você utiliza o seu corpo no ensino da enfermagem?Como você percebe a postura corporal dos alunos de enfermagem? O que você observa neles que considera serem respostas às suas posturas corporais?Os discursos foram analisados e interpretados à luz do referencial teórico-filosófico de Maurice Merleau-Ponty, originando-se três temas: Corporeidade: expressão da vivência, Corporeidade o ser mulher, Corporeidade e a docência de enfermagem. Os resultados do estudo permitiram compreender que a mulher, docente de enfermagem, utiliza-se de seu corpo e corporeidade em sua prática pedagógica, tendo intencionalidades e ações que demonstram a consciência do corpo, além dos aspectos meramente biológicos. Atribuem ao corpo-corporeidade significados importantes que podem contribuir na existência do ser mulher docente de enfermagem e, certamente, repercutir na prática e no conhecimento em enfermagemBy means of the body and corporality, choices can be made that affect interaction with others in a real and authentic manner, as well as intervene in aspects related to the nature of human phenomena: change, creation, sharing, teaching, transformation and being transformed. This study sought to comprehend how a woman professor of nursing perceives her body in her professional practice. Qualitative research was used with a phenomenological approach. Ten women participated in the investigation, all professors of nursing at a public university. Their statements were collected by means of interviews with the following questions: How do you see yourself as a woman and professor of nursing? What meanings have you attributed to your body as a woman and a professor of nursing? How do you utilize your body in the teaching of nursing? How do you perceive the corporal posture of your nursing students? What do you observe in them that you consider responses to your corporal postures? The statements were analyzed and interpreted in light of the theoretical-philosophical reference of Maurice Merleau-Ponty, giving rise to three themes: Corporality: expression of existence, Corporality of the woman being, Corporality and the teaching of nursing. The results of the study showed that the woman professor of nursing utilizes her body and corporality in her professorial practice, having intentionalities and actions that demonstrate an awareness of the body beyond mere biological aspects. They attribute to body-corporality important meanings that can contribute to the existence of the woman professor of nursing and, certainly, have repercussions on the practice and understanding of nursin

Perceptions of caregivers about surgical children’s thirst

Objective: to understand how caregivers experience surgical children’s fasting and how they realize their thirst in the perioperative period. Method: descriptive study of qualitative nature, carried out with 15 caregivers of children between 1 and 12 years old after surgery in a teaching hospital. For analysis, the Collective Subject Discourse method was used. Results: four thematic units emerged: surgical children in the presence of fasting and thirst; realizing thirst in surgical children; experiencing and facing the period of fasting and thirst with children; realizing the action of the health team in the presence of children’s thirst. For families, the experience of fasting is permeated with feelings like helplessness and distress. The presence of thirst, detected by self-report and physical signs, exacerbates their suffering. Conclusion: thirst management alleviates the suffering of children and families. It is therefore necessary to develop strategies for children’s thirst management

Percepção dos cuidadores quanto à sede da criança cirúrgica

Objetivo: comprender cómo el cuidador experimenta el ayuno del niño quirúrgico y percibe su sed en el perioperatorio. Métodos: estudio descriptivo, cualitativo, con 15 cuidadores de niños entre 1 y 12 años en postoperatoria en un hospital universitario. Para el análisis, se utilizó el método del Discurso del Sujeto Colectivo. Resultados: surgieron cuatro unidades temáticas: Niño quirúrgico delante del ayuno y de la sed; Percibiendo la sed en el niño quirúrgico; Experimentar y enfrentarse el ayuno y sed con el niño; Percibiéndose la acción del equipo delante de la sed del niño. Para la familia, la experiencia del ayuno está llena de sentimientos, como impotencia y angustia. La presencia de la sed, detectada por auto-informe y signos físicos, exacerba ese sufrimiento. Conclusión: el manejo de la sed aliviaría el sufrimiento del niño y familias. Por lo tanto, es necesario desarrollar estrategias de manejo de la sed en niño