Nurses' perception and practice towards the humanization of antenatal care and delivery in high-risk maternity hospitals

Orientador: Maria Yolanda MakuchTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: Estudar a percepção e prática dos profissionais de enfermagem em relação à incorporação de ações de humanização na assistência a gestação e parto. Método: Foi realizado um estudo qualitativo e uma revisão integrativa da literatura. A seleção dos participantes foi por amostragem proposital, e o número de participantes foi determinado pelo critério de saturação teórica dos dados. A coleta de dados ocorreu no ano de 2015, no ambulatório do pré-natal de alto risco e no centro obstétrico de duas maternidades públicas de atenção terciária localizadas nas regiões Sudeste (maternidade A) e Nordeste (maternidade B) do Brasil. A amostra foi composta por dois grupos de participantes. Um grupo foi formado por enfermeiros que realizavam assistência ao pré-natal e o outro por enfermeiros do centro obstétrico das duas maternidades. Foram realizadas entrevistas semiestruturadas utilizando um roteiro temático. Todas as entrevistas foram gravadas e transcritas na íntegra. Os dados foram analisados por meio da técnica de análise de conteúdo na modalidade temática. As categorias de análise foram organizadas de acordo com as recomendações propostas pelas políticas públicas de humanização da assistência e dos temas emergentes. Resultados: Para a revisão integrativa da literatura foram selecionados 28 artigos. Evidenciaram-se a necessidade de valorização da formação do enfermeiro para a humanização do parto e a limitação da atuação do enfermeiro decorrente das precárias condições de trabalho, do modelo biomédico presente nas instituições e dos fatores socioculturais. Participaram do estudo de campo 21 enfermeiros, destes seis trabalhavam no ambulatório de pré-natal de alto risco (três da maternidade A e três da maternidade B) e 15 atuavam no centro obstétrico (seis da maternidade A e nove da maternidade B). As enfermeiras que trabalhavam no pré-natal consideraram que a humanização consiste no acolhimento da gestante, assistência individualizada e formação do vínculo. Nas duas maternidades referiram às visitas nas maternidades, grupos de gestantes, orientações sobre os métodos não farmacológicos para o alívio da dor durante o trabalho de parto e incentivo à presença do acompanhante. Relataram a necessidade de aperfeiçoar o conhecimento dos profissionais sobre as politicas de humanização, melhorar a comunicação da equipe, a captação precoce da gestante, aprimorar os materiais educativos e garantir as gestantes o local do parto. Os participantes do centro obstétrico consideraram que a humanização da assistência à parturiente consiste no atendimento holístico, escuta qualificada e nas orientações sobre a evolução do trabalho de parto. A prática do enfermeiro no parto foi distinta nas duas maternidades e no puerpério imediato favoreceram o contato pele-a-pele e o incentivo ao aleitamento materno. Relataram que a estrutura física das duas instituições contribuiu para as práticas de humanização. Conclusão: Os enfermeiros compreendem o conceito de humanização do pré-natal e do parto. No pré-natal as práticas de humanização em comum nas duas maternidades foram o acolhimento, a assistência individualizada e o vínculo com a gestante; e às práticas de assistência ao parto foram distintas nas duas maternidades. Os enfermeiros do pré-natal sugeriram a melhoria da comunicação da equipe, dos materiais educativos e da implantação de uma política interna das instituições para direcionar as ações de humanização; e do centro obstétrico relataram a necessidade de capacitação contínua e valorização do enfermeiro. As facilidades para as práticas de humanização do pré-natal e parto nas duas maternidades foram à estrutura física adequada, as visitas guiadas no centro obstétrico, o trabalho multidisciplinar e o acesso a informações. No centro obstétrico as dificuldades para a prática de humanização foram à insuficiência de enfermeiros, a pouca articulação das ações multidisciplinares e o uso inadequado das salas PPPAbstract: Objective: To study the perspective and practice of nursing professionals towards the development of actions to humanize pregnancy and delivery. Method: A qualitative study and an integrative literature review were conducted. Participants were selected using purposive sampling and the number of participants was determined according to the theoretical saturation of the data. Data collection took place in the year 2015 at the high risk antenatal outpatient clinic and the obstetric center of two public tertiary-level maternity hospitals located in Southern (Hospital A) and Northeastern (Hospital B) Brazil. The sample consisted of two groups of participants. One group was composed of nurses who provided antenatal care and the other included nurses from the obstetric centers of both hospitals. Semi-structured interviews were carried out using a thematic guide. All interviews were recorded and transcribed verbatim. The data were submitted to content analysis. The analytical categories were organized according to the recommendations of the public policies for the humanization of care and the emerging themes. Results: The integrative review included 28 articles. The need to valorize nurses¿ training for the humanization of delivery and the limitation of nurses¿ performance due to precarious working conditions, the biomedical model present in the institutions and sociocultural factors were evident. The field study included 21 nurses. Of these, six worked at the high risk antenatal outpatient clinic (three from Hospital A and three from Hospital B) and 15 worked at the obstetric center (six from Hospital A and nine from Hospital B). The nurses who provided antenatal care reported that humanization consisted of: actions related to pregnant women¿s embracement, individualized care, and bonding between pregnant women and professionals. Professionals from both hospitals reported conducting guided visits to the maternity ward and orientation groups of pregnant women, provided guidelines on nonpharmacological methods for pain relief during labor and encouraged the presence of the companion. They reported the need to enhance professionals¿ knowledge about humanization policies, improve team communication, perform early registration of pregnant women, improve educational materials, and ensure pregnant women¿s access to a birthing room. Participants working at the obstetric center considered that the humanization of the care provided to parturient women consists of holistic care, qualified listening and guidance on the evolution of labor. Nurses¿ practices during delivery were different in both hospitals and they favored skin-to-skin contact and encouraged breastfeeding in the immediate puerperium. They reported that the physical structure of the two institutions contributed to the development of humanization practices. Conclusion: The nurses understand the concept of humanized antenatal care and delivery. The practices for humanizing antenatal care in both hospitals included user¿s embracement, individualized care, and bonding between pregnant women and professionals. The practices for humanizing delivery care were different in both hospitals. The nurses providing antenatal care suggested the improvement of team communication and educational materials, and the implementation of an internal policy to guide humanization actions. The nurses working at the obstetric center reported the need for continued tracing of pregnant women and valorization of nurses. Factors facilitating practices for the humanization of antenatal care and delivery in both hospitals were the adequate physical structure, the guided visits to the obstetric center, the multidisciplinary work, and the access to information. Difficulties for developing humanization practices at the obstetric center were related to the shortage of nurses, the little articulated multidisciplinary work, and the inadequate use of birthing roomsDoutoradoSaúde Materna e PerinatalDoutora em Ciências da Saúd

Characteristics Physicals and Chemicals of Probiotic Drinks Soy-Yamghurt

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The increase in people's healthy life style has increased the demand for organic rice.  However, this is not supported by sufficient increase in the organic rice production. Therefore, Field School of Organic Farming (FS-OF) was conducted as an effort to increase the organic rice production. This FS-OF activity is aimed to improve farmers' understanding and skill about the organic rice cultivation through demonstration plots. The service activities that have been carried out include the production of demonstration plots for organic and conventional rice cultivation to compare their production, handover of technology transfer tools, training in organic rice cultivation, making the liquid organic fertilizers and organic pesticides, and biochar. The results of community service have increased the understanding of field school participants and increased organic rice production by 10% when compared to conventional rice cultivation &nbsp

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Analysis on Soy-Yamgurt Potential as Antidiabetic in Streptozotocin-Nicotinamide Induced Rats

This study was conducted to determine the potential of soy-yamgurt probiotics drink from the mixture of yam and soy extract with a ratio of 1: 1 in reducing the fasting blood glucose level of rats induced by streptozotocin-nicotinamide. Based on the analysis of chemical and phytochemical characteristics of soy-yamgurt, it was found that it has water content (80.97%), total solids (18.85%), protein content (11.95%), total lactic acid (1.03%), viscosity (20.56 Pa.s), lactic acid bacteria (10.22 log CFU/g), fiber content (0.98%), IC50 value (44.99 μg/ml), total phenol (711.90 μgGAE/g) and total flavonoids (1345.73 μgQE/g). The in vivo test used thirty 10-16 week old male Wistar rats with an average weight of 160-200 g divided into 5 groups: P1 (control), P2 (streptozotocin-nicotinamide), P3 (glibenclamide of 0.45 mg/kg body weight), P4 (3 ml of soy-yamgurt) and P5 (3.5 ml of soy-yamgurt).The results showed that the soy-yamgurt at the doses of 3 ml/160 g body weight and 3.5 ml/160 g body weight for 4 weeks in streptozotocin-nicotinamide-induced rats had significantly (P<0.01) lowered blood glucose levels and increased their weight

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Pola Penyajian Informasi dan Keputusan Investor yang Irasional

This study aims to examine the difference between the participants' investment decisions that informed good news followed by bad news rather than participants who informed bad news followed by good news on the pattern of presentation of Step by step and length series information. Design of Experiments in this study is 1x1x2 which is pattern of presentationf Step by step (SBS), a series of information length, and direction of evidence information (good news followed by bad news and bad news followed by good news). The hypothesis in this study were tested with the Mann-Whitney U test. The results from this study indicate that there is no difference between participants investment decisions that were informed of good news followed by bad news than participants who informed good news followed by bad news in the presentation of SBS meanwhile in series pattern length information in the investment decision-making. This suggests that investment decisions taken by investors is as Irrational. Non-compliance results with the theory that in acu caused by four factors that affect the internal validity of such selection, maturation, history, and testing

Belgique

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