O programa de educação estética e artística - PEEA : 2010-2017 : o lugar da Expressão Plástica no Currículo do 1º Ciclo do Ensino Básico

The present dissertation has as main purpose to know and clarify the context and circumstances in which the Program of Aesthetic and Artistic Education (PEEA) appeared in the Portuguese educational panorama (2010-17). On the one hand, we sought to describe the events that preceded the creation of the PEEA (2010) and, on the other hand, to identify its main authors and / or actors, their conceptual influences, their assumptions and programmatic objectives, with a view to contribute to a better knowledge of this educational project and to understand its models of implementation and action (and possible impacts) in the school context, more concretely, in the disciplinary area of the so-called Visual Expressions in the Primary Education. First, there were mapped the main authors, theoretical issues and historical moments of art education (national and international) that influenced the conceptual and empirical assumptions on which the creation of the PEEA were justified. In the 1990s, in Portugal, discourses and documents (educational and political) emerged that point to the need for serious intervention in this area, from the National Education Council’s Opinions (1992 and 1999) to the recommendations of Teachers’ Associations, Organizations International and other ‘specialists’ in Arts Education. Secondly, the focus of the research focused on the intervention areas of the PEEA and the specificities of Teacher Training in the Visual Arts area. In this context, the educational models proposed in the Integrated Program of Visual Arts: The First Look from the influences of the American Model Discipline-Based Art Education (DBAE), which support the theoretical basis of the PEEA, are discussed. Finally, there is the Artisti

End of life person’s evaluation criteria in the decision making regarding artificial nutrition

Background: Artificial nutrition at the end of life is assumed as a medical intervention, however for a large percentage of person’s and families is considered as basic care [1]. Thinking about artificial nutrition and the end of life person, such as the person with advanced, incurable and progressive disease, with a survival expectancy between 3 to 6 months [2] is often reflected on a set of issues. This is a controversial discussion, about the quality of life resulting of one of these means and ethical questioning [3]. It’s relevant to look to the user/family as one, which motivates the urgent intervention of the nurses in decision-making support. Objective: Identify scientific evidence regarding the end-of-life evaluation criteria, to be considered in the nurses’ decision-making about artificial nutrition. Methods: Literature Review (15-06-2017) with PRISMA guidelines for reviews [4]. It’s relevant to look to the user/family as one, which motivates the urgent intervention of the nurses in decision-making support. Objective: Identify scientific evidence regarding the end-of-life evaluation criteria, to be considered in the nurses’ decision-making about artificial nutrition. Methods: Literature Review (15-06-2017) with PRISMA guidelines for reviews [4 in Academic Search Complete, Complementary Index, CINAHL Plus with Full Text®, Psychology and Behavioural Sciences Collection, ScieELO, MEDLINE®, Directory of Open Access Journals, Supplemental Index, ScienceDirect, Education Source, Business Source Complete and MedicLatina. Inclusion/exclusion criteria: nurses who care for adult/elderly persons at the end of life, excluding nurses who care for children; articles about nurses’ intervention in nutrition care to the person at the end of life and the person’s evaluation criteria; full text; in French/Spanish/English/Portuguese; peer-reviewed; published between 2000-2017. A sample of 11 articles was selected. Results: The evaluation criteria to be considered when making decisions on artificial nutrition are: the evaluation of symptoms/problems; emotional value of food; the meaning of the diet for the person at the end of life and definition of prognosis [3,5-6]. In every decision-making, it should be considered the existence of a clinical indication/treatment, a therapeutic objective and the informed consent of a user or legal guardian. Conclusions: It is concluded that the decision on artificial nutrition should integrate the person at the end of life and family, be taken by an interdisciplinary team, considering the definition of the prognosis and the effectiveness of the treatment applied [3]. The intervention of the nurse is understood as a primordial one, based on the best evidence, in relation of proximity [5] considered, simultaneously, the principle of autonomy, beneficence, non-maleficence and justice. There is little evidence of end-of-life nutrition and new studies on the role of nurses within the interdisciplinary team are suggested.info:eu-repo/semantics/publishedVersio

Nursing strategies to reduce the risk of therapeutic obstinacy in artificial nutrition

Background: Nurses have an important role in maintaining a patient's nutrition near the end of life. Aims: To define nursing nutrition strategies with the person near the end of life and their families; systematise the elements to be considered in artificial nutrition decision-making and evaluate the nursing interventions' influence on therapeutic obstinacy risk. Methods: A sample of 11 articles were selected and the results considered strategies to promote oral feeding before artificial nutrition; the follow-up of the health-disease process by nurses and described the nurse's role as a privileged patient advocate in the defence of the ethical principles of decision-making. These principles consider symptomatology, prognosis, psychology and the emotional significance of nutrition. Conclusion: Nurses are qualified professionals with a critical role in the patient's care due to the proximity they have with the patient; the evidence seems to show a relationship between nursing interventions and the reduction of the risk of therapeutic obstinacy; however, there are no studies in this specific area.info:eu-repo/semantics/acceptedVersio

Nurse’s intervention – end of life nutrition approach protocol

Background: To know that nutrition in the present society is increasingly associated with life maintenance and comfort, helps us to understand the complexity of this subject when approached the end of life. Artificial nutrition remains controversial in a palliative context, given the questioning about the quality of life that offers [1]. Protocols help nurses in the decision-making process and increasing their competences. Objective: To present an end-of-life nutrition approach protocol for palliative care. Methods: This study is the result of three integrative literature reviews that intended to measure: which nursing interventions promote end of life nutrition in people without artificial nutrition criteria?; what are the evaluation criteria for the end-of-life person for the nurse’s decision-making of start, don’t start or suspending artificial nutrition?; does the nurse’s interventions towards the end-of-life reduce the risk of therapeutic obstinacy associated with artificial nutrition? Based in Buckman & Spikes Communication Protocol [2], the results were integrated in a protocol form and submitted to the opinion of 13 experts, from 18th October to 6th November 2017, and the respective changes were made. Inclusion criteria of experts were: being health professionals; palliative care experience and/or work development in nutrition subjects. Results: Our experts have on average 37 years old; 10 carry out their activity in Palliative settings, 8 of these have advanced training in Palliative Care. Our protocol considers: I) setting - preparing the environment; II) perception - prior knowledge of the person/family information about nutrition, preferences and considerations regarding the future commitment of feeding and active listening, understanding what the person/family wants to know, especially as to the meaning of nutrition, what that moment represents and invite them to address the subject; III) knowledge - provide adequate information in phases, contextualizing the present symptoms in the disease process (prognosis) and discuss the evaluation criteria before starting artificial nutrition; IV) emotions – attend to the emotions and provide realistic hope; V) strategy – interventions from the patient’s needs are presented in an algorithm form, promoting oral feeding as long as possible. In all process, the person and family autonomy in decision making is preserved. At each step, we identified an element to avoid in the communication process [1,2]. Conclusions: The set of nurse’s interventions in end-of-life nutrition approach systematizes the elements to be considered in decision-making and guarantees the importance of nurses' contribution in risk reduction of therapeutic obstinacy.info:eu-repo/semantics/publishedVersio

Artificial nutrition at the end of life : nurses decision-making

O presente relatório procura descrever o percurso formativo de aquisição e desenvolvimento de competências especializadas, em Enfermagem Médico-Cirúrgica. Foi enquadrado em plano formativo do Mestrado em Enfermagem da Universidade Católica Portuguesa, Instituto de Ciências da Saúde. O processo formativo compreendeu o desenvolvimento de estágio em três contextos diferenciados, tendo em comum o espaço hospitalar: Serviço de Urgência Geral, Viatura Médica de Emergência e Reanimação; Equipa Intra-hospitalar de Suporte em Cuidados Paliativos, Unidade de Apoio Domiciliário e Unidade de Cuidados Intensivos Polivalente. Pensando o desenvolvimento pessoal e profissional desejado na construção de uma intervenção do cuidado especializado foi assumida a temática central e transversal: Nutrição Artificial em Fim de Vida: a Tomada de Decisão pelo Enfermeiro. Esta foi abordada em processo reflexivo e crítico tendo por suporte, ao longo do relatório, a Teoria das Transições de Afaf Meleis e o Modelo da Mudança da Prática Baseada na Evidência de Mary Rosswurm e June Larrabee, assim como, os aportes de revisão integrativa da literatura elaborada. Sabendo a filosofia dos Cuidados Paliativos na promoção do conforto e qualidade de vida, em período de sucessivas transições (Meleis, 2010) o compromisso da nutrição significa a proximidade da morte (Alves, 2013), pelo que desenvolvemos diferentes atividades referentes ao tema, tais como: a construção de dossier temático sobre a nutrição artificial; a criação de protocolo de abordagem da alimentação em fim de vida; o desenvolvimento de formação sobre os critérios de avaliação da pessoa com nutrição artificial em fim de vida e a conceção de póster informativo sobre o mesmo tema. Este relatório apresenta todo o percurso de desenvolvimento considerando a componente científica de base às atividades desenvolvidas e contextualizando as mesmas ao longo dos três espaços de estágio por explanação dos objetivos definidos, descrição reflexiva das atividades desenvolvidas e competências mobilizadas em torno do tema central.This report seeks to describe the formative course of acquisition and development of specialized skills in Medical-Surgical Nursing. It was framed in a training plan of the Master’s in Nursing of the Universidade Católica Portuguesa, Instituto de Ciências da Saúde. The training process involved the development of a traineeship in three different contexts, having in common the hospital space: General Emergency Service, Emergency Medical Car and Reanimation; In-hospital Support Team in Palliative Care, Home Support Unit and Intensive Care Unit. Thinking about the personal and professional development desired in the construction of a specialized care intervention was assumed the central and transversal theme: Artificial Nutrition at the End of Life: Nurses Decision-Making. This was addressed in a reflexive and critical process supported by Afaf Meleis and her Theory of Transitions and the Evidence-Based Practice Model by Mary Rosswurm and June Larrabee, as well as the contributions of an integrative review of the literature. Considering the palliative care philosophy in promoting comfort and quality of life in a period of transitions (Meleis, 2010), the nutritional deterioration means the proximity of death (Alves, 2013) so a multistep approach was developed: the construction of thematic file on artificial nutrition; the creation of a protocol for approaching end-of-life feeding; the development of training on the evaluation criteria of the person with artificial nutrition at the end of life and the design of an information poster on the same subject. This report presents the whole course of development considering the basic scientific component of the activities developed and contextualizing them throughout the three stages of the internship by explaining the defined objectives, reflective description of the activities developed and competences mobilized around the central theme

Métodos de investigação em cuidados paliativos - investigação-ação

Introduction: The action-research methodology favors the development of practice through the creation of new knowledge; perspective change through reflection on practice. It is an action methodology with the interconnection of the dimensions of investigation, action, and training, which has been applied in studies in the area of ​​palliative care. Aim: Identify the contribution of the use of action research, as a method, in the context of palliative care. Materials and Methods: Considered the studies from the last five years (2010 to 2016), with full text, belonging to the collection of articles from MEDLINE and CINAHL database using research on EBSCO host database in English. The themes of action-research and palliative care were selected, and articles that did not fit both themes excluded. Results: Eleven articles obtained; after the selection of themes, were reduced to four, highlighting the group in its development and primacy of intervention in complex issues. Conclusion: This dynamic method, which requires cooperation and collaboration from the participants, has been satisfactorily applied in palliative care. From this can be created, in due contexts, evolutionary actions in the face of a holistic view of the problem-issues and keeping, in tune, theory, and practice, research and action.Introdução: A metodologia de investigação-ação privilegia o desenvolvimento da prática pela criação de novo conhecimento; perspetiva a mudança, através da reflexão sobre a prática. É uma metodologia de ação com interligação das dimensões de investigação, ação e formação a qual tem sido aplicada em estudos na área de cuidados paliativos. Objetivo: Identificar o contributo da utilização da investigação-ação, como método, no contexto dos cuidados paliativos. Materiais e Métodos: Considerados os estudos dos últimos cinco anos (2010 a 2016), com texto completo, pertencente à coleção de artigos da MEDLINE e CINAHL a partir da plataforma de dados EBSCO, em inglês. Foram selecionados os temas de investigação-ação e cuidados paliativos, tendo sido excluídos os artigos que não se enquadrassem em ambas as temáticas. Resultados: Obtidos onze artigos, que, após a seleção de temáticas ficaram reduzidos a quatro, salientando-se o grupo no seu desenvolvimento e primazia de intervenção em questões complexas. Conclusão: Este método dinâmico, que exige a cooperação, colaboração dos participantes, foi satisfatoriamente aplicado na área de cuidados paliativos. A partir deste método podem ser criados, nos devidos contextos, ações de evolução face a uma visão holística das questões-problema e tendo, sempre em sintonia, a teoria e prática, a investigação e ação

WOOD PULP FOR POLYMER COMPOSITES PRODUCTION

The use of cellulosic fibers in composites is advantageous compared to inorganic materials, because they present lower density, abrasiveness and cost, besides the renewable origin. This study aimed to evaluate the influence of wood pulp obtained by the chemical (bleached and unbleached) and mechanical process, and wood-flour of Pinus taeda as reinforcement in low density polyethylene (LDPE) matrix. The composites were extruded and the specimens molded by compression. The samples were characterized by thermal analysis, density, mechanical properties and scanning electron microscopy (SEM). The incorporation of the wood pulps and the wood flour in the matrix improved the composites mechanical properties and reduced the rate of material degradation. All fibers types acted as nucleating agents because the composites had better mechanical properties than pure LDPE. There was influence of the studied parameters on tensile and flexural strength and the interactions were significant. In general, the highest values of strength and stiffness were obtained with the use of thermo-mechanical process pulp as reinforcement and the lowest values with the use of unbleached chemical process pulp. micrographs analysis showed that the coupling agent was effective for compatibilizing the wood fibers with the LDPE in the composites. It was possible to produce composite materials with good physical and mechanical properties and improved thermal stability by experimental model

The economic cost of nursing care of palliative patient in the emergency service

Introdução: Os Cuidados Paliativos compreendem um conjunto de princípios de intervenção na prevenção do sofrimento que acompanha a pessoa na vivência de uma doença limitadora da qualidade e tempo de vida. É desconhecido o custo económico do cuidado de enfermagem ao utente paliativo em admissão hospitalar evitável, pelo que se considera a sua determinação o objetivo geral deste estudo. Mais se reconhece, que a integração dos cuidados paliativos nos sistemas de saúde, nomeadamente, a existência de uma rede de suporte comunitária pode prevenir estas admissões e reduzir custos promovendo ganhos em saúde e em qualidade de vida. Metodologia: O Estudo apresenta-se dividido em três etapas, a primeira que compreende a revisão integrativa da literatura (RIL) sobre o conceito “urgência evitável”, a segunda pela obtenção de consenso sobre o conceito “urgência evitável” com recurso ao Processo Delphi e a terceira e última, pelo estudo observacional, retrospetivo e analítico englobando os custos económicos dos cuidados de enfermagem aos utentes paliativos, em serviço de urgência hospitalar. Resultados: Na RIL obtivemos contributos de 5 artigos analisados, os quais associados ao Processo Delphi realizado nos permitiu a definição do conceito de urgência evitável. Do estudo em contexto hospitalar, obteve-se uma amostra de 273 utentes paliativos em admissões hospitalares evitáveis (76,3%,273,IC95%:71,7-80,8), falecidos, no ano de 2019. Com uma mediana de 84 anos, cerca de 80% foram admitidos a partir do seu domicílio, após 5h de queixas, maioritariamente, por sintomas respiratórios. Estes permaneceram cerca de 24h em serviço de urgência geral (SUG) totalizando uma mediana de 180,98€ de custos por admissão de utente. Extrapolados os dados à realidade nacional pudemos inferir que os custos globais assumidos com as urgências evitáveis (5.558.804,16€) poderiam ser realocados à contratação de 229 enfermeiros (IC95%:216-243). Discussão: Os resultados obtidos podem ser lidos como contextualizáveis à evidência, com a limitação de amostras pequenas, estudos diversificados e escassos, dificultando processos comparativos. Evidenciou-se que, com a poupança assumida e extrapolada ao contexto nacional, seria possível contratar o número necessário de enfermeiros para completar e/ou criar o número de equipas comunitárias de suporte em cuidados paliativos em falta em Portugal e/ou reforçar os recursos humanos das equipas intra-hospitalares de suporte em cuidados paliativos. Conclusões: Releva-se a oportunidade de incrementar resultados, gerir recursos e cimentar a integração dos cuidados paliativos nos sistemas de saúde, assumidos que estão os seus benefícios como este estudo pôde comprovar.Introduction: Palliative Care comprises a set of principles of intervention in preventing suffering that accompanies the person in the experience of a disease that limits the quality and time of life. The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown, so its determination is considered the general objective of this study. Palliative care integration in health systems is recognized to prevent these admissions; a community support network can avoid and reduce costs, promoting health and quality of life gains. Methods: The study is divided into three stages, the first comprising the integrative literature review on the concept “avoidable urgency”, the second by obtaining consensus on the concept "avoidable urgency" using the Delphi Process and the third and last, through an observational, retrospective and analytical study encompassing the economic costs of nursing care to palliative patients in a hospital emergency department. Results: At RIL, we obtained contributions from 5 articles analyzed, which, associated with the Delphi Process carried out, allowed us to define the concept of avoidable urgency. From the study in a hospital context, we have a sample of 273 palliative users in preventable hospital admissions (76,3%,273,95%CI:71,7-80,8), deceased, in 2019. With a median of 84 years, about 80% were admitted home after 5 hours of complaints, mainly due to respiratory symptoms. These remained for approximately 24 hours in the general emergency department, totalling a median of €180.98 in costs per user admission. Extrapolating the data to the national reality, we could infer that the global costs incurred with avoidable emergencies (€5.558.804,16) could be reallocated to hiring 229 nurses (95%CI:216-243). Discussion: The results obtained can be read as contextualizing the evidence, with the limitation of small samples diversified and scarce studies, making comparative processes difficult. It was evident that with the savings assumed and extrapolated to the national context, it would be possible to hire the necessary number of nurses to complete and/or create the number of community support teams in palliative care lacking in Portugal and/or reinforce human resources of in-hospital palliative care support teams. Conclusions: There is an opportunity to increase results, manage resources and consolidate the integration of palliative care in health systems, assuming that its benefits are present, as this study was able to prove

A transferência do utente em fim de vida para uma morte em ambiente hospitalar : uma inevitabilidade?

Tese de mestrado, Cuidados Paliativos, Faculdade de Medicina, Universidade de Lisboa, 2015Esta dissertação tem como objetivo geral - conhecer as razões que suportam a decisão de transferência, de um utente nos seus últimos dias de vida, para o Hospital, quando acompanhado por uma equipa a prestar cuidados paliativos/ações paliativas no domicílio - e para a sua concretização explorámos os elementos que suportam essa tomada de decisão de transferência. Realizou-se um estudo qualitativo, exploratório e transversal em que foram recolhidos um conjunto de dados, obtidos através de resposta a questionários aplicados a enfermeiros de equipas de prestação de CP/AP no domicílio. Através de análise de conteúdo e realização de estatística descritiva foram identificadas as principais dificuldades dos enfermeiros na manutenção dos cuidados domiciliários, as quais se centraram: no défice de disponibilidade da equipa, sem possibilidade de manter a continuidade de cuidados no período das 24h; a inexistência de cuidador informal em muitos dos casos acompanhados e, em outros, a sobrecarga do cuidador. Igualmente, o controlo sintomático e a ação de em situações de emergência paliativa foram identificados. Destacaram-se, também, as estratégias destes profissionais para agir face às dificuldades já mencionadas, sendo possível registar que as principais medidas adotadas são: centrarem-se no apoio ao utente/família; na gestão do horário de funcionamento; na antecipação de situações de crise e na mobilização de recursos, destacando, sempre, o trabalho em equipa. Quando abordado o trabalho desenvolvido pelas equipas, estas, destacam: o estabelecimento de relação de ajuda junto do utente/família e os inúmeros casos em que, respeitada a vontade do utente e família, conseguiram mobilizar os recursos necessários a um fim de vida digno.This dissertation has the overall objective of being familiar with the reasons that support the decision to transfer a patient in his last days of life to the Hospital, when accompanied by a team that provide palliative care / palliative action in the home, and exploring these elements. A qualitative and empirical cross-sectional study was prepared and set data was collected from questionnaires carried out by nurses that provided palliative care and / or palliative actions at home. Through content analysis and by conducting descriptive statistics the main difficulties of nurses in the maintenance of home care focused on the lack of availability of the team, the disability to maintain continuity of care in the 24h, the lack of informal caregivers that are not monitored in many cases and, in others, the burden of the caregiver. Also, symptomatic control and action in situations of palliative emergency were identified. Thus, the strategies of these professionals to act in the face of difficulties already mentioned are focused on: supporting the patient / family; in the management of work hours; the anticipation of a crisis situation and the mobilization of resources, always stressing teamwork. When approaching the work carried out by these teams they establish the relationship of help to the patient / family and the numerous cases in which, respecting the wishes of the patient and family, they were able to mobilize the resources needed for a decent end to life