Simulação realística: tecnologia para consolidação de competências profissionais para segurança do paciente / Realistic simulation: technology for consolidating professional skills for patient safety

Resumo: Segurança do paciente é tema transversal na assistência e no ensino em saúde. Esta pesquisa metodológica enfoca a simulação como metodologia educacional, realizada entre abril e dezembro de 2022, com objetivo de estruturar, validar, aplicar e analisar tecnologia educativa, com vistas a consolidar competências em segurança do paciente para profissionais de enfermagem e medicina em formação nos programas de residência em saúde. O percurso metodológico ocorreu em duas fases. A primeira fase compilou competências para a formação em saúde e a segurança do paciente (etapa 1). Este material foi utilizado em reunião de grupo focal com líderes e chefias de serviços associados à qualidade e educação para subsidiar a identificação de fragilidades em segurança do paciente (etapa 2). A segunda fase correspondeu ao cenário de simulação, composta por oito etapas. A partir das fragilidades, definiram-se os objetivos de aprendizagem (etapa 1) que guiaram a elaboração de compilado teórico-prático nos subtemas educacionais (etapa 2), o qual foi discutido em workshop com os residentes (etapa 3). O cenário foi elaborado a partir de texto narrativo, concebido em ambiente assistencial hipotético, desenvolvido em ambiente simulado (etapa 4); esse foi avaliado pelos componentes do grupo focal (etapa 5). Após treinamento e orientações, ocorreram a simulação e observação crítica da cena pelos participantes (etapas 6 e 7). A oitava etapa correspondeu ao debriefing, com análise do desenvolvimento dos subtemas educacionais; e análise da simulação como recurso para o desenvolvimento e a consolidação de competências em segurança do paciente. Empregou-se a técnica de análise de conteúdo dos depoimentos transcritos; as fases foram registradas descritivamente; os resultados quantitativos foram analisados a partir de números absolutos e relativos. Para a validação do cenário foram utilizados os resultados do ranking médio e de confiabilidade. As fases e etapas sistematizadas foram compiladas em formato de Guia. As lacunas vinculadas às competências e que perfizeram os subtemas educacionais foram relativas à comunicação, adesão aos protocolos de segurança, continuidade do cuidado e trabalho em equipe. Foram objetivos educacionais: desenvolver a comunicação entre a equipe interprofissional; entender a importância dos protocolos e da inserção do paciente no processo de cuidar; desenvolver e consolidar competências profissionais relativas à segurança do paciente. Síntese da literatura subsidiou a contextualização das lacunas, guiando a compreensão e aproximação entre a teoria e a prática, a partir da discussão de casos, revisando e agregando conhecimentos. O cenário simulado foi elaborado e validado de acordo com os objetivos educacionais, observando-se os indicadores estabelecidos; a cena se desenvolveu concomitantemente à observação, propiciando análise crítica dos participantes da pesquisa. A tecnologia de modelagem educacional foi avaliada positivamente quanto às contribuições para o aprendizado e a consolidação de competências; concorreu para simular o cotidiano assistencial e fomentar a reflexão acerca de ações preventivas ao risco para o paciente. A estratégia educacional contribuiu para vigorizar competências em segurança do paciente entre profissionais em formação, cujo método para desenvolvimento e avaliação, compilado na forma de Guia, permite a replicação do percurso metodológico, com vistas à promoção da segurança do paciente.

Abstract: Patient safety is a cross-cutting theme in health care and education. This methodological research focuses on simulation as an educational methodology, carried out between April and December 2022, with the objective of structuring, validating, applying and analyzing educational technology, with a view to consolidating competences in patient safety for nursing and medical professionals in training in the programs residency in health. The methodological course took place in two phases. The first phase compiled competences for training in health and patient safety (step 1). This material was used in a focus group meeting with leaders and heads of services associated with quality and education to support the identification of weaknesses in patient safety (stage 2). The second phase corresponded to the simulation scenario, consisting of eight stages. Based on weaknesses, learning objectives were defined (stage 1) that guided the elaboration of a theoretical-practical compilation on educational subthemes (stage 2), which was discussed in a workshop with residents (stage 3). The scenario was elaborated from a narrative text, conceived in a hypothetical care environment, developed in a simulated environment (step 4); this was evaluated by the components of the focus group (step 5). After training and guidance, the participants simulated and critically observed the scene (steps 6 and 7). The eighth stage corresponded to the debriefing, with analysis of the development of educational subtopics; and simulation analysis as a resource for the development and consolidation of patient safety skills. The technique of content analysis of the transcribed testimonies was used; phases were descriptively recorded; the quantitative results were analyzed from absolute and relative numbers. For the validation of the scenario, the results of the average ranking and reliability were used. The systematized phases and steps were compiled in a Guide format. The gaps linked to competences and that made up the educational subtopics were related to communication, adherence to safety protocols, continuity of care and teamwork. The educational objectives were: to develop communication between the interprofessional team; understand the importance of protocols and the insertion of the patient in the care process; develop and consolidate professional skills related to patient safety. Literature synthesis subsidized the contextualization of the gaps, guiding the understanding and approximation between theory and practice, from the discussion of cases, revising and adding knowledge. The simulated scenario was elaborated and validated according to the educational objectives, observing the established indicators; the scene developed concurrently with the observation, providing a critical analysis of the research participants. Educational modeling technology was evaluated positively in terms of contributions to learning and skills consolidation; contributed to simulate daily care and encourage reflection on preventive actions to risk for the patient. The educational strategy contributed to strengthening patient safety skills among professionals in training, whose method for development and evaluation, compiled in the form of a Guide, allows the replication of the methodological path, with a view to promoting patient safety.

Student's confidence in mental health practice before and after psychiatry rotation: a follow up study / Autoconfiança dos alunos para a prática em saúde mental antes e depois do internato em psiquiatria: um estudo de seguimento

ABSTRACT Objectives The primary objective was to measure the effect of psychiatry rotation in students self-confidence (SC) for managing mental health (MH) issues. Methods An eighteen questions version of "Preparation for Hospital Practice Questionnaire" (PHPQ) adapted for MH was applied before, after and six months later the psychiatry rotation. Sociodemographic and experience with mental illness was measured as confounding factors. Results Hundred and ten students were recruited and four factors were identified: "Diagnosis elaboration and basic care" (F1), "Crisis management and prevention" (F2), "External sickness determinants" (F3) and "Personal distress with clinics" (F4). Cronbach Alpha ranged from 0.71 to 0.90. Previous MH training were not frequent (9.09%), and associated with better SC in F2 (after p < 0.05, 6m p = 0.03). Previous mental disorder was frequent (42.16%), and associated with more SC on F2 (p < 0.01) and F3 (p = 0.03) before course, but only on F3 after (p < 0.01) and not 6 months later. Male gender had more SC in F4 (p < 0.01) before course, but after course and 6m later female gender became more SC in F1 (after p = 0.02, 6m p = 0.01) and equivalent in F4. All factors had higher scores after and 6 months later (p < 0.001). The class considered that an interview script is very important for their SC, and improves assistance (mean > 9.0/10.0). Conclusion Obligatory rotation in MH improved SC in students. Previous training and gender were related with long lasting effects in SC.

RESUMO Objetivos Avaliar os efeitos de empoderamento do internato em saúde mental (SM) na autoconfiança (AC) dos alunos de Medicina. Métodos Uma versão adaptada para a saúde mental do "Questionário de Preparação para Prática Hospitalar" foi aplicada antes, depois e seis meses após o internato. Resultados Cento e dez alunos participaram e quatro fatores foram extraídos: "Elaboração diagnóstica e cuidados básicos" (F1), "Gestão e prevenção de crise" (F2), "Determinantes externos de adoecimento" (F3) e "Sofrimento pessoal com a clínica" (F4). Treinamento prévio em SM é incomum (9,09%), mas foi associado com pontuações mais altas em F2 (p = 0,05 e 6m p = 0,03). Tratamento prévio em SM (42,16% dos alunos) foi associado a valores mais altos em F2 (p < 0,01) e F3 (p = 0,03) antes, mas apenas em F3 (p < 0,01) após o curso. O gênero masculino apresentou valores mais positivos que o feminino em F4 (p < 0,01) antes, mas não após o curso, quando apresentaram valores mais baixos em F1 (após p = 0,02, 6m p = 0,01). Todos os fatores apresentaram valores mais altos após o curso (p < 0,001). Os alunos consideraram o uso de uma entrevista estruturada muito importante para sua autoconfiança e qualidade da assistência (média > 9,0/10,0). Conclusão O internato em SM aumentou a AC nos alunos. Treinamento prévio e gênero estiveram associados com efeitos duradouros na AC.

Admission of alumni from Multiprofessional Residency Programs into the SUS / Inserção de egressos de Programas de Residência Multiprofissional no SUS

ABSTRACT INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.

RESUMO INTRODUÇÃO: Os Programas de Residência Multiprofissional em Saúde (PRMS) configuram-se como estratégia para a formação de força de trabalho para o Sistema Único de Saúde (SUS). OBJETIVO: Investigar a proporção de egressos de PRMS voltados à Atenção Primária à Saúde (APS) inseridos no SUS e fatores associados. MÉTODOS: Trata-se de um estudo seccional desenvolvido com egressos de PRMS voltados à APS de todo o Brasil, referente ao período de 2015 a 2019. Os participantes responderam a um questionário on-line com informações pessoais gerais, inserção na pós-graduação stricto sensu, no mercado de trabalho e especificamente no SUS. Foram aplicados o teste qui-quadrado de Pearson, para análises bivariadas, e Regressão de Poisson, para a análise múltipla. RESULTADOS: Participaram do estudo 365 egressos de Programas de todas as regiões brasileiras. Destes, 80,2% relataram inserção no mercado de trabalho e 47,9% informaram estar trabalhando no SUS. A inserção no SUS esteve associada às profissões que compõem a Equipe de Referência para a APS (RP = 1,87; IC95% 1,54-2,28) e à não inserção em programas de pós-graduação stricto sensu (RP = 0,77; IC95% 0,61-0,97). Quanto às características de inserção, prevaleceram o cenário da APS (47,4%) e o trabalho voltado à atenção à saúde (84,9%). Quase 40% dos egressos inseridos no SUS estão trabalhando por intermédio de vínculos instáveis, além de frequente não valorização do título da residência no recrutamento (56,9%). Entre os inseridos no SUS, 8,7% relataram terem sido selecionados para o enfrentamento da pandemia de covid-19. CONCLUSÕES: Os resultados deste estudo reforçaram a necessidade de política de incentivo à manutenção, criação e valorização dos PRMS e alertaram para possível aumento da dificuldade de inserção das categorias profissionais, frente ao cenário de desfinanciamento da saúde.

Boarding School: A Simple Approach To Reduce Soil Transmitted Helminth Infections In Orang Asli Children Of Sungai Siput, Perak, 2017

@#Soil transmitted helminth (STH) infection is a major public health concern among the indigenous children of Malaysia. Precarious living conditions at home including unavailability of water, drinking of contaminated water, poor sanitation and livestock presence, are known risk factors for the infection. In order to provide better living conditions, these children are enrolled in boarding schools. This study was conducted to determine whether boarding schools is a solution in reducing soil transmitted helminth infection among Orang Asli children in Sg Siput, Perak, Malaysia. An analytical cross-sectional study was conducted among 204 schoolchildren aged 7-17 years from three boarding schools in Sungai Siput, Perak from January to March 2017. Stool samples were collected and examined using direct smear and Kato-Katz technique. Information on sociodemographic and environmental conditions were collected using a modified Demographic Health Survey (DHS) questionnaire. Data analysis was done using IBM SPSS Statistics Processor 20.0.Out of a total of 204 children, only 48% (n= 97) were infected with at least one type of STH species which showed a reduced prevalence as compared to previous studies conducted among home dwelling schoolchildren with overall prevalence of 78-97%. Majority of the children had monoparasitism (31%; n=63) with moderate intensity by T trichuira (n=51, 25%). Univariate analysis shows that unavailability of water at home has a statistically significant association with STH infection among boarding school children (OR=0.73; 95% CI= 0.56-0.95 p=0.021). Multivariate analysis proves children who had unavailability of water at home has 2.1 times more likelihood of getting an STH infection (OR= 2.08; 95%CI= 1.07-4.07; p= 0.032).This study demonstrates a reduced STH prevalence among Orang Asli boarding school children as better living condition there limits the spread of STH infection among them.

Variations In Blood Pressures Amongst Day School Children And Boarding School Children In Western Maharashtra

Introduction: School children majorly face stress due to the pressure and expectations from their parents besides aca-demics, athletics, etc. It is known that depression, stress increases blood pressure. Such wide variations in blood pres-sure at such a young age can increase the incidence of cerebrovascular accidents, ischemic heart diseases, renal failure and preterm death in the adulthood of such children. This survey will guide the parents and teachers to the various problems student face and how can they help the student cope with it. Method: The blood pressure of each student was taken three times to reduce them to minimise the possibility of errors and the blood pressures of all the students were compared according to their age (13-16 years) and the schooling type (boarders and day scholars). Results:On comparing the prehypertensive stage, the numbers of pre-hypertensives are found to be greater in the age group of 15 years in both day scholars and boarders i.e. 14% and 8% respectively. The on comparing the schooling type the day scholars have a greater number of prehypertensive i.e. 25% than boarders which is 17%. Though pre-hypertensives are higher in the age group of 15 years, but the numbers of hypertensives are more in 14 years of age which is 7% (6% in hypertension stage I and 1% in hypertension stage II) in day scholars and 4% (3% in hypertension stage I and 1% in hypertension stage II) in boarders. In schooling type, a similar trend as that of prehypertension is seen i.e. in day schol-ars 14% students are in hypertension stage I and 3% students are in hypertension stage II making a total of 17% of hypertensive in day scholars. Similarly, in boarders there are 6% in hypertension stage I and 1% in hypertension stage II making 7% hypertensive in boarders, thereby showing a higher percentage of hypertensive in day scholars. Conclu-sion: The study revealed Percentage of students in hypertension stage I and hypertension stage II were found more in day scholars (14% HT STAGE I and 3% HT STAGE II) than boarders (6%HT STAGE I and 1% HT STAGE II) re-spectively. Thus, it can be very well concluded that 17% of day school children and 7% boarders were found to be in hypertensive.

A socio-demographic profile, growth, nutritional and hygiene status of children of primary and secondary boarding schools of Gandhinagar district: a cross sectional study.

Background: A school is a key location for educating children about health, hygiene and nutrition, and for putting in place interventions to promote the health of children. Objectives: of current study were 1) To study the socio demographic profile of children of boarding schools. 2) To study the growth, nutritional and hygiene status of children of boarding schools. Methods: The study was a cross sectional study. After taking the permission of principal of resident schools and consent of the parents of children, 867 children from 8 boarding schools were interviewed during February-March 2011. A self-administered questionnaire was used for data collection. Results: Age of the study children (total 867) ranged from 5-19 years. (Mean age = 13.80 ± 1.96 years). Out of 867, 434 (49.9%) were boys and 433 (50.1%) were girls. 32.6% belonged to socio economic class IV. There were only 122 (14.1%) children who had been in boarding school since 4 and more than 4 years. Good personal hygiene was observed in only 75 (8.7%) children followed by fair personal hygiene in 292 (33.7%) children and poor personal hygiene in 500 (57.7%) children. 220 (50.8%) female children had fair personal hygiene and 343 (79.0%) male children had poor personal hygiene and this difference was statistically significant. Prevalence of malnutrition in this study was 7.2% (Females = 4.2%; Males = 10.1%; P <0.001).The bulk of the malnutrition cases were constituted by the grade-I P.E.M. cases (66.1%) followed by grade-II P.E.M. cases (25.8%) and there were 5 (8.1%) cases of grade-III malnutrition only in female children. Conclusion: Poor personal hygiene, poor nutritional status among these children needs great attention and health education.

A Survey on Present Situation of Intelligence among Boarding School-age Children of the Va Nationality / 昆明医科大学学报

Objective To analyze the present situation of intelligence of boarding school-age children of the Va nationality.Methods Multi-stage random sampling method was used to select 650 boarding school-age children from 10 primary schools in ShuangJiang county, and their level of intelligence was estimated by Raven's STANDARD progressive Matrices (SPM) .Results The level of intelligence of boarding school-age children of the Va nationality was significantly lower than the norm ( 0.05) .Conclusions The present situation of intelligence of boarding school-age children of the Va nationality is serious and should be improved as quickly as possible.