Voz da criança e do adolescente que vivem com HIV nos cuidados em saúde: direito à participação na perspectiva do profissional / Voice of children and teenagers living with HIV in health care right to participation from the professional's perspective

Introdução: as crianças e os adolescentes tiveram os seus direitos garantidos pela Convenção dos Direitos das Crianças (CDC). Destaca-se o direito à participação estabelecido pelo art. 12 da CDC e a relevância da sua implementação no contexto dos cuidados em saúde. Este estudo tem como base teórica os Direitos Humanos (DH), a Vulnerabilidade e os Direitos Humanos (V&DH) e o Cuidado Humano à Saúde. Objetivo: compreender como os profissionais de saúde percebem o direito à participação, ou seja, a voz da criança e do adolescente que vivem com HIV em relação ao seu cuidado em saúde. Método: trata-se de um estudo qualitativo, com abordagem participativa que utilizou o Método Criativo Sensível (MCS) a partir do desenvolvimento de Dinâmicas de Criatividade e Sensibilidade (DCS). Para a produção dos dados, foram realizados cinco encontros que contaram com a DCS denominada Livre para criar. A pesquisa foi realizada em três Serviços de Assistência Especializada (SAE) que são referências no atendimento de crianças e adolescentes que vivem com HIV no município de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes foram 16 profissionais de saúde. O corpus do estudo foi submetido à Análise de Discurso (AD) na corrente francesa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (instituição proponente) CAAE: (34250920.2.0000.5327) e pelos Comitês de Ética em Pesquisa das instituições coparticipantes. Resultados: a criança e o adolescente que vivem com HIV experienciam um modelo de cuidado com enfoque biologicista, médico-centrado, com predomínio de ações tecnicistas em saúde. O seu cuidado é permeado por situações de vulnerabilidade individual, social e programática que ao serem reconhecidas pelos profissionais de saúde, possibilitam a adoção da atitude de advogar para a consolidação de um cuidado integral. O respeito aos direitos no contexto de cuidado, especificamente, o direito à participação e à tomada de decisão ainda é incipiente. As crianças e os adolescentes possuem voz em aspectos tangenciais do seu cuidado em saúde e de forma passiva, sendo restringida a uma perspectiva clínica e medicamentosa. Revelou-se que a implementação efetiva do direito não é estimulada na prática, principalmente, pelo desconhecimento da sua legitimidade. Identificou-se os principais obstáculos que limitam o exercício do direito, além de ações e estratégias que são medulares para trilhar novos caminhos. Conclusão: o respeito ao direito à participação constitui-se como um elo promissor nas práticas de saúde à criança e ao adolescente que vivem com HIV, possibilitando a eles serem protagonistas do seu autocuidado, garantido a escuta de sua voz, e transformado os caminhos do cuidado em saúde ao considerar as normas dos DH, configurando-se em um novo modelo de cuidado. As implicações para os profissionais enfermeiros perpassam o seu reconhecimento enquanto referências em desempenhar a significativa tarefa de prover um cuidado em saúde, que trará um novo olhar sob a perspectiva da centralidade dessa população e da efetividade do direito à participação.

Introduction: children and teenagers had their rights guaranteed by the Convention on the Rights of the Child (CRC). The right to participation established by art. 12 of the CRC and the relevance of its implementation in the context of health care. This study is theoretically based on Human Rights (HR), Vulnerability and Human Rights (V&HR) and Human Health Care. Objective: understand how health professionals perceive the right to participation, that is, the voice of children and teenagers living with HIV in relation to their health care. Method: This is a qualitative study, with a participatory approach that used the Sensitive Creative Method (SCM) from the development of Creativity and Sensitivity Dynamics (CSD). For data collection, five meetings were held that counted on the CSD called Livre para criar. The research was conducted in three Specialized Care Services (SCS) that are references in the care of children and teenagers living with HIV in the city of Porto Alegre, Rio Grande do Sul, Brazil. The participants were 16 health professionals. The corpus of the study was submitted to Discourse Analysis (DA) in the French current. The study was approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (proposing institution) CAAE: (34250920.2.0000.5327) and by the Research Ethics Committees of the co-participating institutions. Results: children and adolescents living with HIV experience a model of care with a biological, physician-centered approach, with a predominance of technical actions in health. Their care is permeated by situations of individual, social and programmatic vulnerability that, when recognized by health professionals, advocate for the consolidation of comprehensive care. Respect for rights in the context of care, specifically, the right to participation and decision- making is still incipient. Children and teenagers have a voice in tangential aspects of their health care and passively, being restricted to a clinical and drug perspective. It was revealed that the effective implementation of the right is not stimulated in practice, mainly due to the lack of knowledge of its legitimacy. The main obstacles that limit the exercise of right were identified, as well as actions and strategies that are crucial to tread new paths. Conclusion: that respect for the right constitutes a promising link in health practices for children and teenagers living with HIV, enabling them to be protagonists of their self-care, ensuring the listening of their voice, and transforming the paths of health care when considering the norms of HR, configuring a new model of care. The implications for nursing professionals permeate their recognition as references in performing the significant task of providing health care, which will bring a new look from the perspective of the centrality of this population and the effectiveness of the right to participation.

Application of the Concept of Integrated Medical Care Service in the High Quality Nursing Service of Hemodialysis Patients / 中国医学伦理学

Objective:To construct an integrated medical care service mode in hemodialysis and explore the application effect of the concept of integrated medical service in hemodialysis patients.Methods:In 2016,100 patients who had regular hemodialysis(lasting for more than 3 months) were selected from July to Septembe ras the control group,while another100 patients who had the regular hemo dialysis (lasting for more than 3 months) and received the concept of integrated medical care service were selected from October to December as the observation group.The treatment compliance,the incidence of hemodialysis complications,and patient satisfaction of twogroups were compared.Results:Both the treatment compliance and patient satisfaction of the participants in the observation group were significantly higher than those in the control group (P ＜ 0.05),while the incidence of hemodialysis complications in the observation group was significantly lower than that in the control group (P ＜ 0.05).Conclusion:The implementation of integrated medical careservice concept can fully deepen the service concept of people-oriented and patient-centered,carry out humanized services,improve the treatment compliance of hemodialysis patients,reduce the complications,promote the cooperation of doctors and nurses,enhance the effect of health education,and improve the patient satisfaction.

The effect of one station style in the reform of out-patient service flow / 医学研究生学报

The human-based and patient-centered notion is a significant breakthrough of the management conception of modernized hospitals.The service mode of one station style was first adopted in health examination center in the reform of out-patient service flow.Based on the humanized service notion,we can provide health examination service with high quality and efficiency to various patients by taking multifarious measures such as reforming the department locations,optimizing the health examination course and setting convenience-stations.The service mode of one station style was demonstrated to have not only elevated the quality and efficiency of health examination service,but also increased both the patients satisfaction and the profit and reputation of the hospital.