The health-illness care process and the logic of the nurse's work in the ICU

The present study aims to learn the health production logic in the ICU based on the discourse defended by nurses and on the professional practice that is recognized by the relatives accompanying the hospitalized patients. This is a qualitative and dialectic investigation performed with seven nurses and five relatives in an ICU for adults of a teaching hospital in Santa Catarina. The theoretical-philosophical referential was based on Marxist and Gramscians readings. The results show that the logic of the health production in the ICU is inserted in a dialectic rhythm of autonomy, dependence and co-responsibility for the care. We understand that this reality can demonstrate the need to rethink the knowledge and practices to promote the constant re-formularization and transformation of the assistant context of intensive care.     

The own body as a nurse's living experience on assisting others in their dying process

It refers to the study of the researcher's perception when analyzing her own existence, aiming to learn the sense and meaning of her own body as a living experience while assisting the other in the process of dying. The Merleau-Ponty phenomenology and the new hermeneutic approaches were chosen. A point of contact was established between the living experience of the approximation of the object, unveiled by the own body inserted in the world, the object and the subject of the study. The themes that emerged were about the magical-religious knowledge influences of the perceived world, the real knowledge and the teaching-learning process. The phenomenon elaborated, result of the study, allowed the learning of the thesis of the existence of a sense and meaning for the own body of health professionals when assisting others in the dying process.     

Negotiation: a fundamental process in family medicine

Negotiation, a common term in American society, is a process that can be especially useful to family medicine as a specialty that interfaces with many other clinical areas. The basic concepts of the negotiation process, including Maslow's need theory, terminology, and the three phases of the process (ie, planning, implementation, and follow-up), are applied to family medicine. A case study of a successful curriculum negotiation between family medicine and pediatrics is presented, and the use of need theory in the planning phase and during the strategic approach is analyzed. The negotiation process is also applied to faculty contracts, practice management training for residents, clinical teaching, and interdisciplinary relationships as indications of its broad usefulness within family medicine.     

Sharing the diagnostic process in the clinical teaching environment: a case study

Revealing or visualizing the thinking involved in making clinical decisions is a challenge. A case study is presented with a visual implement for sharing the diagnostic process. This technique adapts the Bayesian approach to the case presentation. Pretest probabilities and likelihood ratios are gathered to obtain post-test probabilities of every question considered in a patient. The technique advocates for the judicious use of diagnostic options based on the best evidence available. Clinical decisions, presentation skills, and critical evaluation of the literature are also important elements considered in this method.     

干预措施对ICU护士床头抬高依从性的影响

探讨提高ICU护士对危重患者床头抬高依从性的方法。方法：回顾性分析干预措施（严密质控,优化测量工具,规范化培训,品管圈成员督查,每月护士会的反馈）前后床头抬高依从性的影响。结果：床头抬高依从率由干预前47.10%提高至干预后80.61%。结论：综合干预措施的实施,能有效地提高护士执行床头抬高的依从性。     

Siblings' experience of pediatric cancer: interviews with children

Most previous research on how a child's cancer affects his or her siblings has relied on various methods but has not involved direct interviews with the children themselves. In this study of the siblings of young cancer patients, youngsters tell their own story, describing their experience of cancer in terms of their emotional responses.     

Sources of variability in uncertain medical decisions in the ICU: a process tracing study

Background: Consistency of medical decision making (equity) is an important component of quality of care. When patients with chronic obstructive pulmonary disease (COPD) present with an exacerbation needing respiratory support they may die if it is not provided. However, if the disease has reached its terminal stage, ventilation will prolong the process of dying. The ventilation outcome is uncertain and there is evidence of variability when this decision is made, the sources of which are not well understood.     

How the family acts regarding the health-disease process of a family member with breast cancer

Qualitative study performed with ten relatives of cancer patients in two clinics located in Feira de Santana-BA, aiming at analyzing how the family thinks, feels, and acts concerning the disease. Data was collected by means of a semi-structured interview and analyzed by dialectic hermeneutics. Results showed that most interviewees associated cancer and death, and the first reaction concerning the disease was unexpected, with a feeling that "the world has fallen". With time, there appeared hope, solidarity and faith to face the disease; however, they regarded emotional support as critical for the treatment. Family experience regarding breast cancer was seen as a "life change" in individuals, in emotional, religious and biological terms. Such changes showed the need for support groups to help patients and their relatives to face the disease.     

The experience of the family caring for a relative with cancer

The proposal of this study is to understand the kind of care developed by family members of patients suffering from cancer, in order to help and support them in such a difficult situation. The study also aims at understanding the experience the family goes through by identifying the kind of feelings family members experience during the period of the disease. We will adopt a qualitative approach having symbolic interacionism as our theoretical reference. It was observed that in order to take care of the patient the family develops several forms of support and care, thus creating new ways to function in this situation. While caring for the patient the family expresses its feelings and its interpretation of the situation.     

气管插管术在ICU抢救中的应用体会

急危重症患者抢效,保持呼吸的道通畅是重要原则.大量的临床实践证明,对于心跳呼吸停止及其严重缺氧的呼吸衰竭患者,单纯依靠鼻导管吸氧,面罩吸氧或口对口呼吸不可能纠正缺氧状态,必须及时进行气管内插管,经口或鼻气管建立人工呼吸通道,才是行之有效的方法.     

Coping with grief following perinatal death: a multifaceted and natural process

Coping with grief following perinatal death is a natural process that every individual experiences in his own personal and unique way. Parents go through varying emotions in the months following the death of their baby. Empathic support and understanding, both from the parents' social network and from professional caregivers, have a positive effect on the mourning process. Parents benefit from individually focused counseling and assistance in making their own choices with regard to saying goodbye and the way in which they will cope with their grief in the immediate future, as parents, within the family and in relation to the people in their surroundings. It is recommended that the attention for the parents and their lifeless child and all care behaviour be the same, as much as possible, as after the birth of a living child.     

Pediatric experience with brain death determination

A retrospective study of the experience at the University Pediatric Hospital during a six-year period when 2529 patients were admitted to the Pediatric Intensive Care Unit (PICU) and 80 were diagnosed with brain death. Etiologic causes, age and sex distribution and use of confirmatory studies were evaluated. The specific criterias for brain death determination in children are discussed and it was found that 3.1% of all the admissions to PICU were diagnosed with brain death. This diagnosis was most common in the 6 to 12 year old children (35%) and in infants younger than 2 years of age (30%). Trauma accounted for 41.0% of the cases. In babies less than 6 months of age, 71.4% were battered. Only 11% accepted organ donation.     

Students' experience with women's health care in a family medicine clerkship

Clerkship encounter forms were used to assess the types of diagnoses seen, the level of activities performed (student responsibility), and self-reported competence (comfort level) in dealing with patients. INTRODUCTION: Many medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses encountered by the students. This study examines clerkship students' experience with women's health care diagnoses. METHODS: Over a 2-year period, 445 students completed 3320 patient encounter forms for patients with a women's health diagnosis, noting patient age, location of care (office, hospital, etc.), up to four presenting diagnoses, the degree to which the student was involved with selected activities (taking a history, performing a physical examination, observing only, etc.) and the degree of self-reported competence. RESULTS: Of the 78 854 diagnoses presented, 3677 (6.1%) were women's health conditions, most commonly normal pregnancy (47.5%), disorders of menstruation (8.2%), menopausal and postmenopausal disorders (7.4%), disorders of the breast (6.0%), pain in female genital organs (5.7%), and disease of the cervix, vagina and vulva (5.2%). Students reported a high level of competence in diagnosing and treating these patients. The students routinely discussed women's health cases with their preceptors. DISCUSSION: Students reported that they were 'unskilled' or 'marginally competent' with approximately 10% of the women's health patient encounters, compared with 6% for all other encounters. The clerkship provided students with the greatest opportunity to observe and discuss individual cases with a preceptor. However, students infrequently suggested a treatment or provided patient education or women's health counselling.