Objective: to analyze the knowledge standards that found nursing practices in the home care setting. Method: qualitative study using a single case study strategy, supported by the dialectical methodological framework. Thirteen nurses who work in home care services from two municipalities in Minas Gerais, Brazil, participated. The data were obtained in 266.5 hours of participant observation and 8 hours and 58 minutes of interview and submitted to Critical Discourse Analysis. Results: empirical knowledge was revealed to be fundamental for clinical, managerial and educational care at home. The adaptations specific to this environment require aesthetic knowledge. The relational and educational actions, the decisions responsible for benefiting the individual and his family, the doubt and willingness to learn when dealing with unpredictable cases and the assessment of the socioeconomic conditions of the family, represent, respectively, personal, ethical, lack of knowledge and sociopolitical aspects present in the practice of nurses in home care. Conclusion: the particularities of home care trigger different patterns of knowledge to ensure creative, sensitive, human and responsible care. Innovation and availability to learn are part of nurses' performance in home care. The need for differentiated training is reinforced in order to respond to the increasing complexity in this field.
Background Technological advances in health care currently provide better care conditions and have increased survival rates of premature infants, along with increasing the life expectancy of chronically ill children. In this context, the home care service has emerged as an effective tool for the treatment of this group of children. Thus, this preliminary study aimed at evaluating the effectiveness of the Home Care Service (HCS) with regard to pediatric care. Methods A cross-sectional study was performed through a medical record analysis of a tertiary hospital in Minas Gerais/Brazil. Two groups were compared: 36 patients from the HCS (home group) and 13 patients hospitalized with an indication for home care (hospital group). To analyze the effectiveness of HCS, we evaluated the number of readmissions, infection rate, number of procedures, and optimization of beds. Results The hospital group presented 6.04 times more infections and was submitted to 6.43 times more procedures. The home group presented lower readmission rates; with 41.66% of children studied not being readmitted and 76.19% of those who needed readmissions did so after more than 30 days from hospital discharge. HCS optimized hospital beds and allowed, over five (5) years, the hospitalization of around 102 patients in the hospital studied. Conclusion In this preliminary study, HCS reduced the number of procedures and infections compared to hospitalized patients. Moreover, HCS presented lower readmission rates and optimized hospital beds, which could be considered an indication of effectiveness.
Objetivo: Avaliar, por meio de dados de vida real, a capacidade dos leitos hospitalares brasileiros versus as recomendações da Organização Mundial de Saúde (OMS), como esses leitos estão sendo utilizados, de onde vêm os pacientes, quanto isso custa, as diferentes patologias que têm chegado aos hospitais e o percentual de tempo de internação em leitos de cuidado intensivo. Métodos: Estudo retrospectivo histórico realizado entre julho de 2018 e junho de 2019 a partir de dados obtidos do Datasus e subsequentemente processados em MySQL para diferentes perspectivas. Todos os índices foram construídos por meio de quintis de dias de internação e posteriormente subdivididos em análises mais específicas, confrontadas com literatura específica do assunto e diferentes diretrizes internacionais. Resultados: O Sistema Único de Saúde (SUS) teve um total de 9.275.680 pacientes únicos internados durante o período de análise, tendo um custo total de R$ 183 bilhões, totalizando 63.817.613 de diárias hospitalares com uma média de 6,3 dias de internação, R$ 1.972,73 de custo médio por internação e R$ 286,73 de custo médio diário. Conclusão: O SUS e toda a sua estrutura em perspectiva histórica são bem recentes. Cabe ainda aprimorar os processos de atenção de rede primária (portas de entrada), bem como desenvolver e disseminar os processos de desospitalização (portas de saída/reintrodução para a atenção primária).
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