Dissertations / Theses on the topic 'Violence in hospitals'
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1
Frondigoun, Elizabeth Richmond. "Workplace violence : schools and hospitals." Thesis, University of Strathclyde, 2007. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=22177.
Abstract:
This thesis is a sociological exploration of violence at work. It is concerned with examining doctors, nurses' and teachers' experiences of violence at work in the institutional setting of schools and hospitals. It argues that media representations of this phenomenon, while having been helpful in raising awareness of violent incidents towards staff as mainly inter-personal and neglecting the institutional context of violence, have been unhelpful in extending knowledge and understanding. Thus it is argued that there are significant gaps in understanding of the nature and extent of violence in these contexts. The thesis aims to extend the current theoretical and empirical understanding of violence at work through the perceptions and experiences of these institutional actors and to examine how the institutional setting - physically and structurally - affects them in their professional roles in public sector schools and hospitals. Qualitative and quantitative data were gathered from two local authority areas in west central Scotland. Bourdieu's concepts of field, habitus and capital are used to examine the complex inter-relations of institutions, institutionalism and professional/client interactions that create a particular set of conditions which are challenged through the use of violence. 'Fields' represent the political and organisational structure of public sector health and education services whilst the 'habitus' forms the site of delivery for these services and the particular institutional cultural dispositions associated with them. The concept of 'capital' is used to examine the inter-personnel relationships, and the inter-personal relationships between client groups, in the work habitus. It concludes that the need for an integrated approach to understanding violence in the context of institutions is crucial if effective interventions are to be made and appropriate policies developed.
2
Mat, Saat Geshina. "A comparative study of experiences of violence in Malaysian and English hospitals." Thesis, Loughborough University, 2010. https://dspace.lboro.ac.uk/2134/8418.
Abstract:
This PhD thesis compared incidents of violence in two Malaysian hospitals and two English hospitals. Using a model of workplace violence, the aims of the thesis were to explore and compare six constructs: extrinsic, intrinsic, triggers, experiences, moderators, and consequences of workplace violence as perceived by Malaysian and English hospital staff. This study used data on experiences of violence gathered in 2005 for incidences in hospitals that occurred up to one year before the survey. The 2004 data from the Incident Report database (IRD) of the English hospitals was also used. Two instruments were developed for this thesis. First was the General Violence Victimization Questionnaire (GVQ), an instrument to identify the types, prevalence, nature, consequences, post-incident support, and reporting trends of violence in hospitals. The second instrument was the Violence Victimization Semi-structured Interview (VicQ) which explored factors leading to the violent incident, the violent incident itself, and psycho-social issues relating to the violent incident. Both instruments were translated into the Malay language for use in Malaysia. 227 people participated in the quantitative survey: 162 people from the Malaysian Government Hospitals (MGH) and 115 people from the National Health Service (NHS). A total of 25 people volunteered to be interviewed as part of the qualitative aspect of the study: 15 from the MGH and 10 from the NHS. Six categories of violence were compared: verbal, nonverbal, threat, physical, sexual, and psychologically-based. A total of 4118 violent incidents (1402 in MGH and 2716 in NHS) were reported. The most common type of violence was psychologically-based violence in the MGH and verbal violence in the NHS. Both samples perceived that the major source of workplace violence was from patients and involved one male perpetrator. There were differences between the two samples indicative of cultural differences. Of those interviewed, the Malaysian participants perceived that offenders were intrinsically motivated to offend. The English participants perceived that offenders had either intrinsic or extrinsic motivation for perpetuating violence. Differences were noted for substance abuse and customer relations as triggers of organisational violence. Comparisons of moderators were different for the two country samples. Comparisons of consequences were not significantly different. Comparisons across several demographic variables (gender, age, and occupational groupings) were not significant between the two country samples with regards to workplace violence victimisation. However, a comparison of length of service was found to be significant. The final path model differed from the original model of workplace violence. Additional findings include a difference between the established definition and participants‘ definition of workplace violence, a lack of anti-violence policies in Malaysian hospitals, under reporting, and unforeseen direct and direct relationships among the six constructs.
3
To, Mei-kuen Erica. "Workplace violence in Accident & Emergency Department of Hong Kong." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B42577469.
4
Leung, Po-shan Melissa. "The prevalence of domestic violence among the female Chinese population in the accident and emergency department." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25910383.
5
Carey, Leslie Sean, and Kathie Sylvies. "Gender and violence: A study of inpatients at a forensic psychiatric hospital." CSUSB ScholarWorks, 2000. https://scholarworks.lib.csusb.edu/etd-project/1582.
Abstract:
"Our society has generally viewed women as less aggressive and less likely to commit acts of violence in comparison to men. Statistics show that only 13 per cent of the violent crimes in the United States have been committed by women (Steffensmeier and Allan, 1996). However, employees at psychiatric hospitals often report problems of increased violent behavior among their female inpatients. This perception of the female inpatient population is further complicated by the mixed research findings regarding gender and violence. Considering the possible other environmental causations, gender alone should not prove an accurate variable in addressing violent behavior. Variables such as age, location, time, ethnicity, institutionalization and violence to self as opposed to violence to others will likely show significant relevance. This study will attempt to demonstrate how these other biopsychosocial variables play a role in violence prediction for this group of forensically committed patients other than gender."
6
羅淑兒 and Suk-yee Lo. "Vulnerability and resilience to workplace violence among health care workers in public hospitals." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41547822.
7
Lo, Suk-yee. "Vulnerability and resilience to workplace violence among health care workers in public hospitals." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41547822.
8
Vickers, Julia P. "The subjective work experiences of hospital patient attendants." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ44882.pdf.
9
Hewett, Deirdre. "Workplace violence targeting student nurses in the clinical areas." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5183.
Abstract:
Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Workplace violence in health care is a worldwide phenomenon. In nursing, the nature of workplace violence is predominantly non-physical in nature. Literature reveals the devastating consequences for the individual nurse, both physically and / or emotionally, depending on the nature of the violence. The consequences for the organisation / institution and the profession are equally devastating, manifesting in reduced standards of patient care and increased attrition from the profession. The pervasiveness of this problem indicates that to date, remedial and protective measures have been unsuccessful. However, most of the research done on workplace violence in nursing has been conducted amongst qualified nurses. The purpose of this study was to investigate the extent of workplace violence, targeting student nurses in clinical areas. The setting was the Western Cape College of Nursing and the population was second, third and fourth-year, pre-registration students. The research objectives addressed various aspects, for example, type, prevalence, perpetrators, consequences and management of workplace violence. A quantitative research design, utilising a survey, was chosen for the study. A probability sample of n = 255 students was selected, using stratified, random sampling as the sampling method. The variables selected for stratification were gender and year of study. A self reported, anonymous questionnaire, guided by the literature review and by the research objectives, was utilised for data generation. Summary statistics were used to describe the variables, whilst distributions of variables were presented in the form of histograms and frequency tables. Where appropriate, the relationships between demographic and research variables were described, using suitable statistical analyses. The findings revealed that the perpetration of non-physical violence against student nurses is widespread, particularly that perpetrated by co-workers, more specifically registered, staff- and assistant nurses. The under reporting of workplace violence was a common finding. Student nurses suffer grave emotional consequences as a result of workplace violence. Almost half of the respondents admitted that they had considered leaving nursing due to workplace violence and that it had negatively affected their standard of patient care. The overall conclusion was that, in accordance with a worldwide trend amongst all categories of nurses, student nurses are targets of workplace violence in the clinical areas. These findings have particular implications for the management of nursing education institutions. The fact that student nurses are targeted to the extent revealed in this study indicates that existing preventive measures in the clinical areas have not been effective. The recommendations arising from this study therefore focus on equipping the vulnerable trainee with the tools to withstand workplace violence. As such, the recommendations are directed at the management of the nursing education institution, to create awareness around the problem, to empower students to confront and cope with workplace violence and to support students traumatised by workplace violence. Finally, this study suggests avenues for further research, for example, research in the same setting after implementation of the recommendations, or further research into the dynamics of workplace violence, targeting student nurses from the perspective of qualified nursing staff or patients.
AFRIKAANSE OPSOMMING: Geweld in die gesondheidsdienste werksplek is ‘n wêreldwye verskynsel. In verpleging is geweld in die werksplek oorwegend nie-fisies van aard. Die literatuur wys op die ingrypende fisiese en / of emosionele gevolge vir die individuele verpleegkundige, afhangend van die aard van die geweld. Die gevolge vir die organisasie of instelling, asook vir die verpleegberoep, is eweneens ingrypend en manifesteer in verlaagde standaarde in pasiëntsorg en ‘n toename in verpleegkundiges wat die beroep verlaat. Die algemene verskynsel van die problem dui aan dat regstellende en beskermende maatreëls tot dusver onsuksesvol was. Die meeste navorsing oor geweld in verpleging is egter tot dusver onder gekwalifiseerde verpleegkundiges gedoen. Die doel van hierdie studie was om die omvang van werksplek-geweld, met studenteverpleegkundiges as teikengroep, in die kliniese areas na te vors. Die studie is by die Wes-Kaap Kollege van Verpleging uitgevoer en die populasie was al die tweede, derde en vierde-jaar, voor-registrasie studente. Die geformuleerde navorsingsdoelwitte vir die studie het verskeie aspekte aangespreek, soos byvoorbeeld, tipe, frekwensie, die uitvoerders van geweld, gevolge en die hantering van werksplek-geweld. ‘n Kwantitatiewe navorsingsontwerp, met gebruikmaking van ’n opname, is vir die studie geselekteer. ‘n Waarskynlikheidsteekproef van n = 255 studente is deur middel van gestratifiseerde, ewekansige steekproefneming geselekteer. Geslag en jaar van studie was as die veranderlikes vir stratifikasie gekies. Die instrument vir data-insameling was ‘n self-voltooide vraelys, gebaseer op die literatuurstudie en gerig deur die navorsingsdoelwitte. Opsommende statistieke is aangewend om die veranderlikes te beskryf, terwyl die verspreidings van veranderlikes in die vorm van histogramme of frekwensie-tabelle aangebied is. Waar toepaslik, is die verhoudings tussen demografiese en navorsingsveranderlikes met behulp van toepaslike statistiese analises beskryf. Die bevindinge het onthul dat die pleeg van nie-fisiese geweld teenoor studenteverpleegkundiges algemeen voorkom, veral daardie deur mede-personeel, meer spesifiek geregistreerde, staf– en assistent verpleegundiges. Die onderrapportering van werksplek-geweld was ‘n algemene bevinding. Studenteverpleegkundiges ly aan erge emosionele gevolge, as gevolg van werksplek-geweld. Byna die helfte van die respondente het erken dat hulle oorweeg het om die beroep te verlaat en dat sodanige geweld hul standaard van pasiëntsorg negatief beinvloed het. Die oorkoepelende gevolgtrekking was dat studenteverpleegkundiges, in ooreenstemming met ‘n wêreldwye neiging onder alle kategorieë van verpleegkundiges, die teiken van werksplek-geweld in die kliniese areas is. Hierdie bevindinge hou spesifieke implikasies vir die bestuur van verpleegonderriginrigtings in. Die feit dat studenteverpleegkundiges tot die mate, soos in die studie onthul, geteiken word, het aangetoon dat bestaande voorkomende maatreëls in die kliniese areas oneffektief is. Die voorstelle vanuit hierdie studie is dus daarop gerig om die ontvanklike nuweling toe te rus om werksplek-geweld teë te staan. As sulks is die voorstelle gemik op die bestuur van die verpleegonderrig-inrigting, om bewustheid rondom die probleem te skep, om studente te bemagtig om geweld te konfronteer en te hanteer, en om studente, wat as gevolg van werksplek-geweld getraumatiseer is, te ondersteun. Laastens word moontlikhede vir verdere navorsing voorgestel, soos byvoorbeeld, navorsing in dieselfde omgewing na die implementering van die voorstelle, of verdere navorsing in die dinamika van werksplek-geweld teenoor studenteverpleegkundiges, vanuit die perspektief van gekwalifiseerde verpleegpersoneel of pasiënte.
10
MORRISON, EILEEN FRANCES. "THE TESTING OF INSTRUMENTS TO MEASURE RULES, ROLE INCOMPETENCE AND VIOLENCE IN PSYCHIATRIC INPATIENTS." Diss., The University of Arizona, 1986. http://hdl.handle.net/10150/183965.
Abstract:
The purpose of this study was to test research instruments to measure social and therapeutic rules, role incompetence and violence in hospitalized psychiatric patients. Instruments were tested to measure the specific concepts of: the Discrepant Interpretation of the Therapeutic Rules (GTRS and PTRSI), the Inconsistent Enforcement of the Social Rules (SRSI), the patients' Inability to Adhere to the Therapeutic Rules (PTRSII), the patients' Inability to Adhere to the Social Rules (SRSII) and Violence (VS). The study used a descriptive correlational design. The nursing staff sample consisted of 57 nursing staff working in nine clinical psychiatric units of four local hospitals. The nursing staff sample completed research ratings on 162 patient subjects hospitalized on the units. The data were analyzed for estimations of the psychometric properties of the research instruments. The theory was estimated using correlational and multiple regression techniques. The results indicated that with the exception of the General Therapeutic Rule Scale, the instruments had strong evidence of reliability and validity. The General Therapeutic Rule Scale had limited evidence of reliability and validity. The theoretical model testing indicated that three of the predicted theoretical relationships were supported. The expanded empirical model testing indicated three additional relationships. The amount of variance in violence explained by the expanded empirical model was R² = 18%. The major findings of this study were: (a) the social rules were more important than the therapeutic rules in predicting violence, (b) contrary to the literature, personal patient variables such as, age, sex, and diagnosis did not contribute to violence in the hospital setting, (c) a patient history of violence outside the hospital contributed to the patients' inability to adhere to the rules, (d) a direct relationship existed between the therapeutic and social rules, (e) the subdimensions of violence against self, others and property may be theoretically distinct dimensions of violence, and (f) the relationship of violence and other variables may be curvilinear.
11
Kennedy, Maureen Angeline. "Workplace violence: an exploratory study into nurses interpretations and responses to violence and abuse in trauma and emergency departments." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
Abstract:
Violence in society has reached epidemic level and has permeated the walls of the workplace. Workplace violence has also spread across all occupations, especially those dealing with the public, and has escalated over the years. In this thesis the researcher explored the experiences, perceptions and coping mechanisms used by nurses exposed to violence in the health setting. The main focus was to determine how the nurses interpret abuse, and does this interpretation determine their response to the abuse.
12
Bock, Theresa Melodie. "Assessment of attitudes related to the management of aggression and violence in four psychiatric hospitals." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6835.
Abstract:
Thesis (MCur)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: The aim of this descriptive survey was to investigate the attitudes of mental health care providers with regards to the management of aggression and violence. The absence of scientific data describing the attitudes of nurses towards the management of aggression and violence motivated the researcher to conduct this study. The researcher undertook a descriptive survey to describe the attitudes of nurses towards the management of aggression and violence. The management of aggression and violence attitude scale (MAVAS) was administered to N92 nurses with different qualifications these nurses are employed in the acute admission units of four psychiatric hospitals in a province in South Africa. The results showed no significant differences in attitudes between the different categories of nurses in most of the questions. Enough evidence was gathered that indicated, compared to trained staff, staff without a qualification in psychiatric nursing science had found it difficult to calm patients down, had not understood the effect of the environment on a patient, had felt that patients should control their feelings and had lacked the perception of trained nurses, with regards to the effect of negotiation and poor communication on violent and aggressive mental healthcare users. These findings can make significant contributions towards the implementation of training programmes and policies to assist staff to deal with patient related aggression and violence. Furthermore the data generated can contribute towards future research in this field with subsequent expansion of skills programmes.
AFRIKAANSE OPSOMMING: Die doelstelling van hierdie navorsings studie was om die houding van psigiatriese gesondheidsdiens voorsieners ten opsigte van die hantering van aggresie en geweld te bepaal. Die afwesigheid van wetenskaplik gefundeerde data het die navorser genoop om hierdie studie te onderneem. Die navorser het derhalwe ʼn beskrywende studie gedoen om die houding van verpleegsters ten opsigte van die hantering van aggressie en geweld te bepaal. Die “management of aggression and violence attitude scale” (MAVAS) is deur N92 verpleegsters met verskillende kwalifikasies voltooi. Hierdie verpleegsters is indiens van vier verskillende psigiatriese hospitale in ʼn provinsie in Suid- Afrika. Die verpleegsters werk in die akute opname eenhede van die onderskeie hospitale. Die resultate het geen noemenswaardige verskille tussen die onderskeie kategorieë verpleegsters se houding teenoor die hantering van aggressie en eweld aangedui nie. Genoegsame bewys is ingesamel wat aandui; dat in vergelyking met opgeleide personeel, personeel sonder ʼn kwalifikasie in psigiatriese verpleeg wetenskappe, dit moeiliker vind om pasiënte te kalmeer, nie verstaan watter effek die omgewing op ʼn pasiënt het nie. Dié kategorieë voel pasiënte moet hul gevoellens beheer en het ook nie dieselfde persepsie ten opsigte van die effek van onderhandeling en swak kommunikasie op aggressiewe en geweldadige psigiatriese gesondheids diens verbruikers as hul kollegas nie. Hierdie bevindings is ʼn belangrike bydrae ten opsigte van die implementering van opleidings programme en beleid ten einde personeel te ondersteun om pasiënt verwante aggressie en geweld te hanteer. Die nuwe data gegenereer deur dié navorsings studie kan bydra tot toekomstige navorsing in hierdie veld asook gevolglike uitbreiding van vaardigheids programme.
13
Casson-Crook, Martine. "Psychology interns' experiences of working with survivors of violence at psychiatric hospitals in Cape Town." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/14615.
Abstract:
Includes bibliographical references (leaves110-126).South Africa has very high rates of violence and many people who are treated within psychiatric hospitals have been exposed to interpersonal violence. However little has been documented about trauma interventions in the South African context. Twelve clinical psychology interns completing the second year of their clinical masters training at Valkenberg, Groote Schuur and Lentegeur Hospitals were interviewed. The interviews were recorded, transcribed, coded and analysed according to grounded theory methodology, in order to establish: the kinds of violent experiences to which patients are exposed; patients' presenting complaints and diagnostic trends that were noticed amongst patients; the therapeutic work that is being undertaken with patients by interns and the theoretical models on which their work is based; the various challenges that interns encounter in their work with survivors of violence, and the training issues that arose for interns during the course of their work. The findings were compared with the available literature regarding the impact of exposure to violence and models of intervention, which is based predominantly on research conducted in economically developed countries. It was established that rates of exposure to violence are very high amongst the psychiatric patients seen by these interns and multiple traumatisation was felt to contribute to the complexity of their patients' presentations. Despite having received some training in working with survivors of violence during the course of their generalist training, interns felt ill- equipped to work with many of these patients because of the degree of complexity of patients' problems, including the contextual issues which continue to impact on patients. Most interns reported that they would have benefited from more specialist training. Existing theoretical models formed the basis for the interns' understanding of the psychological impact of exposure to violence but established intervention models were felt to be mostly inadequate with this patient population. In light of these findings areas for further consideration and research are suggested.
14
Wood, Benjamin R. "Workplace violence in the emergency healthcare setting balancing the needs of behavioral patients-in-crisis with the personal safety of hospital staff /." Online version, 2009. http://www.uwstout.edu/lib/thesis/2009/2009woodb.pdf.
15
To, Mei-kuen Erica, and 杜美娟. "Workplace violence in Accident & Emergency Department of Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B42577469.
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Myburgh, Naomi. "Violence in nursing : competing discourses of power, care and responsibility." Thesis, Link to the online version, 2007. http://hdl.handle.net/10019/349.
17
Tachere, Oghoteru Richardson. "Experiences of casualty doctors regarding their role in the management of gender-based violence victims at the intermediate hospitals, Oshakati." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1309.
Abstract:
The research focused on the experiences of casualty doctors regarding their role in the management of gender-based violence victims at the Intermediate Hospital Oshakati, Namibia. A qualitative, exploratory, descriptive and contextual research design was utilized and data were collected by means of semi-structured interviews. These were audio-taped, transcribed verbatim and analyzed using the Tesch’s method of qualitative data analysis by the researcher in conjunction with an independent coder. The research findings revealed that the study participants experienced gender-based violence as a common and recurrent public health issue. Participants indicated that the majority of the victims presented with a wide range of physical injuries as well as significant emotional trauma. With further exploration, it emerged that participants identified alcohol abuse, low socioeconomic status and several relationship problems as prevalent factors associated with gender-based violence. They also recognized that the current programme managing gender-based violence provides a measure of safety for victims by making emergency services available. In addition, these services could be accessed free of charge and victims identified as ‘high-risk’ were offered sanctuary in the ward to prevent further harm. Study participants further observed that the presence of a multi-disciplinary team of care-givers also contribute positively to the management of gender-based violence victims. However, participants experienced several challenges that impair their role in the management of gender-based violence victims. Notable among these are high workload (arising from shortage of personnel and offering services to non-emergency cases in casualty), lack of collaboration among team members and a lack of proficiency in psychosocial intervention strategies. Based on the study findings, it is hereby recommended that clear guidelines for the management of gender-based violence victims should be established and a better collaboration among all cadres of professionals involved in this issue should be promoted. In addition, campaigns to sensitize the community about values that can help in the prevention of gender-based violence and dangers of alcohol abuse as well as strengthening the legislative framework vis-à-vis implementing punitive measures against culprits, should be vigorously pursued.
18
Duraiappah, Vasanthi. "A multifaceted approach to assaultive incidents in a psychiatric setting /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18914.pdf.
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Hubbard, Laura. "Factors Related to Adult Violence and Aggression in Healthcare Settings." Honors in the Major Thesis, University of Central Florida, 2004. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/420.
Abstract:
This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucfBachelors
Health and Public Affairs
Nursing
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梁寶珊 and Po-shan Melissa Leung. "The prevalence of domestic violence among the female Chinese population in the accident and emergency department." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25910681.
21
Ilkiw-Lavalle, Olga. "Enhancing mental health staff confidence and skills in response to aggression and violence a longitudinal study of aggression minimisation training /." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060712.143008/index.html.
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Peixoto, Maria das GraÃas Barbosa. "Estudo epidemiolÃgico das vÃtimas de acidentes de trÃnsito admitidas em hospital de emergÃncia de Fortaleza." Universidade Federal do CearÃ, 1998. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=10561.
Abstract:
A violÃncia no Brasil vem crescendo progressivamente e nos Ãltimos anos assumiu um lugar de destaque no cenÃrio da SaÃde PÃblica. No CearÃ, a violÃncia do trÃnsito cresce em proporÃÃes assustadoras. Em 1996, os acidentes de trÃnsito ocuparam o primeiro lugar no grupo de causas externas com 32,0% dos Ãbitos tanto para o Estado como para a Capital. Este estudo objetivou analisar os aspectos epidemiolÃgicos dos acidentados no trÃnsito, admitidos no maior hospital de emergÃncia de Fortaleza - Instituto Josà Frota (IJF). à descrita a casuÃstica de pacientes atendidos em conseqÃÃncia de acidentes de trÃnsito, realizados em regime de internaÃÃo, no perÃodo de fevereiro a abril/97 (N = 377). Os resultados mostram que, do total dos pacientes estudados, cerca de 8,0% foram a Ãbito; 89,9% sobreviveram sem incapacidade fÃsica e 2,1% com incapacidade fÃsica. O traumatismo mais freqÃente foi a fratura de crÃnio, acometendo praticamente a metade dos acidentados (46,9%). Das vitimas que evoluÃram a Ãbito, 76% foram em funÃÃo de lesÃes cerebrais. Das que desenvolveram incapacidade fÃsica, 50% sofreram lesÃo medular. A prevalÃncia de incapacidade fÃsica entre os acidentados admitidos no IJF ficou em torno de 2,1%. Quando se analisou o tipo de acidente, verificou-se a importÃncia dos acidentes por abalroamento/colisÃo e atropelamento, tanto pela concentraÃÃo em faixas etÃrias jovens, como pela gravidade dos traumatismos e lesÃes impostas e potencial evoluÃÃo ao Ãbito. O maior nÃmero de vitimas foi observado na faixa etÃria de 15 a 49 anos, com 71,1% do total de acidentados. Observou-se o predomÃnio do sexo masculino, em 81%, numa proporÃÃo de 4:1. Dentre os acidentados, o maior percentual com os motociclistas (26%), seguido dos pedestres com 21,5%. Analisando as causas do acidente, observou-se que as mais freqÃentes foram a desatenÃÃo do motorista (49%) seguida pela desatenÃÃo do acidentado (46%), e pelo excesso de velocidade (42,8%). Verificou-se que o primeiro atendimento Ãs vitimas foi feito por transeuntes e que 66% dos pacientes internados receberam tratamento clÃnico/cirÃrgico.In recent years external causes of death (traffic accidents, violence) have been growing progressively in Brazil, becoming a major public health problem. In CearÃ, traffic accidents have been increasing, reaching a frightening share of overall mortality. In 1996, traffic accidents had become the leading single cause of mortality in the group external causes with 32.0% of deaths, being the same in the State of Cearà as in the capital city. The objective of this study was to analyze epidemiological aspects in a population of traffic accident victims admitted to the biggest emergency hospital in Fortaleza, Institute Josà Frota (IJF). The case histories of patients admitted in consequence of traffic accidents are described, the study being conducted during hospitalization in the period from February to April 1997 (n=377). It was found that 8% of the patients studied died, while 89.9% survived without any physical handicap and 2.1% with physical impairment. The most frequent traumatism was the fracture of the cranium, which accounted 46.9% of the injured. Among the victims who died, the biggest part died as a result of brain injuries, 50% of those who suffered from remaining physical impairment had medullar injuries. The percentage of the permanently handicapped among victims was 2.1%. Analyzing the type of accident, collisions, run overs and knock downs play an important part, having a high case / fatality and accounting for severe traumatisms, especially in the group of young people. The major number of victims was found in the age group between 15 and 49 years - 71% of the total injured. Accident victims are predominately male, 81%, being the gender ratio 4:1. The majority of the victims were motorcyclists (26%), followed by pedestrians 21.5%. Analyzing the causes of the accidents, it was observed that carelessness of the driver was the most frequent (49%), followed by negligence of the victim (46%) and excess of velocity (42.8%). It was also verified that the first aid for the victims was done by passersby and that 66% of the hospitalized patients received clinical surgery treatment.
23
Van, Wijk Evalina. "An investigation into patients perceptions of contributing factors towards their aggressive and violent behaviour after admission to a mental health facility." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3530_1189064270.
Abstract:
Aggressive and violent behaviour in inpatient mental health facilities is found worldwide and is a frequent and serious clinical and nursing care problem. Despite the importance of international research findings and recommendations, it appears that patients perceptions of the possible contributing factors toward aggressive and violent behaviour in mental health facilities is an area of enquiry that has not been widely explored in South Africa in general, or in the Western Cape, in particular. It is against this background that this study endeavoured to investigate the external and situational contributing to patients aggressive and violent behaviour in mental health facilities in Cape Town, as seen from patients perspectives.
24
Gingi, Pelisa. "Factors associated with the psychological response of nurses’ victims of inpatients violence in a psychiatric facility for adults with intellectual disability in cape town." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4024.
Abstract:
Background and Research Problem: It is well-known that nurses around the world are exposed to various forms of violence at their workplaces. In psychiatric facilities, many of these incidents are perpetrated by patients against nurses. There is a perception that the current legislation and regulations in the country do not adequately protect psychiatric nurses (health care workers in general) against workplace violence. The preliminary literature suggested that most quantitative studies on workplace violence in psychiatric facilities have concentrated on secondary and tertiary psychiatric hospitals looking at the prevalence, the association between demographic factors and violence behaviour, nurses‟
therapeutic responses, and the impacts on the quality of care. Studies on workplace
violence in a psychiatric facility for adults with intellectual disability in the country are limited. Secondly, it appeared from the preliminary literature review that similar studies have not looked at this phenomenon from the individual resilience perspective.Therefore, this study will seek to determine the factors associated with the psychological response of nurses‟ victims of inpatient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Aim: To determine factors associated with the psychological response of nurses‟ victims of in-patient violence in a psychiatric facility for adults with intellectual disability in Cape Town.
Objectives: To describe the (1) individual resilience of nurses working at a psychiatric facility for adults with intellectual disability; (2) psychological response of nurses‟ victims of in-patients‟ violence at a psychiatric facility for adults with intellectual disability; and (3) association between the individual resilience characteristics and the psychological responses of nurses victims of in-patients‟ violence in a psychiatric facility for adults with intellectual disability.Methodology: Descriptive-exploratory design using a quantitative approach was used.All categories of nurses (professional nurse, enrolled nurse and enrolled nursing
assistance) working at the psychiatric facility for adults with intellectual disability were eligible for the study. Convenient sampling was conducted to select 127 participants who met the inclusion criteria. Self-administered questionnaire was used to collect data. Data was analysed using the SAS V9.3 computer programme. Ethical clearance was obtained from University as well as approval from the management of the psychiatric facility prior to approaching the study participants.
Results: The results of the study showed high level of resilience among nurses on
Assessment of Resilience Scale (82.9%, n=104); nurses psychological responses to
violence were equally distributed between avoidance (mean =4.65 and SD=1.36),
intrusion (mean= 4.55 and SD=1.50), hyper arousal (mean=4.46 and SD=1.60) resulting in total mean of 13.67 (SD=4.14) on the revised Impact of Event Scale (IES-R). Measure of association between resilience and the impact of violence on the psychological wellbeing of nurses showed that nurses with high resilience score (82.9%, n=104) fitted the symptoms of PTSD on the IES-R. Spearman Rank correlations (r) analysis showed the total scores of IES-R (r=0.04, p=0.68), avoidance (r=0.01, p= 0.34), intrusion (r=0.08,p=0.34), and hyper-arousal (r= -0.002, p=0.97). Further research looking at the nurses‟ reliance and their responses using resilience theory is needed.Magister Curationis - MCur
25
Aguiar, Janaina Marques de. "Violência institucional em maternidades públicas: hostilidade ao invés de acolhimento como uma questão de gênero." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-21062010-175305/.
Abstract:
A violência institucional em maternidades é tema de estudo em diversos países. Pesquisas demonstram que além das dificuldades econômicas e estruturais, freqüentes nos serviços públicos, encontram-se, subjacentes aos maus tratos vividos pelas pacientes, aspectos sócio-culturais relacionados a uma prática discriminatória quanto a gênero, classe social e etnia. A hipótese deste trabalho é a de que a violência institucional em maternidades é, fundamentalmente, uma violência de gênero que, pautada por significados culturais estereotipados de desvalorização e submissão da mulher, a discrimina por sua condição de gênero e a toma como objeto das ações de outrem. Essa violência se expressa, de forma particular, no contexto da crise de confiança que a medicina tecnológica contemporânea engendra, com a fragilização dos vínculos e interações entre profissionais e paciente. O objetivo do estudo foi investigar como e porque a violência institucional acontece nas maternidades públicas no contexto brasileiro. Para tanto, foi realizada uma pesquisa de corte qualitativo com 21 entrevistas semi-estruturadas com puérperas atendidas em maternidades públicas do município de São Paulo e 18 entrevistas com profissionais de saúde que atuam em diferentes maternidades, do mesmo município e adjacentes. A análise do material buscou relatos de violência institucional nos depoimentos e os valores e opiniões associados. Os dados revelaram que tanto as puérperas quanto os profissionais entrevistados reconhecem práticas discriminatórias e tratamento grosseiro no âmbito da assistência em maternidades públicas com tal frequência que se torna muitas vezes esperado pelas pacientes que sofram algum tipo de maltrato. Dificuldades estruturais, a formação pessoal e profissional, e a própria impunidade desses atos foram apontados como causas para a violência institucional. Os relatos também demonstraram uma banalização da violência institucional através de jargões de cunho moralista e discriminatório, usados como brincadeiras pelos profissionais; no uso de ameaças como forma de persuadir a paciente e na naturalização da dor do parto como preço a ser pago para se tornar mãe. Consideramos que a banalização da violência aponta para a banalização da injustiça e do sofrimento alheio como um fenômeno social que atinge a toda sociedade; para a fragilização dos vínculos de interação pessoal entre profissionais e pacientes e para a cristalização de estereótipos de classe e gênero que se refletem na assistência a essas pacientes, além de contribuir para a invisibilidade da violência como tema de reflexão e controle institucionalInstitutional violence in maternity facilities is the subject of study in several countries. Researches show that besides economic and structural difficulties, which are frequent in state-run facilities, there are, underlying the abuse experienced by patients, socio-cultural aspects related to a discriminatory practice towards gender, social class and ethnicity. The hypothesis of this work is that institutional violence in maternity facilities is essentially a gender-based violence which, guided by stereotypical cultural meanings of devaluation and subjugation of woman, discriminates her by her gender condition and takes her as object of others actions. This violence is expressed particularly in the context of the confidence crisis that contemporaneous medical technology engenders, with the weakening of bonds and interactions between professionals and patient. The objective of this study was to investigate how and why the institutional violence occurs in state-run maternity facilities in the Brazilian context. The work was carried out through qualitative research with 21 semi-structured interviews with birthing women treated at state-run maternity facilities in city of São Paulo and 18 interviews with health professionals working in different facilities in São Paulo and adjacent cities. The analysis of the material sought reports of institutional violence in the statements of the people interviewed and the values and opinions associated to them. The data showed that both birthing women and professionals interviewed acknowledge discriminatory practices and rude treatment in the state-run maternity facilities to such a degree that it is often expected by patients to suffer some kind of mistreatment. Structural difficulties, personal and professional education, and even the impunity of such acts were identified as causes of institutional violence. The reports also showed a trivialization of institutional violence through the use of moralistic and discriminatory jargon, used in jokes by professionals; through the use of threats as a way to persuade the patient and through the idea of naturalization of labor pain as the price to be paid to become a mother. We believe that the trivialization of violence points to the trivialization of injustice and suffering of others as a social phenomenon that affects the whole society, to the weakening of the ties of personal interaction between professionals and patients and for the crystallization of stereotypes of class and gender that reflect in the care for these patients, besides contributing to the invisibility of violence as a theme for reflection and institutional control
26
Talina, António Miguel Cotrim. "Internamento compulsivo em psiquiatria. estudo comparativo de doentes com internamento compulsivo versus voluntário na Grande Lisboa." Master's thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2004. http://hdl.handle.net/10362/5545.
Abstract:
RESUMO
O internamento compulsivo em psiquiatria é uma intervenção de última linha
nos indivíduos que manifestam perturbações mentais graves e recusam tratamento,
fundamentada nos princípios de necessidade terapêutica e de protecção social.
Em Portugal, a última lei que regulamenta o internamento compulsivo vigora
desde 1999 (Lei 36/98 de 24 de Julho) e configura esta medida como um internamento
por decisão judicial, à semelhança de outros países europeus.
A presente investigação, de características exploratórias, pretendeu avaliar os
doentes internados involuntariamente do ponto de vista socio-demográfico e clínico e
estudar as diferenças entre estes doentes e os doentes internados voluntariamente na
região da Grande Lisboa. Para atingir estes objectivos foi delineado um estudo
observacional, transversal e comparativo. A partir de uma amostra de conveniência de
doentes internados compulsivamente procedeu-se ao emparelhamento dos doentes com
psicoses “funcionais”, segundo as variáveis sexo, idade, diagnóstico e duração da
doença, com igual número de doentes internados voluntariamente. Como instrumentos
de avaliação foram aplicados uma entrevista semi-estruturada para as variáveis sociodemográficas
e clínicas, o Brief Psychiatric Rating Scale 4.0 para a psicopatologia e
duas sub-escalas do Historical, Clinical, Risk Management-20 para o risco de violência.
No período do estudo (1 de Março a 30 de Junho de 2002) foram internados
compulsivamente 74 indivíduos, metade dos quais foram conduzidos aos serviços de
urgência com mandado da Autoridade de Saúde. O internamento de urgência foi o
procedimento inicial em cerca de noventa por cento dos casos. A maioria dos doentes
pertenciam ao sexo masculino (60%) e apresentavam quadros psicóticos “funcionais”
(82%). Na amostra emparelhada de 102 doentes não se observaram variáveis
sociodemográficas ou clínicas significativamente diferentes em relação aos doentes
internados voluntariamente, com excepção dos antecedentes e risco de violência.
Os resultados sugerem que a proposta de internamento compulsivo neste grupo
de doentes seguiu um modelo de decisão baseado na prevenção de perigo.
27
Omérov, Majda. "Violence in psychiatric inpatient care /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-850-5/.
28
金達人 and Tat-yan Deyoung Kam. "Workplace violence prevention programme targeting nursing staff in hospital setting." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720792.
29
Lin, Hai, and 林海. "Risk factors of violence against healthcare providers in hospital setting." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42997252.
30
Kam, Tat-yan Deyoung. "Workplace violence prevention programme targeting nursing staff in hospital setting." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720792.
31
Lin, Hai. "Risk factors of violence against healthcare providers in hospital setting." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42997252.
32
Deslandes, Suely Ferreira. "Violencia no cotidiano dos servicos de emergencia: representacoes, praticas, interacoes e desafios." Rio de Janeiro : [s.n.], 2000. http://teses.cict.fiocruz.br/pdf/deslandessfd.pdf.
33
Ford, Paul Leslie. "Patient Care Provider Safety: Examining one intervention to reduce hospital violence." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4042.
Abstract:
Abstract
In the summer of 2009, Tampa General care providers met with Hospital Administration to express concern that violence on care units was a growing problem and making it difficult to provide quality care. Nurses stated that such violence was one important reason many of their peers choose to retire. Administration took this situation seriously and formed a committee to gather information and submit suggestions to reduce the violence. The committee consisted of representatives from several nursing units, human resources, risk management, security, and administration. Duties assigned included investigation of the actual number of reports on all units and trends. The committee was also charged with the production of a report regarding reviewing other hospital data, literature review, and developing recommendations.
Internal reports indicated that the total prevalence of reported violence as well as the incidence per patient had increased annually since 2005. The hospital reports contradicted the national literature regarding the emergency department (ED) and psychiatric unit (Psych) being the two hospital units with the highest number of violent events. One possible reason for the difference is that these departments require all care providers to attend de-escalation and self-defense classes annually. Based on these findings, the researcher developed and adapted training similar to that of the ED for other units reporting aggressive, abusive, and violent patients. The committee approved a draft plan for implementation. Following presentation to Nursing Administration, some modifications were made, and the Internal Review Boards of the hospital and University of South Florida (USF) approved the project.
The hypothesis tested in this study was whether training in de-escalation and self-defense modifies providers' behaviors to prevent or reduce aggressive, abusive, or violent behavior by patients and visitors. The independent variable was training. The dependent variable was requests for assistance with unruly, angry, or violent patients or visitors. Event reports of the year prior were used for historical comparison. Event reports for the experimental period were assembled subsequent to the training for comparison.
Nursing Administration selected two units to receive the training intervention. The two units selected were neither the worst nor the best in numbers, but rather the middle. Nursing required that all training be scheduled in normal department meetings and that Nurse Managers of the units agree to participate. The research design presumed that at least 85% of care providers on a unit would attend the training. Schedules were developed to accommodate all care providers. The training was presented during June of 2010.
Experimental and comparison units were monitored each month for the number of reported violent events (Code Grays) on each unit. During the fourth months of monitoring, there was a data spike in the Cardiac Care unit. No action was taken until another spike occurred during the sixth month. It was determined that an error had occurred that partially invalidated the data from the Cardiac Care unit: the 85% participation rate among staff had not been reached. Monitoring continued for 12 months after the training. The Eldercare unit showed reduced requests for assistance. Overall, the Cardiac Care unit increased requests for assistance from the year before. Results were adjusted for patient census. Wilcoxon Signed Ranks Testing was performed and displayed using box plots to show how far the median changed during the research from one group to the next. The analysis compared prior year with the year following the interventions, and indicated that there was a movement toward a reduction of Code Grays. To determine if there was a difference between comparison units and experimental units 12 months after the training, Poisson Regression Analysis was utilized. When the comparison units were set as the reference, Poisson analysis indicated the events were decreasing on both units. The Cardiac Care unit did not have a statistically significant p value. The Eldercare unit had a p value of .019.
In conclusion, the results are mixed and statistically inconclusive. From the care providers' perspective, any reduction in violence is significant. The data regarding the training interventions indicates that there was an empirical, albeit not a statistically significant, change in Code Gray reports. Training may have reduced the violence on the Eldercare unit by nearly half.
34
Winstanley, Sue. "Violence and aggression toward health care staff in a general hospital." Thesis, University of Liverpool, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367178.
35
Cristina, Irene dos Santos. "Violência contra as mulheres. Revisão do projeto institucional do Centro Hospitalar Barreiro Montijo EPE." Master's thesis, Universidade de Évora, 2016. http://hdl.handle.net/10174/19915.
Abstract:
A violência é um problema que perturba a sociedade e a saúde individual e cole-tiva. A violência contra as mulheres é uma forma específica de maus tratos. Tem conse-quências para as mulheres que diretamente a sofrem, com repercussões sociofamiliares, acarretando marcas, mágoas e prejuízo grave nas esferas bio-psico-sociais. O CHBM-EPE tem em curso um programa de atendimento a mulheres vítimas de violência. Tor-na-se necessário realizar a sua revisão e atualização. No projeto atual, através de recolha de dados junto de provedores e beneficiárias de cuidados realizou-se o diagnóstico de situação, descrevem-se ambas as perspetivas e propõem-se medidas de melhoramento. O relatório aqui apresentado consiste na descrição da intervenção realizada. Os resulta-dos serão tidos em conta na revisão do Programa do CHBM-EPE contra a violência doméstica. Pretende-se a melhoria da qualidade dos cuidados; ABSTRAT:
Violence Against Women. Review of the Institutional Project of the Hospital Barreiro - Montijo EPE.
Violence is a problem that disrupts society and the individual and collective health. Violence against women is a specific form of ill-treatment. It has consequences for the female figures who directly suffer with social-familial repercussions, leading brands, hurts and serious injuries in the bio-psycho-social spheres. The CHBM-EPE has an ongoing program of assistance to women victims of violence. It is necessary to carry out its review and update. The current project, through data collection from providers and recipients of care will describe both perspectives. In the current project, through data collection from providers and recipients of care there was the diagnosis of the sit-uation, describes both perspectives and are proposed improvement measures. The report presented here is the description of the intervention performed. The results will be taken into account in the review of CHBM-EPE Program against domestic violence. It is in-tended to improve the quality of care.
36
Hutton, Scott. "A Longitudinal Study of Workplace Incivility in a Hospital." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1211989910.
37
Bekelepi, Ntombiyakhe. "Knowledge and skills of professional nurses in managing aggressive patients in a Psychiatric Hospital in the Western Cape." University of the Western Cape, 2015. http://hdl.handle.net/11394/4681.
Abstract:
Magister Curationis - MCurBackground: Mental illness has become more common than many other diseases such as heart disease, cancer or diabetes. Aggression or violence by patients towards psychiatric nurses is a global issue. These nurses, therefore, face the huge challenge of providing nursing care to aggressive psychiatric patients. Without the necessary knowledge and skills, the nurses are vulnerable to all kinds of injuries, given the time spent managing aggressive patients. Purpose and objectives: The purpose of the study was to determine the level of knowledge and skills that professional nurses possess to manage the aggression of psychiatric patients. The objective of the study was to ascertain whether the knowledge and skills of professional nurses were sufficient to manage aggressive psychiatric patients. Method: A quantitative approach and descriptive design was used to conduct this study at a Psychiatric Hospital in the Western Cape, South Africa. The target population consisted of 149 professional nurses employed at the Psychiatric Hospital. The sample for the study was all-inclusive i.e. all professional nurses employed at the hospital. Only 70 participants were available for the study. Structured questionnaires were distributed to the participants for data collection and the response rate was 77% (n=54). Data analysis was done with the aid of a statistician using a Statistical Package for Social Science, version 22, and nominal as well as ordinal data was analysed using descriptive analysis. The process and purpose of the study was explained to the participants, who gave their consent, prior to the distributing of the questionnaires. The researcher obtained permission from the necessary authorities before commencing with the study. Findings: The study found that nurses were more likely to be exposed to verbal aggression as opposed to sexual aggression. It also revealed that nurses with less years of experience had more knowledge than their counterparts who had more years of experience in same position. Furthermore, the study revealed that those who had training in aggression management reported that the training did not meet their needs. Overall, the findings revealed that nurses had a fair knowledge of managing aggressive psychiatric patients. The overall findings also revealed that professional nurses had the required skills to manage aggressive patients. Recommendations: There is a need for on-going in-service training and refresher courses in the management of aggression. There should also be a needs analysis before commencing with these training courses which should be made compulsory for all staff to attend. Further studies should be conducted on the different categories of nurses, and other disciplines within nursing, to ascertain their knowledge of the management of aggression. Qualitative studies should also be conducted on nurses‟ experience of aggression in different settings.
38
Cezar, Eliene Simões. ""Problemas de violência ocupacional em um serviço de urgência hospitalar da cidade de Londrina-Paraná"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-06052005-213359/.
Abstract:
A violência no trabalho tem se apresentado como um fator preocupante em muitos hospitais de todo o mundo. Este estudo teve como bjetivo caracterizar os problemas de violência ocupacional, detectados pelos trabalhadores das equipes de enfermagem e médica do Serviço de Urgência Hospitalar. Trata-se de um estudo descritivo e transversal, com abordagem quantitativa dos dados. Foi realizado no Serviço de Urgência (SU) de um hospital geral da cidade de Londrina - Paraná. A população foi constituída de 47 trabalhadores, sendo 33 trabalhadores da equipe de enfermagem e 14 médicos. Os dados foram coletados por meio de entrevistas com os trabalhadores das equipes médica e de enfermagem utilizando-se um roteiro contendo perguntas abertas e fechadas; entrevistas com os gerentes dos serviços médicos e de enfermagem, por meio de aplicação do wokplace violence checklist adaptado à realidade estudada e de consulta documental aos registros de violência contra os trabalhadores do hospital nos últimos setes anos e prontuários dos trabalhadores vitimados. Os dados foram analisados por meio de estatística descritiva. Dentre os trabalhadores da equipe de enfermagem 100% dos enfermeiros, 88,9% dos técnicos e 88,2% dos auxiliares de enfermagem referiram ter sido vítimas de atos de violência no trabalho, assim como 85,7% dos médicos, embora essas agressões não constem dos registros do hospital. As violências sofridas pelos trabalhadores do SU foram 95,2% na forma de agressão verbal, 33,3% por assédio moral e sexual. As violências sofridas pelos trabalhadores causaram sentimentos de tristeza, raiva, irritação, ansiedade e estresse. Os principais fatores de risco de violência ocupacional, evidenciados foram: desequilíbrio emocional dos pacientes (70,2%), falta de pessoal treinado para lidar com situações de violência (48,9%), sobrecarga de demanda de pacientes atendidos (46,8%). Em relação à segurança do ambiente de trabalho, os gerentes dos serviços médicos e de enfermagem consideraram que o SU oferece moderada segurança aos trabalhadores, constataram a ausência de alarmes e detectores de metais, e de vigias/guardas para manter segurança. Os resultados evidenciaram que apenas oito registros de violência ocupacional foram documentados em sete anos e que em 50% dos registros, os trabalhadores de saúde foram os acometidos por atos de violência, principalmente os auxiliares de enfermagem, que foram agredidos fisicamente por pacientes. Medidas preventivas para a violência ocupacional e educação permanente para todos os trabalhadores devem ser implementadas no serviço estudado visando à segurança no trabalho e à qualidade da assistência prestada.Violence at the workplace has presented itselt as a worrying factor amongst many hospitals around the world. The aim of this study was to characterize occupational violence complications noticed by medical and nursing teams workers in a hospital urgency service. It is a descriptive and transversal study with a quantitative data approach set at the urgency ward of a general hospital in Londrina-PR. The population was configured by 47 workers, 33 were from the nursing team and 14 were medical doctors. The data were gathered through interviews with the medical and nursing teams using a form with open and closed questions, interviwes with the medical and nursing staff managers by the application of a workplace violence checklist adapted to this specific reality and review of violence registry suffered by the hospital staff in the last 7 years and their medical records. The information was analysed through descriptive statistic. Among the nursing team 100% of nurses, 88.9% of technicians and 88.2% of auxiliary nurses said that they had been victims of violence at the workplace. Likewise 85.7% of doctors said the same thing although not documented. The violence afflicted on these workers were 95.2% due to verbal assault and 33,3% due to moral and sexual. The violence suffered by the workers caused them sadness, anger, irritation, anxiety and stress. The main risk factors to occupational violence were: patients emmotional unbalance (70,2%), lack of staff prepared to deal with violent situations (48.9%) and patient overload (46.8%). Concerning safety at workplace, the manager of medical and nursing teams consider that the urgency service provides medium safety to workers and point to absence of alarms devices and metal detectors as well as security guards to keep safety. Results showed that only 8 occupational violence registries were documented throughout 7 years and 50% involved health workers that suffered violence, mainly auxiliary nurses that were physically injured by patients. Preventive measures to occupational violence and permanet education to all workers should be applied at the studied service in order to improve safety at the workplace and quality to the assistance given.
39
DeFehr, Janice. "Domestic violence against women and the impact of routine screening in a hospital emergency department." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq23271.pdf.
40
Sandoval, Verónica, Soledad Vildoza, and Claudia Osorio. "Violencia hacia el profesional de enfermería." Bachelor's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería, 2016. http://bdigital.uncu.edu.ar/8621.
Abstract:
Los hechos de violencia van en aumento, tal es así que ha invadido los lugares de trabajo, siendo los enfermeros los principales expuestos ya que son la cara visible de toda institución médica y mantienen contacto directo con los pacientes, familiares y/o acompañantes. La violencia en el ámbito laboral de la salud no debe ser considerada como parte de los riesgos de trabajo, si no que por el contrario debe ser reconocida como un problema grave que afecta a la salud de los enfermeros. Si bien la enfermería es una profesión feminista y hacia ella van dirigidos los maltratos, el profesional varón no queda exento de este flagelo. Los incidentes de violencia a los que se exponen los profesionales son de tipo verbal, físico, psicológico, afectando de manera directa al desarrollo de las actividades propias de enfermería. Este trabajo de investigación tiene como objetivo determinar cómo vivencian los profesionales de enfermería que trabajan en Clínica Médica, Guardia General y Traumatología del Hospital Central, los hechos de violencia a los que han sido expuestos en sus lugares de trabajo durante el primer semestre del año 2015 y determinar a qué tipos de violencia están expuestos. De una población de 84 enfermeros, se tomó una muestra de 69 profesionales de los servicios mencionados anteriormente, los que contestaron una encuesta anónima con preguntas cerradas.Fil: Sandoval, Verónica. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Vildoza, Soledad. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Osorio, Claudia. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
41
Vigil, Kathryn Irene. "The association between physical, sexual, and emotional abuse and physical pain a comparison of psychiatric patients in Ontario, Canada and Burlington, Vermont : a project based upon an investigation at the University of Vermont, Burlington, Vermont /." Click here for text online. Smith College School for Social Work website, 2007. http://hdl.handle.net/10090/1021.
Abstract:
Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2007Thesis submitted in partial fulfillment for the degree of Master of Social Work. Includes bibliographical references (leaves 56-62).
42
Goff, Joyce A. "Intraprofessional Conflict among Registered Nurses in Hospital Nursing: A Phenomenological Study of Horizontal Violence and Bullying." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/shss_dcar_etd/82.
Abstract:
By the year 2025, the nursing workforce shortage will exceed 500,000 registered nurses (RN). Hospitals will primarily experience this loss. The retention of RNs is a critical issue for hospitals, and studies about RNs leaving jobs in hospital nursing are essential to addressing the workforce shortage. Limited data exists about why RNs leave hospital nursing, other than job dissatisfaction. There is limited current data on whether horizontal violence, bullying, and intraprofessional conflict between RNs influence such decisions. This qualitative phenomenological study explored RNs’ experiences of horizontal violence, bullying, and intraprofessional conflict in hospital nursing. Findings suggest behaviors such as alienation, intimidation, sabotage, lack of intellectual respect, and failed professionalism contribute to horizontal violence and intraprofessional conflict among RNs in the hospital workplace. These findings may help develop strategies to educate healthcare teams and hospital administrative staff, and lobby for universal anti-horizontal violence and anti-bullying policies in hospitals. The findings highlight the need for conflict management training for RNs and healthcare workers, to facilitate intraprofessional communication and collaboration, and the need for further research.
43
Zorozábal, de la Cruz Flor Guicela. "Violencia psicológica y disfunción sexual de la mujer, Hospital Loayza, 2009." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2010. https://hdl.handle.net/20.500.12672/2474.
Abstract:
Objetivo: Analizar la relación entre la violencia psicológica por parte de la pareja y la disfunción sexual de origen no orgánico de la mujer en edad fértil, que asiste a la consulta externa del Hospital Arzobispo Loayza - 2009.
Metodología: Estudio observacional, analítico, de casos y controles, de dos grupos seleccionados bajo diagnóstico, a cuyas poblaciones se les aplicó el cuestionario de Tamizaje de violencia psicológica (estandarizado en el Hospital Arzobispo Loayza y MINDES) y cuestionario de Disfunción Sexual de origen no orgánico.
Resultados: Se estudiaron 91 mujeres con disfunción sexual (casos) y 91 sin disfunción sexual (Controles), donde la edad promedio de los casos y los controles fue de 31 ± 9 años. El análisis bivariado demostró asociación significativa (p menor 0,05) de la violencia psicológica, nivel educativo (secundaria y superior), estado civil y el tiempo de vivir en pareja. Al aplicar el análisis multivariado a los factores significativos con el modelo de regresión logística, fueron confirmado los factores de riesgo: violencia psicológica (OR=9.64: IC 95%: 4.71 - 19.8), tiempo de vivir en pareja (OR=2.54; IC 95%: 1.2 - 5.3) y nivel educativo (OR=1.79; IC 95%: 0.6 - 5.6).
Conclusiones: La mujer con violencia psicológica de parte de la pareja, tiene mayor posibilidad de presentar Disfunción Sexual de origen no orgánico, se debe prevenir que la violencia psicológica forme parte de la vida de la mujer.Objective: Analysis of the relationship between physiological violence from the partner and sexual dysfunction of non organic origin the women of childbearing age attending the outpatient department of the Arzobispo Loayza Hospital - 2009. Methodology: Observational, analytic study of cases and controls, between two groups selected under diagnostic, to whose populations were applied a questionnaire of psychological violence screening (standardized in Arzobispo Loayza Hospital and MINDES- Ministry of Women and Social Developing) and survey of sexual dysfunction of non organic origin. Results: 91 Women with sexual dysfunction were studied (cases) and 91 without sexual dysfunction (Controls), whose average in age was 31 ± 9 years. Bivariate analysis demonstrated there is a significant association (p less than 0, 05) in psychological violence, higher educational proficiency (secondary and post-secondary), civil status and cohabitation time in couples. Upon applying the multivariate analysis model to the significant factors with logistic regression, only two risk factors were confirmed: Psychological violence (OR=9.64; CI 95%:4.71 - 19.8), cohabitation time (OR=2.54; CI 95%: 1.2 - 5.3) and higher educational proficiency (OR=1.79; CI 95%: 0.6 - 5.6). Conclusions: Women experiencing psychological violence caused by the partner have higher chances of having sexual dysfunction from non-organic origin; it must be prevented psychological violence to be part of women's life.
Tesis
44
Deslandes, Suely Ferreira. "Violência no cotidiano dos serviços de emergência: representaçöes, práticas, interaçöes e desafios." reponame:Repositório Institucional da FIOCRUZ, 2000. https://www.arca.fiocruz.br/handle/icict/4440.
Abstract:
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Previous issue date: 2000Analisa a interferência cotidiana da violência na dinâmica organizacional dos serviços de saúde, nas representaçöes e práticas dos seus agentes. Os serviços de emergência foram escolhidos porque neles a violência adquire visibilidade e constância, misturando-se ao próprio processo de trabalho e às distintas interaçöes entre profissionais e clientela. O objetivo central foi o de apreender, numa perspectiva compreensiva, o significado e as várias faces que a violência adquire nas múltiplas redes (de trabalho, de poder, ético-morais, organizativas) que se constituem e se reproduzem no cotidiano da assistência. Realiza uma associaçäo de diferentes abordagens (quantitativa e qualitativa) e técnicas (observaçäo participante, entrevistas e aplicaçäo de questionários), o que possibilitou tanto identificar as concepçöes, valores, práticas, formas de interaçäo grupais como indicar suas denominadas "áreas internas". A etnoia foi o caminho metodológico capaz de totalizar esses múltiplos esforços. A violência no cotidiano dos serviços de emergência assume múltiplas formas, como: condiçöes vis de atendimento oferecidas à populaçäo; um modelo de atendimento que despersonaliza, ignora e coisifica o usuário; um processo de trabalho que impöe doses consideráveis de sofrimento aos seus trabalhadores; uma demanda de atendimento que, pela gravidade das lesöes, vai significar um desafio técnico, uma possibilidade de avanço do conhecimento; uma forma de interaçäo entre profissionais e clientela, quando estes se tornam oponentes, algumas vezes chegando ao confronto corporal; reproduçäo de preconceitos e estigmas sociais que serviräo, muitas vezes, de critérios seletivos para a qualidade da atençäo dispensada; omissäo de apoio às vítimas da violência que, sabidamente, estaräo novamente à mercê das mesmas agressöes. Busca nas consideraçöes finais adotar uma perspectiva propositiva, revendo os limites de nosso estudo e propondo novas indagaçöes.
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Cruz, Fernanda, Nelson Tapia, and Marisa Vega. "Nivel de riesgo de los enfermeros ante actitudes violentas de pacientes psiquiátricos internados." Bachelor's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería, 2016. http://bdigital.uncu.edu.ar/8600.
Abstract:
El personal de enfermería tiene que trabajar con pacientes que, en ocasiones, presentan conductas agresivas (físicas o verbales) hacia los enfermeros, como insultos y golpes. Este tipo de conductas perjudica la labor de enfermería. Este trabajo se realizó en el Hospital El Sauce, en los servicios “B" y “D", donde se albergan pacientes con diferentes patologías psiquiátricas, como trastorno de la personalidad, esquizofrenia, oligofrenia, entre otras, y tiene como objetivo fundamental determinar el nivel de riesgo de los enfermeros, ante actitudes violentas de pacientes psiquiátricos internados en dicho hospital. A su vez pretende conocer el tipo de agresiones a que están expuestos, conocer características socioculturales de los enfermeros, identificar las características de la organización del trabajo del sector de enfermería y establecer el nivel de exposición al riesgo de agresiones en el que se encuentran los enfermeros sujetos de estudio. Es un estudio con diseño de tipo descriptivo y transversal. La población y muestra fueron 30 enfermeros/as de los servicios “B" y “D" y para recolectar datos se utilizó un cuestionario con preguntas cerradas.Fil: Cruz, Fernanda. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Tapia, Nelson. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Vega, Marisa. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
46
Mikalonis, Judith A. "Successful Mitigation of Workplace Violence against Emergency Department Nurses| What Hospital Leaders Are Doing to Accelerate Progress." Thesis, Pepperdine University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13420601.
Abstract:
The purpose of this study was to explore and understand the successful prevention and mitigation of workplace violence (WPV) against nurses in the Emergency Department (ED), and to learn what multidisciplinary hospital leaders are doing to accelerate progress. Specifically, the research considers the strategies, policies and actions hospital leaders are using to prevent and mitigate WPV; the positive progress or outcomes that have been realized thus far; what these leaders have learned in the process, and what they aspire to achieve in the future. In the process of exploring why and how positive progress accelerated, it was found that hospital leaders experienced positive progress in WPV prevention and mitigation when their hospitals provided a WPV program utilizing these exemplary strategies: (a) collaborative multidisciplinary partnerships, (b) fully engaged executive support, and (c) operationalized data. It was interesting to note that as multidisciplinary partners and fully engaged executives collaborated, and supported their teams in the process of establishing these WPV initiatives, a culture of respect was catalyzed and WPV initiatives gained momentum. The details of this research highlight that operationalized data—WPV data put to use in a centralized, customized, evidence-based approach—appears to have functioned as a key accelerant of positive progress in WPV prevention and mitigation for these hospital leaders.
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Anyosa, Gutiérrez Blanca Flor. "Violencia doméstica en gestantes y características del agresor. Hospital de Huaycán 2019." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2019. https://hdl.handle.net/20.500.12672/16406.
Abstract:
Establece la relación entre la violencia doméstica ejercida en
las gestantes y las características del agresor, Hospital de Huaycán 2019.
El estudio fue enfoque cuantitativo, observacional,
analítico, prospectivo y transversal, con diseño correlacional simple. El
tamaño de la muestra fue de 219 gestantes. En los resultados se observó que la violencia doméstica
se dio en el 74.4% de gestantes, siendo la principal la violencia psicológica
(74%). Al evaluar las características sociodemográficas de la pareja
agresora se encontró que el grado de instrucción está relacionado a la
violencia domestica (p=0.007). En cuanto a las características psicológicas,
el sentirse superior (p=0.000), el gusto por ordenar (p=0.000), los celos
(p=0.000), el piropear a otras mujeres (p=0.000), la infidelidad (p=0.001) y
voltear las cosas a su conveniencia (p=0.002) de la pareja agresora está
relacionado a la violencia doméstica. En cuanto a la historia familiar, el
padre machista (p=0.001), con quienes vivió en la niñez (p=0.017) y la
violencia en la niñez de la pareja (p=0.000) está relacionado a la violencia
doméstica. Respecto a los hábitos, el consumo de cigarrillos (p=0.001), de
alcohol (p=0.001) y de drogas (p=0.023) está relacionado a la violencia
doméstica. Concluye que existe relación significativa entre la violencia doméstica
ejercida en las gestantes y las características sociodemográficas del
agresor (grado de instrucción), características psicológicas, la historia
familiar y los hábitos de la pareja agresora del Hospital de Huaycán 2019.
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Pham, Thi Kim Loan Wirat Kamsrichan. "Perception toward domestic violence against women of health providers of the Thahn Nhan general hospital in Hanoi, Vietnam /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd387/4838005.pdf.
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Borda, Niño Adriana Carolina. "Las condenadas : an ethnography of sexuality and violence in Bolivia." Thesis, University of St Andrews, 2014. http://hdl.handle.net/10023/6278.
Abstract:
This is an ethnographic study of discourses and experiences concerning sexual exchanges among kin “who are too closely related to marry each other” (OED), or what in lay language is called “incest”. I investigate the ways in which a certain kind of incest, that between older men and younger women, primarily from different generations, is experienced by women of predominantly rural origin, who have been hospitalized in the major public psychiatric hospital in Bolivia, in Sucre. In this sense, this research is as much a study of incest as it is of psychiatric institutionalization. These experiences will be considered in the context of a wider field of ethnic, class and gender discourses that are produced by medical staff, community organizations, as well as national judicial institutions. The category of 'incest' is problematized in terms of how kinship is constructed, not only as a series of dynamic discourses (as practices whose effect is the production of events) but also as mobile experiences, however socially regulated. With this in mind, I present an account of Andean concepts and treatment of incest, as well as of legal and medical categories. Specifically, I focus on the play between discourses in the context of the psychiatric hospital, the judicial court and the communities of selected inmates. I show how the inmates' experiences of intergenerational incest and sexual violence in general are related to the dominant ethnic, class and gender narratives produced by medical staff, community organizations, and judicial institutions.
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Trajano, Adriano Dias 1974. "Análise dos óbitos por trauma em um hospital universitário brasileiro." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309554.
Abstract:
Orientador: Gustavo Pereira FragaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: O trauma é a principal causa de óbito e incapacidade entre as idades de 1 e 44 anos no Brasil. Revisões da mortalidade têm capturado cada vez mais um retrato detalhado da incidência do trauma, o papel do cuidado préhospitalar e a necessidade de uma política de prevenção. A avaliação do período de tempo e o local das mortes traumáticas podem melhorar a estimativa de um sistema de trauma e identificar as áreas que podem ser beneficiadas com mais recursos e pesquisa. Objetivo: Analisar a epidemiologia dos óbitos por trauma no Hospital de Clínicas da Universidade Estadual de Campinas (Unicamp) se houve mudança no perfil dos óbitos e mostrar um panorama do atendimento hospitalar através dos anos. Método: Estudo retrospectivo de séries temporais utilizando banco de dados registrados em protocolo da Disciplina de Cirurgia do Trauma da Unicamp. Os sujeitos da pesquisa foram os óbitos intra-hospitalares por causas externas durante os anos de 1995, 2000, 2005 e 2010. Para comparar as variáveis categóricas foram utilizados os testes Qui-Quadrado ou exato de Fisher. Para comparar as variáveis numéricas foi utilizado o teste de Mann-Whitney. Para estudar a tendência de óbitos, tipos de trauma e mecanismos de trauma entre os anos foi usado o teste de tendência de Cochran-Armitage. O nível de significância adotado para os testes estatísticos foi de 5% (p < 0,05). Resultados: Dos 549 óbitos, foram selecionados 467 casos (85% do total), sendo 325 pacientes (69,6%) admitidos com sinais de vida e 142 (30,4%) considerados mortos ao chegar. A média etária foi de 35,3 ± 18,0 anos, com predomínio da faixa etária de 25 a 39 anos (23,6%). O gênero masculino foi maioria com 85,4%. O traumatismo fechado aconteceu em 73,0% dos casos e trauma penetrante em 27,0%. No decorrer dos anos, houve um aumento significativo (p < 0,001) de óbitos por acidentes motociclísticos, que saiu de 7,3% em 1995 para 31,5% em 2010. Em contrapartida, houve um decréscimo significativo (p = 0,030) de vítimas de ferimento por arma de fogo, 21,0% em 1995 para 9,6% em 2010. Cerca de 60% dos óbitos aconteceu com menos de 24 horas da admissão. A principal causa de óbito continua sendo as lesões do sistema nervoso central (56,3% do total), seguida do choque hemorrágico (18,1%) e sepse/falência de múltiplos órgãos e sistemas (17,1%). O ISS médio dos pacientes com sinais de vida foi de 26,41 ± 9,00, sendo 71,3% com ISS > 25. O segmento corpóreo, com AIS ? 4, mais acometido foi à cabeça (68,3%), seguido do tórax (13,5%) e abdome (12%). O RTS médio foi de 5,24 ± 2,05. Apenas 25,8% dos óbitos tinha TRISS < 0,50. Conclusão: Durante os últimos 15 anos houve uma mudança dos óbitos por trauma em nosso hospital, com uma grande diminuição dos ferimentos penetrantes e uma maior incidência de mortes em ocupante de motocicleta. A curva trimodal das mortes, com o terceiro pico de mortalidade tardia, ainda é notada na presente casuística
Abstract: Introduction: Trauma is the leading cause of death and disability between the ages of 1 and 44 years in Brazil. Mortality reviews have captured an increasingly detailed picture of the impact of trauma, the role of pre-hospital care and the need for a prevention policy. The evaluation of the time period and location of traumatic deaths can improve the estimative of a trauma system and identify areas that may benefit from more resources and research. Objective: To analyze the epidemiology of trauma deaths at the Clinic Hospital of the University of Campinas (Unicamp); determine if there was a change in the profile of deaths and show an overview of patients care through the years. Methods: Retrospective study using time series database registered in the Unicamp Trauma Surgery protocol. The research subjects were in-hospital deaths due to external causes during the years 1995, 2000, 2005 and 2010. To compare categorical variables, we used chi-square or Fisher exact test. To compare the numerical variables we used the Mann-Whitney test. To study the trend of deaths, types of trauma and trauma mechanisms between years was used to test Cochran- Armitage trend. The significance level for statistical tests was 5% (p <0.05). Results: Of the 549 deaths, 467 cases were selected (85% of total), 325 patients (69.6%) admitted with signs of life and 142 (30.4%) considered dead on arrival. The mean age was 35.35 ± 18.03 years, predominantly aged 25 to 39 years (23.6%). The majority were males with 85.4%. The blunt trauma occurred in 73.0% of cases and 27.0% for penetrating trauma. Over the years, there was a significant increase (p <0.001) in deaths from motorcycle accidents, which increased from 7.3% in 1995 to 31.5% in 2010. In contrast, there was a significant decrease (p = 0.030) for victims of injury by firearms, 21.0% in 1995 to 9.6% in 2010. About 60% of deaths occurred less than 24 hours of admission. The main cause of death remains the central nervous system lesions (56.3% of total), followed by hemorrhagic shock (18.1%) and sepsis / multiple organ failure and systems (17.1%). The mean ISS of patients with signs of life was 26.41 ± 9.00, and 71.3% with ISS > 25. The body segment, with AIS ? 4, the most frequently affected was the head (68.3%), followed by the chest (13.5%) and abdominal (12%). The RTS average was 5.24 ± 2.05. Only 25.8% of deaths had TRISS <0.50. Conclusion: During the past 15 years there has been a shift in traumatic deaths in our hospital, with a large decrease in penetrating injuries and a higher incidence of deaths in motorcyclist occupant. The trimodal curve of deaths, with the third peak of late mortality, is still noted in the present study
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências