Paola Kallyanna Guarneri Carvalho de Lima

Background/Objectives: The COVID-19 pandemic exerted unprecedented pressure on healthcare professionals and systems worldwide. To manage this increased demand, hospitals extended working hours, resulting in increased strain on workers and impacting their professional well-being. Simultaneously, the numerous deaths due to illness meant that healthcare professionals did not have sufficient time to process grief, which may have led to unresolved grief and other mental health problems. The aim of this study was to understand the experiences of loss and grief and their repercussions on Brazilian healthcare professionals working on the front lines during the COVID-19 pandemic. Methods: This qualitative study followed Charmaz’s constructivist grounded theory. The study used the COREQ checklist. Between August 2024 and January 2025, 24 healthcare professionals who worked on the front lines during the COVID-19 pandemic were interviewed via telephone. Participants were primarily female (n = 14) with a mean age of 42 years (SD = 9.13). Interviews were audio-recorded and transcribed. Results: The core phenomenon that emerged from the analytical process is “between exhaustion and resilience in a war-like scenario: challenges and opportunities in the care provided by frontline professionals during the COVID-19 pandemic”. This main axis was anchored in three categories: (1) adversities imposed by COVID-19 on the functioning of health services; (2) witnessing sudden deaths and the physical absence of families; (3) reconstruction of meanings and personal and professional growth. Conclusions: The experience of grief was intensified by the peculiarities permeating the death process in the pandemic context and the modification of farewell moments. The study exposes a need for training programs focused on medical, nursing, psychological, and other areas of care education that involve not only understanding clinical issues but also recognizing loss and grief as an integral part of care processes. Importantly, legislators should allocate additional resources to services that provide psychological support to healthcare professionals, in order to promote their adaptive coping.

The COVID-19 pandemic has resulted in countless losses around the world, profoundly affecting the lives of many people, especially those who faced the death of family members, bringing several negative repercussions to these families and constraining the experience of grief. This study aimed to understand the experience of loss and grief among bereaved individuals who lost family members during the COVID-19 pandemic. This qualitative study was guided by Charmaz’s constructivist grounded theory as a methodological framework. The study adhered to the Criteria for REporting Qualitative research (COREQ) checklist. Data collection took place between May and November 2023 through telephone interviews that were audio-recorded and later transcribed in full. The purposive sample consisted of 21 bereaved family members who had lost their loved ones during the COVID-19 pandemic. Participants were mainly female (n = 16) with a mean age of 55.5 (SD = 16.2). The loss of their family members occurred 12 to 24 months before data collection. The following central phenomenon was identified through the analytical process: “Family experience of loss and grief: between the unspoken goodbye and post-loss adjustment”. This was anchored in the following three categories: (1) Anguish and fear of the unknown; (2) Death by COVID-19—communication of death and lack of goodbyes; and (3) (Re)construction of meaning—support networks and the grieving process. Our findings recommend that policymakers allocate additional resources to grief support services to better prepare for future pandemic events. Furthermore, it is necessary to invest in the implementation of relevant training programs for healthcare professionals, with a family centered approach.

Introdução: compreender como profissionais da Estratégia Saúde da Família percebem a intoxicação infantil e as práticas de cuidado desenvolvidas em comunidade em situação de vulnerabilidade social. Métodos: pesquisa de abordagem qualitativa baseada no referencial dialógico de Paulo Freire. Foi desenvolvida por entrevistas face a face, com 15 profissionais integrantes de equipes da Estratégia Saúde da Família de um município do Noroeste do Paraná, Brasil. As entrevistas foram áudio gravadas, transcritas e submetidas à Análise de Conteúdo de Bardin. Resultados: as percepções foram articuladas em três categorias temáticas: Intoxicações infantis e o ambiente domiciliar: como os acidentes ocorrem; Prática profissional para atendimento, encaminhamento e prevenção das intoxicações infantis; e Limites para a prática de promoção e prevenção das intoxicações infantis no território. Conclusão: as percepções revelam os profissionais não considerarem a família inserida em um contexto sociocultural como centro da ação profissional, poucos referiam ao cuidado no contexto da promoção da saúde e prevenção.

Objective: to analyze readmissions and deaths of hospitalized patients due to the effects of alcohol abuse. Methods: documentary, longitudinal and retrospective study, by analysis of hospital records, carried out in a teaching hospital, by descriptive analysis, univariate association, using Pearson's chi-square test. Results: 399 readmissions of 278 patients were analyzed. Two hospitalizations predominated (69.6%). Most were male (85.2%), and the mean age was 47.15 years (± 13.91); 91.2% were readmissions due to the use of alcoholic beverages, with 45.3% of complications associated with injuries, poisoning and external causes of morbidity and mortality. Twenty-seven (9.7%) patients died. The readmissions of retirees/housewives had an odds ratio of 3.0 of progressing to death. Conclusion: the analysis showed prevalent readmissions and mortality in males, productive age group, with a significant association of risk in intensive care patients and cause of death associated with complications of chronic alcohol use. Contributions to practice: the identification of the causes of readmissions helps nursing professionals in the early recognition of signs of severity and serves as a subsidy for the development of prevention strategies and actions to improve the care network.

A toxicovigilância é o conjunto de medidas e ações que tem por finalidade conhecer a ocorrência e fatores relacionados às intoxicações e promover sua prevenção ou controle. O estudo tem como objetivo descrever a experiência dos participantes do projeto de extensão universitária por sistema ativo de toxicovigilância em ambiente hospitalar. Trata-se de um relato de experiência vivenciada por estudantes durante participação no projeto de extensão universitária intitulado Toxicolovigilância: busca ativa e educação em serviço de saúde, desenvolvido em um centro de informação e assistência toxicológica da região Noroeste do Paraná em 2020, apresentado em duas unidades de análise: o cenário e cotidiano da toxicovigilância por busca ativa e a vivência dos participantes no projeto. O projeto tem contribuído para o efetivo conhecimento das ocorrências toxicológicas locorregionais, devido a importância que a busca ativa de casos possui ao diminuir a subnotificação, e para a proposição de formas de controle e prevenção adequadas à realidade macrorregional. As atividades extensionistas possibilitam ao estudante melhor compreensão da realidade hospitalar associada às intoxicações, sendo primordial para o desenvolvimento de educação em saúde e ações de saúde pública. Os dados subnotificados servem de alerta aos gestores de saúde pública sobre a necessidade de implementarem estratégias de prevenção desses agravos. Palavras-chave: Intoxicação; Vigilância Epidemiológica; Sub-registro; Educação em Saúde Active search for toxic surveillance in hospital health service Abstract: Toxicovigilance is the set of measures and actions aimed at recognizing the occurrence and reasons related to poisoning and promoting its prevention or control. This study aims to describe the experience of the participants of the university extension project using an active drug surveillance system in a hospital environment. Experience report of experience lived by students during participation in the university extension project entitled Toxicovigilance: active search and education in health services, developed in a toxicological information and assistance center in the Northwest region of Paraná in 2020, presented by two units of analysis: the scenario and daily life of drug surveillance through active search, and the participant's experience in the project. The project has added knowledge to the locoregional toxicological occurrences due to the importance that the active search for cases plays in reducing under-reporting and recommending control and prevention forms suitable to the macro-regional reality. Extension activities contribute to the student's better understanding of the hospital reality associated with poisoning, which is crucial for developing health education and public health actions. Underreported data work as a warning to public health managers about the need to implement prevention strategies for these diseases. Keywords: Poisoning; Epidemiological Monitoring; Under-registration; Health Education

Objective: To analyze the root cause of occurrences of severe intoxication in children and adolescents from the perspective of sentinel events. Methods: Observational, retrospective, and qualitative study of a series of cases of seven children and young people with a confirmed clinical picture of intoxication by various agents, treated in a stabilization room of emergency care units or intensive care, and notified to toxicological information and assistance center from January to June 2019. The epidemiological surveillance of sentinel events was used based on a review of hospital documents and in-depth interviews with family members. The Root Cause Analysis (RCA) matrix was used to evaluate the cases and the systematic reconstruction of the cases' antecedents.Results: The age profile of the study population, the pattern of agents and substances involved - poisoning by intentional ingestion in five (71%) cases, indicated critical points and missed opportunities for prevention. The individual and family history analysis indicated as direct causal factors the deviations from norms for preventing poisoning at home or in the family context for all cases.The prevention and health promotion activities in the health services constituted the underlying causes of the occurrences.Conclusion: The root cause analysis identified a deficiency in public policies, but the interface between education, public security, social assistance, economy, and health policies would be preponderant for preventing childhood and youth poisoning.

Introdução: Jovens representam um grupo de alta vulnerabilidade à tentativa de suicídio, e a autointoxicação é o meio mais utilizado para o ato suicida. Objetivo: Descrever a estrutura e os antecedentes de famílias de jovens internados por tentativa de suicídio com agentes químicos. Método: Pesquisa descritiva e transversal, em entrevistas com familiares de 12 jovens internados por autointoxicação, de 2011 a 2016, e notificados a um centro de informação e assistência toxicológica do noroeste do Paraná - Brasil. Utilizou-se entrevista semiestruturada e a confecção de genogramas, agrupados por núcleos de similaridade. Resultados: A maioria dos jovens era do sexo feminino, idades entre 14 e 19 anos; quatro casos com tentativa de suicídio anterior, sete com transtorno mental e três com abuso de drogas. Ao longo das duas gerações, a estrutura familiar acompanhou as diversidades da sociedade, com diminuição da taxa de fecundidade, aumento de famílias chefiadas por mulheres, separação conjugal, avós responsáveis pelo cuidado dos netos e fragilidade dos laços familiares. O relacionamento intrafamiliar apresentou dependência emocional entre o jovem índice e os avós, mas constantes atritos e desavenças no meio familiar, pouco contato emocional com os pais e baixo suporte familiar antes da tentativa de suicídio. Como antecedentes para a tentativa de suicídio, verificou-se o uso de drogas de abuso, os transtornos mentais e os conflitos de identidade de gênero. Conclusões: O genograma auxiliou na compreensão da estrutura e diferenças intergeracionais, na identificação do familiar significante e das relações familiares como fatores para as tentativas de suicídio.