A atuação do psicólogo no contexto das referências ambulatoriais em saúde mental de Aracaju - SE

Psychologists‟ insertion in mental healthcare ambulatory clinics occurred during the decade of 1980, in the context of the claims disseminated by sanitary and psychiatric reforms, of the formation of minimum mental healthcare teams and of the retraction of the private clinic. Historically, this migration had been accompanied by the importation of practices traditionally applied at the clinics. Furthermore, the lack of clear guidelines from the Health Ministery occasioned the opening of ambulatory clinics with diversified structures at each city. The objective of this dissertation was to study the practices of psychologists at mental healthcare ambulatory references at Aracaju-SE. Were interviewed psychologists of these services and managers of the municipal health secretary using a semi-structured interview guideline, in addition to the analysis of management reports. It was observed that the mental healthcare references had experienced substantial changes referred to its structures and operation, leading to a present framework of expansion and readjustment. It was realized that there is an effort by the psychologists to maintain individual and group assistance, using adjustments in the frequency of the sessions and in the focus of the activities. Besides the progresses, the relation with the psychiatrist still works basically through the medical record, blocking advances on joint discussions of the cases. Some advances toward the amplified clinic are notable, like the overcoming of the isolated usage of psychiatric diagnostic and the replacement of the line‟ criterion by the urgency one. Sheltering had become an interesting strategy on flux ordination, however the mismatch between offer and demand seems to be a matter which extrapolates the psychologists‟ sphere at the references. For this reason the narrow of the relation with family healthcare centers seems to be the major challenge to be faced by psychologists at mental healthcare ambulatory references

Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

Percepção de cuidadores de crianças acerca da prevenção de acidentes domésticos infantis: análise à luz do modelo de crenças em saúde

This study aimed to analyze the perception of home caregivers of children from zero to five years-old on child domestic accidents and their influence in preventing these events. Exploratory and descriptive study with a qualitative approach, conducted with 20 caregivers attended at the Family Health Unit of Cidade Nova in Natal/Rio Grande do Norte, Brazil. The participants should have age less than 18 years-old, being a caregiver of at least a five year-old child and living in the area ascribed of Family Health Unit in the neighborhood Cidade Nova. Data collection occurred between March and April 2013 and a semistructured interview script was used. This stage was preceded by the acquiescence of the director of health institution where the research was developed, the Health Department of the Municipality of Natal as well as the Ethics Committee in Research of Universidade Federal do Rio Grande do Norte under Opinion nº 219 872 and CAAE nº 12236013.7.0000.5537. It is noted that respondents were asked to formal authorization by the Term of Consent. The data were treated according to the technique of the Collective Subject Discourse and analyzed based on three dimensions of the Health Belief Model, relating to perceptions of susceptibility to infant domestic accidents, self-efficacy to prevent infant and indicia domestic accidents for action of preventing domestic accidents in childhood. The results revealed that all the respondents were women, who, in their majority, they are mothers of the children they care, and predominantly they are aged between 18 and 30 years-old, full high school education and unemployed. Concerning the perception of susceptibility, it was unveiled understanding of deponents on various types of accidents, which are considered preventable. For this purpose, it was highlighted that the constant surveillance of the children is essential, keeping in view their high degree of curiosity and immaturity. On the perceived selfefficacy, the participants reported adopting preventive measures; however, they reported experiencing falls, burns, electric shocks and dog bites. In regard to the meaning attributed to experienced accidents they highlighted their feelings of guilt and despair, particularly about the cases understood as serious. Regarding the last dimension analyzed, related to indications for action, family, friends and television were the main source of information about household accidents and their prevention methods; however, health professionals were rarely cited as issuers of such knowledge. It is concluded that there is a widespread perception of women about prevention of domestic accidents and the weakness in the view of health professionals, including nurses, as disseminators of this information. This suggests the need to strengthen the dialogue on the issue and encouraging the participation of caregivers actively in the prevention of child domestic accidents

Acompanhamento do crescimento e desenvolvimento da criança: a participação das mães da área rural

The accompaniment of growth and development is the central thrust of child care in primary health care in order to contribute to the reduction of infant morbidity and mortality and promote healthy development. Despite its importance, the family health unit located in rural Parazinhocounty experiences the problem of frequent absences of children to follow-up consultations. Thus, this study aims to analyze the participation of mothers in the accompaniment of growth and development of children in the Family Health Strategy. This is an exploratory, descriptive study with a qualitative approach with the method action research, developed with mothers who are part of the monitoring of the growth and development of children in the rural area of the municipality of Parazinho/RN from May to October 2014. Data collection was performed using the focus group techniques, participant observation and individual interviews. Data were analyzed using thematic analysis of categorization. The study was approved by the Research Ethics Committee, under the opinion embodied 617,559 and CAAE 28598014.7.0000.5537. In step situation analysis, were conducted two focus groups, attended by a total of 14 mothers of different rural locations. From the speeches, one realizes that they have a satisfactory understanding of the monitoring of the growth and development of the childwas a learning moment. The nurse was mentioned as key professional that actionof accompaniment. The main reason that mothers to abandon consultations is access to health services, due to the distance from their homes to the basic unit, the shortage of public transport for the movement of users and delay between the service and the back home. As a strategy to try to tackle these problems, at the suggestion of their mothers was created Monitoring of Growth and Development Itinerant, where the FHS team moved to rural locations, performing activities related to children's health. Mothers who participated in the action approved the initiative as improving access and care of health needs, despite indicate dissatisfaction as the poor infrastructure and little privacy in consultations. Therefore, it is concluded that, despite the difficulties encountered often for lack of management support and involvement of some professionals, the monitoring of growth and development itinerant proved to be an important tool in solving the problem of access to services oriented to the health of child, in addition to functioning as a space for the realization of health education, becoming, since then, an activity inherent in family health team schedule.

O atendimento ao idoso na unidade de saúde da família: um estudo de representações sociais

The attention to health issues in aging has increased and it becomes a challenge for public policies directed to the elderly. This study aimed at learning the social representations built by seniors about the service in the Family Health Unit. It is an exploratory study, funded by the Theory of Social Representations of Moscovici. It was held at the Health Unit of the Family Felipe Shrimp, located in the neighborhood Felipe Shrimp in the city of Natal / RN-Brazil. The participants were one hundred and two elderly / as, served by the Family Health Strategy. The data collection period was extended from July to September 2014. Data were collected through the Word Free Association Test and Interview semi-structured, and analyzed with the help of EVOC software. Interviews were conducted with 20 elderly and subjected to content analysis. The research was approved by the Ethics Committee of the University Hospital Research Onofre Lopes, in the opinion 704,323. It was possible to apprehend negative connotations regarding attendance, listing it as bad and disrespectful, and the limited hours of service, difficult to schedule appointments and tests and inadequate infrastructure, the most marked aspects. Seniors express satisfaction with the medical care, however, they understand that it is necessary that all services are properly integrated to a qualified service. The statements reveal that the service in the drive needs to implement new strategies host for users to participate more in educational and health promotion. It is noted, the need of integrated care, the host of qualified hearing in the health services that they address the elderly seeking care at the clinic of the family, so sticking to the principles of the Unified Health System.

Quedas em idosos assistidos na estratégia saúde da família: frequência e fatores associados

The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion nº 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher’s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.

A representação social do cuidado no programa saúde da família na cidade de Natal

RODRIGUES, M. P.; LIMA, K. C.; RONCALLI, A. G. A representação social do cuidado no programa saúde da família na cidade de Natal. Ciênc. Saúde Coletiva, v. 13, n. 1, p. 71-82. 2008. ISSN 1413-8123.

A representação social do cuidado no programa saúde da família na cidade de Natal

RODRIGUES, Maisa Paulino; LIMA, Kenio Costa de; RONCALLI, Angelo Giuseppe. A representaçao social do cuidado no programa saúde da familia na cidade de Natal. Ciência & Saúde Coletiva, v. 13, n. 1, p. 71-82, 2008.Disponivel em: . Acesso em: 04 out. 2010.

Humanização do atendimento à criança na atenção básica: visão dos profissionais

Objetivou-se compreender a humanização do atendimento à criança na Atenção Básica na visão dos profissionais. Estudo qualitativo, realizado em uma Unidade de Saúde da Família de Natal-RN, Brasil. Dezesseis profissionais responderam a um formulário contendo questões referentes ao atendimento à criança, à humanização e às práticas realizadas para humanizar o atendimento. Os dados foram categorizados por temas e analisados a partir dos princípios da Política Nacional de Humanização. Para os profissionais, humanizar o atendimento envolve acolher, escutar, aconselhar sobre o que está sendo realizado com a criança, valorizar a família, e tornar o sujeito ativo no atendimento, mesmo que de forma incipiente. A maioria dos profissionais descreveu atendimento que valorizava parte dos princípios da política de humanização, mesmo com dificuldades para implementá-los na rotina. Requer, portanto, estímulos e atualização dos profissionais para uma postura autocrítica sobre o atendimento

Atuação das equipes da atenção primária na identificação precoce do câncer infanto-juvenil

Identificar o conhecimento de profissionais da atenção primária sobre a identificação precoce do câncer infanto-juvenil e descrever o desempenho das equipes de saúde antes da realização de treinamentos para identificação precoce do câncer infanto-juvenil. Método: Os dados foram obtidos por um questionário e grupo focal com 30 profissionais de uma Unidade de Saúde da Família, e analisados por temas geradores. Resultados: Os profissionais possuem conhecimentos sobre a identificação do câncer infanto-juvenil, e, demandam conhecer mais sobre os sinais e sintomas para identificação precoce, e a prestação de uma assistência sistematizada. Conclusão: Torna-se fundamental estimular a qualificação dos profissionais da atenção primária para a identificação precoce e o fortalecimento de uma rede de assistência que proporcione atendimento integral e a redução no retardo do diagnóstico de câncer infanto-juvenil

Atenção à saúde da pessoa idosa na estratégia saúde da família no município de Santo Antônio/RN: um estudo de caso

According to demographic estimates, by the year 2025 Brazil will be the sixth country in the world in number of elderly. For this reason, it is a purpose of public policies to help people to reach that age being healthier. The current health care model of health surveillance through the Family Health Strategy (EFS, in portuguese) is configured as a gateway into the care of the elderly in the Unified Health System (SUS, in portuguese). It is also an area of development of practices to promote health, prevention and control of chronic nondegenerative diseases. The aim of this study was to analyze the health care of the elderly provided by ESF professionals for the achievement of a full care. The study is descriptive case study with a quantitative approach, performed in the city of Santo Antônio/RN. The population included all health professionals, who are FHS members of the city that agreed to participate of the survey, a total of 80 professionals. Data were collected using a structured questionnaire, having mostly closed questions and divided into two parts: one containing sociodemographic information of health professionals and vocational training and the other, the activities carried on by the professionals in senior care, being analyzed from a database tabulated in a spreadsheet and discussed according to the descriptive statistics in tables, graphs and charts using frequencies, medians and values of central tendency. It was verified a predominance of professionals who finished highschool, mostly female, aged from 30 to 34 years old, with training completed in the last 10 years, without being graduated in the field of geriatrics or gerontology and mostly without training in gerontology. Family members and caregivers were the components of the social support network most identified by the professionals (66.3%).The elderly access to the Family Health Basic Unit was considered by83.8% of professionals as the most important factor that interferes in the activities of health care of the elderly. Considering the inclusion of the family in care: 98.8% of professionals consider the family as one of the goals of care, but 82.5% assist the family to know their role and participate in the care of the elderly, emphasizing that no professional makes use of tools for evaluating the functionality of the family. Regarding the actions taken to assist the elderly, 91.25% have home visits program to the elderly, 88.75% use the host program; 77.5% know the habits of life, cultural, ethical and religious values of the elderly, their families and their community ;51.25% complement the activities through intersectoral actions, 50%participate in groups of living with the elderly; 33.75% keeps track and maintain updated the health information of the elderly; 11.25% of the professionals perform the Single Therapy Planning (PTS, in portuguese) and few implement the actions to promote health according to PTS; there is a deficit in the number of professional categories in the identification and monitoring of the frail older people in their households. It is concluded that the health care of the elderly developed by ESF professionals differs among the professional categories. It was identified weaknesses in the promotion of an active and healthy aging and also in the establishment of an integrated and full care of the elderly. It is recommended the adoption of permanent educational activities by the City Management, initially for ESF professionals in the the perspective of the guidelines of the National Policy of Health Care for the Elderly and later to the other professionals that are part of the health care network of the elderly, at all levels of care in the city for the development of strategies and practices that promote the improvement of the quality of healthcare for the elderly, expecting concrete and effective results in terms of promoting health within Brazilian reality

Avaliação do cuidado de enfermagem na perspectiva da segurança do paciente em unidades de terapia intensiva: na visão de profissionais, pacientes e familiares

Technological advances combined with healthcare assistance bring increased risks related to patient safety, causing health institutions to be environments susceptible to losses in the provided care. Sectors of high complexity, such as Intensive Care Units have such characteristics highlighted due to being spaces designed for the care of patients in serious medical condition, when the use of advanced technological devices becomes a necessity. Thus, the aim of this study was to assess nursing care from the perspective of patient safety in intensive care units. This is an evaluative research, which combines various forms of data collection and analysis in order to conduct a deepened investigation. Data collection occurred in loco, from April to July 2014 in hospitals equipped with adult intensive care unit services. For this, a checklist instrument and semi-structured interviews conducted with patients, families, professionals were used in order to evaluate the structure-process-outcome triad. The instrument for nursing care assessment regarding Patient Safety included 97 questions related to structure and processes. Interviews provided data for outcome analysis. The selection of interviewees/participants was based on the willingness of potential participants. The following methods were used to collect data resulting from the instrument: statistical analysis of inter-rater reliability measure known as kappa (K); observations from judges resulting from the observation process; and added information obtained from the literature on the thematic. Data analysis from the interviews was carried out with IRAMUTEQ software, which used Descending Hierarchical Classification and Similarity analysis to aid in data interpretation. Research steps followed the ethical principles presented by Resolution No. 466 of December 12, 2012, and the results were presented in three manuscripts: 1) Evaluation of patient safety in Intensive Care Units: a focus on structure; 2) Health evaluation processes: a nursing care perspective on patient safety; 3) Patient safety in intensive care units: perception of nurses, family members and patients. The first article, related to the structure, refers to the use of 24 items of the employed instrument, showing that most of the findings were not aligned with the adequacy standards, which indicates poor conditions in structures offered in health services. The second article provides an analysis of the pillar of Processes, with the use of 73 items of the instrument, showing that 50 items did not meet the required standards for safe handling due to the absence of adequate scientific guidance and effective communication in nursing care process. For the third article, results indicate that intensive care units were safe places, yet urges for changes, especially in the physical structure and availability of materials and communication among professionals, patients and families. Therefore, our findings suggest that the nursing care being provided in the evaluated intensive care units contains troubling shortcomings with regards to patient safety, thereby evidencing an insecure setting for the assistance offered, in addition to a need for urgent measures to remedy the identified inadequacies with appropriate structures and implement protocols and care guidelines in order to consolidate an environment more favorable to patient safety.