Violência institucional no âmbito da saúde reprodutiva : a percepção de mulheres usuárias do SUS, na cidade de Natal/RN

Institutional violence ranges from the most widespread lack of access to the poor quality of services provided. It includes abuses committed by virtue of the unequal power between patients and professionals within institutions. The aim of this study was to analyze the perception of women with regard to this type of violence, in the services offered at a reproductive health facility belonging to the National Health System (SUS) in Natal, Brazil. Interdisciplinary perspective is important, in that it provides interaction and complementarity between various disciplines, favoring, in an integrated way, a thematic approach in research activities, teaching and extension, involving professionals, students and researchers in medicine, social services, psychology, nursing, anthropology and physical therapy. A quantitative/qualitative approach was used, involving a sample of 401 women, as part of a transversal observational study. In the qualitative stage, which consisted of participatory observation and semi-structured interviews, we used an intentional sample of 10 individuals. The data were analyzed using logistic regression techniques, correspondence analysis and categorical thematic content analysis, showing that the 2 questions that investigated directly the perception of institutional violence obtained affirmative response frequencies of 28.2% and 31.8%, respectively. In regard to data collected in a field diary related to participatory observation, the main complaints referred to the health providerpatient relation, translated into dissatisfaction with the interpersonal relationship and with the resolution of the specific demand that required care. From content analysis, we classified 4 categories: Access; Information; Health professionalpatient relation; and Respect/dignity. We identified 6 subcategories: Impossibility of choice; Repressed demand; Communication difficulty; Asymmetric interpersonal relations; Privacy/confidentiality; Disrespect. We concluded, therefore, that the data presented show that in the reproductive health care programs, there are indicators of institutional violence. However, it is difficult to approach this phenomenon, mainly because of the power relations involved in the patient-health care provider interaction, resulting from unawareness that determinate situations violate sexual and reproductive rights. This can be explained by sociostructural questions that reveal marked inequalities, ratified by issues related to violation of the rights of National Health System (SUS) patients

Morte como desafio afetivo para o profissional da saúde: ansiedade e sentimentos de quem lida com o paciente terminal com câncer

It is a Cross-sectional and multi-disciplinary study whose population selection was made by department of human resources (composed by a Manager, an Oncologist and a Psychologist) from the hospital where this research was realized. They also collaborated with important information about the work of that professionals in the hospital. We also counted on a Statistic who made study design calculating the sample and analyzing data. This research issued Evaluating health professionals anxiety levels who care for cancer terminally ill and their feelings about that work as well as identifying the factors which have influence on it. 100 health professionals from the Hospital which is a reference on cancer caring in Brazil situated in the city of Natal, state of Rio Grande do Norte, participated of this research. There was a sample loss of 21%. Data were collected through a questionnaire and State-Trait Anxiety Inventory (STAI). Results showed that 15% of the professionals have low State Anxiety levels, 70% Medium State Anxiety levels and 15% high State anxiety levels. The Number of Patients and Working in another Institution have interfered in the anxiety levels. Doctors and Nursing Assistants and Technicians have got the highest high State Anxiety percentage (25%). 73% of them declare to feel some sort of different behavior and/or feelings in caring for terminally ill. The most remarkable professionals feelings were Suffering and Sadness, and Terminally ill Children was the most difficult age group to care for. We conclude that work overload and having more than one job can interfere in professional stress levels and anxiety. Dealing with terminally ill, specially children one, can cause on the professionals psychological suffering. It s recommended the development of supporting and training strategies to reduce and/or to prevent Stress and Anxiety high levels

Avaliação da terapia comunitária na atenção primária à saúde

A busca por um modelo democrático de saúde despertou a atenção do governo brasileiro para o estabelecimento de prioridades e estratégias, que impulsionaram a implantação do Programa de Saúde da Família (PSF), atualmente denominada Estratégia Saúde da Família (ESF), a fim de aproximar a equipe de saúde da comunidade e, assim, implementar ações de promoção da saúde e de prevenção do adoecimento. Nessa perspectiva a Terapia Comunitária (TC) emerge como uma tecnologia de cuidado voltada à saúde mental na Atenção Básica de Saúde. Desde 2007, a TC vem sendo desenvolvida no município de João Pessoa/PB por profissionais da ESF: enfermeiras, agentes comunitários de saúde, médicos, odontólogos, fisioterapeutas, nutricionistas, psicólogos, entre outros. O estudo teve como objetivos: avaliar a satisfação dos usuários em relação à TC na Atenção Básica no município de João Pessoa/PB; medir o nível de satisfação dos participantes da TC em relação a essa ferramenta do cuidado; identificar elementos importantes para a satisfação em relação à TC por parte dos usuários. Trata-se de um estudo avaliativo, transversal e observacional, realizado no período de maio a agosto de 2009. Utilizou-se como instrumento de coleta de dados a Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental Satis-BR, bem como um instrumento de perguntas complementares utilizado pelos terapeutas comunitários. Os resultados revelaram que dos 198 (100%) entrevistados, 105 (53%) verbalizaram satisfação e 93 (47%) muita satisfação nos encontros de TC, o que evidencia que a totalidade da amostra está satisfeita com a terapia. Os elementos importantes que concorreram para a satisfação dos usuários da TC foram: respeito, dignidade, escuta, compreensão, acolhimento, apoio nas necessidades e boas instalações dos locais onde ocorre a terapia. A TC vem fortalecendo o cuidado à saúde mental, por se constituir como uma tecnologia de prevenção e fortalecendo a porta de entrada para a rede de saúde mental e de apoio psicossocial. Conclui-se, portanto, que a TC vem se destacando como instrumento de inclusão da saúde mental na Atenção Básica no atendimento aos usuários do Sistema Único de Saúde

Avaliação gerontológica multidimensional das condições de saúde de idosos residentes em instituições de longa permanência

Introdução/objetivos: A avaliação do estado de saúde de idosos institucionalizados é considerada prática essencial à promoção e recuperação da sua saúde, a qual deve incluir a investigação de aspectos multidimensionais e multidisciplinares relacionados ao envelhecimento saudável. O estudo objetivou avaliar as condições de saúde dos idosos residentes em instituições de longa permanência (ILPI) do município de Natal RN. Métodos: Trata-se de um estudo descritivo, longitudinal, envolvendo seis ILPI filantrópicas, com uma população de 243 idosos. A coleta de dados se deu por meio de entrevistas com os idosos nas instituições mediante a aplicação de um questionário com informações sócio demográficas, saúde e institucionalização, além de várias facetas multidisciplinares que envolvem a escala de avaliação cognitiva (Mini Exame do Estado Mental); o índex de KATZ, para avaliação das atividades da vida diária e uma análise do estado nutricional com questões antropométricas (peso, estatura, circunferência abdominal) e Índice de Massa Corpórea. Participaram do estudo todos os idosos com idade igual ou superior a 60 anos, que aceitaram responder a entrevista e assinaram o Termo de Consentimento Livre e Esclarecido e/ou a impressão datiloscópica. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande do Norte, sob parecer n° 164/2011. Resultados: Os participantes do estudo incluem 243 idosos, sendo a maioria mulheres (172 = 70,7%), com média de idade de 79 ± 9,44 anos. 124 idosos são solteiros (51,0%) e 66 viúvos (27,0%). A prática de atividades físicas não é rotina nas instituições, onde a maioria dos idosos (82,7%; n = 201) não realiza nenhum tipo de atividade. 78% dos idosos (n = 192) chegou a instituição sendo levados por familiares, enquanto que apenas 18% (n = 44 idosos) por vontade própria e 4% (n = 7 idosos) não souberam responder. Quanto aos aspectos cognitivos, identificou-se que 64,2% dos idosos (n = 156) apresentaram alterações significativas dentro da pontuação dos escores com restrições em responder aos demais questionamentos durante a entrevista por apresentarem limitações cognitivas e/ou dificuldades senso perceptivas.Conclusão: O presente estudo evidenciou alterações cognitivas na maioria dos idosos institucionalizados impossibilitando-os a continuidade da realização da avaliação global da saúde. A identificação correta da perda cognitiva em idosos é de suma importância para a equipe de saúde a fim de promover a detecção precoce de alterações cognitivas e a adoção de tratamento adequado, no sentido de contribuir para uma melhor qualidade de vida desta população

Pensando o estatuto do idoso no âmbito da saúde: uma reflexão à prática da cidadania

Um envelhecer saudável compreende fundamentalmente, o atendimento de necessidades que vão além da manutenção de um bom estado de saúde física. Faz-se necessário valorizar o idoso como pessoa socialmente útil, favorecendo, direta e indiretamente, o idoso, a família e comunidade para o alcance de um estilo de vida desejável. Pautando-se nessas reflexões, a partir da importância de um estudo em que se procure avaliar até que ponto, segmentos da sociedade e o próprio idoso, conhecem os direitos deste, e com isto, procurar pontuar conceitos de cidadania, vinculando os idosos a essas práticas, tendo como ponto de partida neste estudo, a saúde, como prática muito questionada no cotidiano. Este estudo, portanto, tem como objetivo verificar o conhecimento de estudantes universitários sobre os direitos do idoso no que se refere à saúde, contemplados no Estatuto do Idoso e explorar os direitos do idoso no âmbito da saúde na concepção de estudantes universitários. Trata-se de um estudo exploratório descritivo, numa abordagem qualitativa, centrando-se na análise dos aspectos legais (jurídicos) sobre o conhecimento dos direitos do idoso no âmbito da saúde pelos estudantes e sua implicação na prática da cidadania. O estudo foi realizado na cidade de João Pessoa - Pb, estudantes universitários de diferentes cursos do Campus I da Universidade Federal da Paraiba. O instrumento utilizado para coleta de dados foi uma entrevista semi-estruturada. Os coletados foram qualitativamente, explorando-se as falas dos sujeitos, utilizando-se a técnica de análise de conteúdo temática categorial. Os resultados encontram-se apresentados em quadros e temas. A partir de diferentes artigos realizados no decorrer do curso. Diante da expressividade dos resultados encontrados nesta pesquisa, é possível afirmar que os estudantes universitários ainda conhecem pouco o direito dos idosos, em particular, no campo da saúde, mesmo os estudantes da referida área. No contexto interdisciplinar este estudo sugere ações dirigidas à população do estudo propiciando pesquisas com maior impacto na mídia dirigida tanto aos idosos como a sociedade em geral

Qualidade de vida, funcionalidade e morbidade referida : avaliação em idosos na atenção básica de saúde

Demographic and epidemiological transformations have led to an increase in elderly populations in the world, and chronic diseases become the main health problem in this population, with consequences for the independence and autonomy, and interfering in the lifestyle and daily activities, and may decrease the welfare and quality of life. So, there is an urgent need for multidisciplinary research on the quality of life, understood as a multidimensional and subjective concept, as well as the associated factors, such as health habits, presence of chronic conditions and functional capacity. Thus, In qualitative terms, the Article 1 provides an assessment and perception of the elderly about their quality of life. Article 2, in turn, presents the results of more extensive quantitative research, which can be seen that age, presence of chronic diseases and depression were associated with the quality of life. Thus, we discuss the need for action was planning and health strategies, with interdisciplinary approach, considering the environmental context and reality of family elders, promoting quality in the process of aging

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

Cartografia da percepção de mês e profissionais sobre a atenção a saúde de crianças/adolescentes soropositivos no município de Natal

This study had as objective to identify to the perception of mothers and professionals of health on the attention to the health of HIV-Positive children/adolescents in the city of Natal-RN. It is a descriptive-exploratory study with quantitative and qualitative approach, carried through in the Giselda Trigueiro Hospital and in the State and Municipal Health Councils in Natal - RN, from march to december of 2005. The sample was composed by 56 participants, 33 mothers of children who use specialized assistance and 23 professionals. Data collection occurred with the application of a half-structuralized interview. Quantitative data were analyzed through descriptive statistics and qualitative data were submitted to content analysis. Prevailing categories in relation to the cartography of the attention to seropositive children and adolescents in Natal were: Organization and dynamics of the attention; Institutional management and human development; Control and prevention; other contexts of attention; relationship/communication team-patient and organization and functioning of the services. The profile epidemiologist of the children, adolescents and of the people/mothers, who take care of them with HIV/Aids, followed the evolution of the epidemic in the country and the world. It was verified that mothers need care and information; however they make a positive evaluation of the attendance they receive. It was also observed many gaps in the services of assistance, in which the researched group was attended, beyond imperfections in the communication between health professionals and users. The professionals recognize the advances that the politics represent for the assistance of people with Aids; however feel themselves limited by the precariousness of the system and the partner-economic conditions of the people. According to these data, it can be verified great challenges to go through in the context of integrality of the assistance to HIV positive children and adolescents in the city of Natal and in the improvement of the communication in the institution of reference

O concreto e o simbólico no cotidiano da educação em saúde: práticas, representações e processo identitário dos agentes comunitários de saúde de João Pessoa PB

The present study is about an etnographic research based on the Theory of Social Representation and its complementary approach, the Theory of Central Core based on the bourdiesianos concepts of field and habitus , concerning that these concepts, articulated to the constructed social representation, may contribute to the study of social identities. Its aim is to acknowledge which identity references community health agents (CHA), agents from Community Health Agent Program (CHAP) and Family Health Program (FHP) from João Pessoa PB and which social representation is constructed by them towards health education. The study had the participation of 119 CHAs, from which 90,3 % were female and 9,7% were male. Since the identity is also built by the representation of others towards the group, 63 professionals of the FHP group (16 nurses, 16 nursing assistents, 12 doctors, 9 dentists, 6 dentistry office assistents, 4 coordinators, 1 psicologist and 1 receptionist) and 1 nurse from CHAP took part of the study, oficial documents from the Health Ministry were analyzed, verbal information from its representatives were also taken into consideration, as well as reports from the many benefitiaries of the CHA, CHAP and FHP. For data collecting, we used the combination of (a) Direct Observation and Participant Observation of the functioning micro-areas of the CHA at the Family Health Units, and the Union of the Agents; (b) Free-Association of words and expressions to stimulate the CHA , Health Education and Health ; (c) Questionnaire; (d) Interviews. The interviews were submitted to a thematic analysis of its topic. The free-association was analyzed taking in consideration the vèrgesiana proposal (a combination of the frequency and average order of evocation) which treatment enabled the identification of the central and peripheral systems of social representation towards health education and the community health agent. A test of central refutation, associated to the analysis of the indicated evocations as the most important, provided empirical evidence of social representation towards health education as orientation , prevention and hygiene , as well as the identity of CHA as supervisor , friend , help , important , and the link between the community and the Family Health Staff. Other professionals from CHAP, FHP and the Health Ministry share all of these representational contents, especially the concepts of friend and link , also shared by the community. A habitus towards the community health agents was identified, as a representation based on trust and friendship, which gives the professional a great importance towards the daily inconsistencies faced by the community

Protagonismo silencioso: a presença da OPAS na formação de recursos humanos em saúde no Brasil

The aim of this study is to assess the contribution of the Pan American Health Organization (PAHO) to the field of human resources for health in Brazil. The assumption is that this organization not only influenced the development of this field, but but that it was also influenced by Brazilian institutions and by national political movements, through the interaction of its consultants with these movements. Four projects were selected, through which the contribution of PAHO was evaluated: the Program for the Strategic Preparation of Health Personnel (PPREPS), the Project for the Large Scale Formation of Middle and Low Level Personnel (Large Scale Project), the Project for Qualification in the Development of Human Resources in Health (CADRHU) and the Project for the Managerial Development of Basic Units of the National Health System (GERUS). To operacionalize the study, we used three basic complementary procedures: a bibliographic research, documental research and an interview. The time frame considered was from 1975, the year an agreement was signed between PAHO, the Ministry of Health and the Ministry of Education and Culture, establishing PPREPS. It was through this program that the first PAHO team of national human resource consultants was contracted. The period between 1975 and 1999 was marked by political and social movements that changed the course of health in the country; among these was the Movement of Sanitary Reform in Brazil, which culminated in the implementation of the National Health System (SUS). This paper shows the connections of the PAHO consultants with this movement and the implications that this had for the Program of Cooperation in the Development of Human Resources of PAHO/Brazil. It also demonstrates that as the program became contaminated by national movements of health system reorganization and of democratization of Brazilian society, it proposed, in cooperation with national institutions, an organization of determinate areas of operation of these same institutions. The manuscript further reveals that, with the Large Scale Project, the human resources program determined the pedagogical and methodological option that would be the model for various other educational projects undertaken by a number of Brazilian institutions with the technical cooperation of PAHO. And finally, the repercussions and contributions of these projects, which strengthened the the field of human resources in the public health services of the country, are identified. Data analysis was based mainly on the theories of Bourdieu, Gramsci and Freire

Interação entre a equipe de enfermagem e a gestante com diagnóstico de pré-eclâmpsia

The objective of this exploratory descriptive study with a qualitative approach was to analyze the perception of the nursing team and the pregnant women hospitalized with pre-eclampsia regarding the interactive process occurring in the care relationship. Data were collected by semi-structured interview with twenty nursing professionals that work in the high-risk ward and ten pregnant women with the diagnosis of pre-eclampsia. The discourses were analyzed using the content analysis method, in the modality of thematic identification. Three categories were identified that describe the perception of the interaction by the nursing professionals: recognizing the needs of the hospitalized pregnant woman, understanding the woman with pre-eclampsia, and presenting difficulties in the interactive process. With regards to the pregnant women, four categories emerged: recognizing the clinical care, feeling the lack of information, experiencing feelings during the hospitalization, and envisioning the interaction process. The meaning of the discourses was analyzed according to the principles of symbolic interactionism. The results indicate that both, the nursing professionals and the pregnant women, have a limited perception of their interaction, suggesting a need for further reflection about this reality in the health service units and in the nursing education environment

Saúde Mental e enfermagem: em busca da integralidade na ESF

The present work shows an inquiry about the conceptions and practical work of the nursing professionals on the accompaniment of mental sick patients in the Family s Health Strategy, under the approach of the completeness in health. The justification of this research is given by bringing an special attention concerning the subjet to these professionals of health: the gradual abandonment of the traditional manicomial model leads to the insertion of mental patients in the community . The nursing professionals must be prepared to receive these patients in the basic net of health and contribute to help their adaptation and insertion in the social environment as citizen. In this context, considering the entire attention to the mental health, it is important to detach that the assistance to the patient must search his reinsertion in the community by providing programs that develops his sociability. This analytical study was developed using a qualitative approach and a thematic verbal history. Ten nurses of Nova Natal s Health of the Family Unit, of Felipe Camarão Mista s Unit and of Cidade da Esperança s Health Unit contributed for its development . The information was acquired through an instrument research that made possible the accomplishment of the interviews. These ones were set previously and counted on the assent of the participants. The interviews were recorded and analyzed in accordance with the pertinent literature concerning the subject. The aggregation of the information was then discussed. At this moment three thematic axles were defined dividing the categories of analysis. According to the results of the interviews, the practical procedure given to the patients with mental upheaval is resumed by the prescription of psicotroprics medicaments. It doesn t provide an accompaniment by the professionals of health, specifically, nurses, to the patients and their families. The lack of qualification and a multi-professional team emerged as one of the challenges for the implementation of practical procedures towards the patients with mental upheaval. Therefore, the results of this research show the necessity of transformations in the current scene of the mental health in the Family s Health Strategy. These changes can be reached by politics investments on the mental health area, not only financially but by providing human resources that should allow the professionals to exert the completeness procedures

Conhecimento dos adolescentes sobre métodos contraceptivos: pesquisa-ação em uma unidade do programa saúde da família de Natal

It is a descriptive study with a qualitative approach, and an action-research type, which aimed to analyze the changes of knowledge about contraceptive methods invested to a teenager group attended in Igapó Family Healthcare Unit, in the city of Natal/RN, after consent and institutional assent of Ethics Committee of Rio Grande do Norte Federal University (Protocol No. 131/07). It were researched 16 teenagers of both sexes, with age ranging from 11 to 16 years. We used two structured questionnaires, one in the initial diagnosis and another during the seven meetings of the focus group, in addition to the field notes and the meetings discussions transcriptions. The data-collection was performed in the period of two months by a team composed by a nurse the research coordinator, a dentist, a nursing assistant, a community-based healthcare worker and a nursing academic. The quantitative and qualitative data were organized, tagged and categorized into spreadsheet in Microsoft Excel, being held a thematic analysis of speeches performed by the study participants. The results were presented as tables, graphics, photos, drawings and word clippings. The educational strategy developed in focus group allowed adolescents to discuss, exchange ideas and opinions on several contraceptive methods, providing expansion in knowledge of all contraceptives discussed, especially those natural and surgical, which were less mentioned at the beginning of the study. Among the advantages of the contraceptive methods listed by teenagers, was highlighted avoiding pregnancy and STDs in use of the barrier method of condom. As for the disadvantages more frequently noted by the survey with the misuse of barrier methods, was highlighted get pregnant, acquire STD's and do not prevent STD's in hormonal, natural and surgical methods. Adolescents showed consistency between the advantages and disadvantages and types of contraceptive methods, showing a widening in knowledge among them. It may be said that, in general, those surveyed had a good understanding about the use of the various contraceptive methods. Thus, the study participants had positively evaluated all the criteria used to qualify the meetings in the focus group. The action strategy of the focus group should be encouraged by professionals who work with teenagers, since they prefer to live in groups, one characteristic of adolescence.

A fragilidade e suas representações para idosos domiciliados no contexto da estratégia de Saúde da Família

This study aims to analyze social representations of elders to their fragile situation at home, with the presence of one or more characteristics, as defined by the Brazilian Ministry of Health. It is a descriptive and qualitative study, based on methodological -principles of the Theory of Social Representations. Setting was the homes of elderly residents in the area ascribed to a Family Health Unit (FHU) in the city of Natal. A total of 10 elderly subjects, whose choice was intentional and according to the need for USF home visit in a period of time, considering the saturation process of the information. As collection procedures were used the semi-structured interview and participant observation in accordance with the ethical rules of Resolution No. 196/96, with the assent of the Ethics and Research UFRN. To analyze the results, it was used the thematic content analysis in the aspect of preparation of representations, focusing on the totality of the discourse of the subjects. The results indicate that most study participants felt difficult to give meaning to the terms weakness and to be weak, although many present one or more aspects of the syndrome of frailty. From the content analysis of participants speeches in this study, we achieved the following categories: fragility as illness and disease as aging, aging and frailty as causes of changes and difficulties in daily life, the presence of family life in the fragile elderly, fragility as weakness and the risk for falls, the perception of being weak like a different person in addition to the absence of fragility in elderly life. Thus, through the processes of anchoring and objectification, the "fragile being" became familiar and concrete, showing that the meaning of weakness, besides the scientific definition found in the reified universes, can be reinterpreted and built within the consensus universes. About the care received by the staff of Family Health, from the viewpoint of older people there seems to be an understanding about the role of professional nurses; on the other hand, older people often mention the role of the Community Health Agent

Atuação dos enfermeiros da estratégia de saúde da família frente à violência intrafamiliar contra a criança

The family violence against children became visible, in the context of public health, due to the damage and injuries generated in the lives of children and to the growing need of investment in physical and human resources to fill this demand. In this context, it is believed that intervention could prevent such events and are configured as primary strategies to prevent the corollaries generated by the violence. In this perspective, this study aims to analyze the performance of nurses dealing with the Strategy of Family Health viewing to identify actions based on the paradigm of health distribution. This is a descriptive, exploratory and qualitative research. The data were analyzed based on the content analysis about the method proposed by Bardin. The study was conducted in Mossoró-RN and the participants were 14 nurses working for the Family Health Strategy in Health Units of this town. The instrument for data collection was a semi-structured questionnaire, with questions answered by the participants themselves. It was evident to the study that the nurses believe that health education are the main tool for dealing with domestic violence against children, being developed, however, in its positivist and vertical way. The actions used to develop health performed by the team on their daily lives are limited to educational activities and are carried exactly when cases of family violence against children are notified. Barriers to the practice emerged from fear of reprisals from the agressor, overwork, lack of management support and difficulty for the realization of interdisciplinary, intersectorality and comprehensive care.