Variáveis relacionadas ao processo de adesão a um programa de prevenção de quedas em idosos cadastrados na Estratégia de Saúde da Família

Introduction: Falls among older adults is a public health problem, therefore it is necessary preventive actions, however the adherence is the major problem faced by practitioners and researchers working on falls prevention programs. Objective: To evaluate the variables related to the adherence to falls prevention programs among the elderly enrolled in a Basic Health Unit (BHU). Methods: Was performed an observational cross-sectional analytical study. All elderly registered in a BHU and able to ambulate independently were invited to participate in a falls prevent program. The Elderly who Adhered to the Program (EAP) were evaluated at BHU; and the Elderly Not Adhered to the Program (ENAP) were identified and assessed at home. The assessment for both groups was performed using an evaluation form containing personal data, measures and clinical scales to assess cognitive status, balance, mobility, fear of falling, handgrip strength. Data were analyzed with SPSS 20.0. In addition to this assessment, the ENAP underwent a semi structured interview, in which we used the qualitative approach based on the figure of the Collective Subject Discourse. Results: The study included 222 elderly, 111 EAP and 111ENAP, most aged between 70 and 79 years (48.2%), female (68.5%), married (52.3%) and illiterate (47.7%). Consolidated as protective factors for adherence, worst rates of physical activity (p = 0.001), balance (p = 0.010) and cognition (p = 0.007). The interview of ENAP identified two themes: "Local implementation of programs for the prevention of falls" and "Relationship between BHU and the elderly health care," and found that the elderly who did not adhere were unable to displace and did not mention that primary care programs are related to health care in elderly. Conclusions: Elderly who do not adhere to the program differ from elderly who adhere as worst indices of cognition, balance and physical activity which implies greater risk of falling; and they were unable to participate in falls prevention program and by to be caregiver and showed displacement difficult

Efeitos da prática mental na marcha de indivíduos com doença de parkinson: ensaio clínico randomizado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Influência da prática de yoga sobre os sintomas da menopausa

Yoga has been studied and practiced for over three thousand years and nowadays it is widely adopted as a mean to assist the health of individuals. Additionally, numerous benefits to the health rehabilitation and quality of life of elderly individuals has been attributed to this set of techniques. In women, the aging process is characterized by the interruption on ovarian follicular activity (menopause) characterized by a number of neuroendocrine and physiologic changes. Those changes are frequently accompanied by uncomfortable and occasionally debilitating symptoms. Although there is profuse clinical information about menopause, studies on the potential therapeutic application of yoga during the climacteric period are scarce. The objective of this research was to investigate the psychophysiological effects of 12 weeks of yoga practice in 88 postmenopausal women. The volunteers were divided into a control group (no intervention), exercise group and yoga group. Instruments were applied for the evaluation of climacteric syndrome, stress, depression, quality of life, and anxiety. In addition, the determination of hormonal levels of FSH, LH, estradiol, cortisol and progesterone, and biochemical levels of glucose, cholesterol, triglycerides, HDL, LDL, urea, creatinine, AST and ALT were conducted. Our results showed that the yoga group had significantly lower scores after the regular practice of yoga for menopausal symptoms. Besides, those changes were accompanied by a statistical significant improvement in the stress levels, decrease in depression scores, and higher scores in quality of life when compared with the control group and the exercise group. As well, the regular practice of yoga promoted the maintenance of cortisol levels compared to control group after 12 weeks. Regarding the biochemical parameters yoga practitioners presented lower levels of LDL in the blood. These results are supported by previous studies which found that regular practice of yoga improves quality of life of subjects, Thus, herein we propose that yoga can be a non-pharmacological alternative to management of menopausal symptoms and stress in postmenopausal women

Adaptação e validação da escala de motivação à prática de atividades físicas

The study of the motivation to practice physical activities is relevant once through this it is possible to develop intervention strategies for sedentary population. In this way, the present dissertation aimed to adapt and validate for the Brazilian context the Motives for Physical Activity Measure Revised (MPAM-R). It was investigated yet the relation of some socio-demographic variables (age, gender, Body Mass Index - BMI, types of physical activity; way to practice and time of practice) and the participants means in the motives studied. The physical activity (PA) is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure above the basal level. However, in the present study it was considered motivation for two types of PA: the physical exercises and sports. The Self-Determination Theory (SDT) underlay this research, once it has been used in the sportive context, beyond the facto of it was used as theoretical base to the development of MPAM-R. To attain the proposed goals, it was accomplished translations to Portuguese of the original English scale. Next, was carried out the semantic analysis and the judge analysis. For the empirical analysis of items, participated 309 practitioner of PA, classified in physical exercises practitioners and sports practitioners, with ages between 16 and 74 years, distributed equally by sex. They answered the final version in Portuguese of the MPAM-R and socio-demographic questions. The data was collected in Natal/RN, where the researcher approached people in some places where the PA is practiced, following she communicated that their involvement will be spontaneous and their responses will be confidential. The obtained results pointed the confirmation of the existence of five factors in the final version of the instrument, that was composed by 26 items that presented the following statistics indexes: x² (289) = 757.75, p < 0.000, x²/DF = 2.62, with GFI of 0.83, AGFI of 0.80 and RMSEA of 0.07. The reliability (Cronbach Alpha) of the complete instrument was 0.90, and the indexes of each factor were considered satisfactory too: Enjoyment (α = 0.88), Health (α = 0.84), Appearance (α = 0.79), Competence (α = 0.85) and Social (α = 0.75). It was observed that, in general, the main motive presented by the participants to practice PA was Health. It was verified yet, that women and aged had a higher mean in the Health factor; among the exercise practitioners was found a higher mean in the Appearance factor; and a higher mean in the Social factor was found among those that practice PA with accompaniment. It was concluded that the MPAM-R presented satisfactory psychometric parameters, became it useful in futures researches. Moreover, proposed the accomplishment of new studies that considered others variables to the intent of the better understanding of motivation to practice physical activity

A psicologia e o programa de saúde da família :novas possibilidades, velhos dogmas?

The model of attention to health has been suffering alterations due to the difficulty faced to put into practice its universal, democratic and institutional layout. Since the movement of Sanitary Reform, which focused in the demands of a new health context and the process of work in the area of health, one seeks uninterruptedly, to find a way which leads to the execution of the principles of SUS. Despite having tried, the model of Sanitary Vigilance centered within the work of a multi-professional team has shown fragmentation and little adequacy to the necessity of health in the population. Whilst inserting himself in the field of health, the psychology professional has taken with him his clinic way of attending to individuals being one more in the team to act in a de-contextualised and little critical way. In virtue of this framework, the Ministry of Health invests in the Family Health Program as a new guide in the health system, restructuring the basic attention at a new logic of action. In this way, the municipality of Natal-RN implants, in the year 2002, the PSF in the Northern Sanitary District, a context in which professional teams are created where there is not an inclusion of a psychologist. Consequently, this professional is excluded of his work space in the previous Basic Unities of Health. This piece of work constitutes in the investigation of the implementation and instrumentalization of the Northern Sanitary District PSF of Natal-RN, having as its objective to analyze the implications of this execution for the structuring of the health network services and more specifically the alterations that this implementation could be making to the practice of the Psychology Professionals, emphasizing its advances, obstacles and limitations. To make this work feasible it was necessary to search for data and information from the implementation and execution of the PSF in the DSN, carrying interviews from a semi-structured guide, with 21 institutional actors (members of the team, coordinators and directors of the unities and psychologists)

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

O fazer do psicólogo no núcleo de apoio à saúde da família

The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care

A clínica que se vive: reflexões sobre a prática da Psicologia clínica na contemporaneidade

The increasing search for the psychological attendance, express in the waiting list in the clinics, clinic-school and in the private clinics, beyond the increase of the choice of psychology as professional career among the pre-college students, allows us to reflect about the place that is occupied by the Psychology, nowadays. The main focus of this study is the clinical Psychology, an area of psychology. The interest in to deepen the reflection regarding of the place that the psychologist and his acting had been assumed in our society, emerged from our own actuation as clinical psychologist. Reflections concerning the suffering of man of our time, accompanying our inquietude while researcher and made us question about the actuation of clinical psychology, nowadays. This research aimed to understand how the clinical psychologists perceive their practice, attempting to get appointments regarding of what is to be clinical psychologist in contemporaneity, more specifically, in the face of the psychic suffering. Based on a phenomenological perspective of research were accomplished semi-structured interviews and a discussion group with clinical psychologists. From the obtained results, we arrived to the following conclusions: a) the most of participants considered the academic formation of the psychologist insufficient and far from social reality; b) the speeches revealed that there is still a relation between the practice of clinical psychologist and the medical model of attendance. Nevertheless, was observed a change in the new psychologists conception of clinic, but is still in development; c) in the most of speeches, we founded consensus about the idea of that the social context which the contemporaneous world lives, had generated new demands of suffering; d) the clinical listening is considered the specificity of the clinical psychologist. We believe that this study had been contributed to fomenting the discussion about the academic formation of clinical psychologist and, the concepts and models of clinic that now base the actuation of the professionals that are inserted on the work market

Análise de redes do cotidiano a partir do encontro entre usuários e profissionais da estratégia saúde da família

O presente estudo discute a formação de Redes Sociais no cotidiano da Estratégia Saúde da Família, a partir de aportes da teoria sociológica sobre redes, interações, dádiva e reconhecimento. O objetivo geral é analisar as redes sociais locais em saúde a partir da interação de usuários e profissionais da Estratégia Saúde da Família na Unidade de Saúde de Ligéia, em Natal, RN. Seus objetivos específicos são: Mapear as redes sociais locais em saúde existentes no território adscrito; Identificar os tipos de interações cotidianas entre os sujeitos; Compreender a percepção dos sujeitos sobre o processo de formação de redes sociais a partir das interações. Caracteriza-se enquanto pesquisa qualitativa exploratória cujos sujeitos foram profissionais e usuários vinculados à referida unidade de saúde. Para a coleta de dados foram utilizadas entrevistas individuais semiestruturadas e debates em grupos focais, estimulados pela Metodologia de Análise de Redes do Cotidiano (MARES), pertinente para abordar a complexidade das relações sociais e mapear os diferentes conteúdos expressos e as formas de mobilização coletiva. A análise dos dados foi realizada através da Técnica de Análise Temática de Conteúdo, proposta por Minayo. Os resultados foram interpretados à luz das Teorias da Dádiva (Mauss) e do Reconhecimento (Honneth). Os sujeitos visualizaram: Rede Virtual (28,20%); Rede de Atenção à Saúde (25,64%); Redes de Usuários (17,95%); Rede Pessoal (10,26%); Conselho Comunitário (10,26%); Escolas (7,69%). Os participantes não perceberam os arranjos familiares enquanto Redes Sociais. Os tipos de interações sociais identificadas foram: Confrontação/Negociação (41.02%); Harmônicas (25,70%); Correlativas (17,90%); Definidas pela Organização (15,38%). A formação de redes sociais ocorre a partir de interações cotidianas entre pessoas, pela articulação inseparável de conteúdos e formas, catalisadas pelo contexto, experiência e cognição, valorizando a liberdade, a expressividade e a diversidade dos parceiros de significação. Foram encontradas duas categorias, na percepção dos sujeitos, sobre a formação de redes sociais do cotidiano: Diálogo e Encontro. Validamos e recomendamos o uso da metodologia MARES: Na formação, para despertar uma visão mais tolerante e humana de si e do outro; Na avaliação qualitativa dos serviços, por facilitar a reflexão sobre a prática e (re)organização do processo de trabalho; Na comunidade, para estimular movimentos sociais existentes ou emergentes. A aposta no circuito da dádiva e do reconhecimento recíproco, durante o trânsito nas redes sociais em saúde, pode ser capaz de tecer uma práxis transformadora, pela busca e alcance de confiança, respeito e estima, nos espaços de encontro entre usuários e profissionais da Estratégia Saúde da Família

Limites e possibilidades da educação em saúde na estratégia de saúde da família de Pau dos Ferros/RN

A Estratégia Saúde da Família (ESF) apresenta-se como um espaço privilegiado para a efetivação de práticas de educação em saúde orientadas pelo diálogo entre o saber científico e o saber popular, uma vez que é nesse espaço de saúde que profissionais e indivíduos/família se interrelacionam, criam vínculos, dialogam e constroem soluções para o enfrentamento dos problemas de saúde da população. O objetivo geral deste estudo foi analisar os limites e as possibilidades de efetivação da educação em saúde voltada para a coletividade na ESF de Pau dos Ferros/RN. Nesse sentido, buscou-se conhecer as concepções de educação em saúde dos profissionais de nível universitário da ESF; observar onde as práticas de educação eram desenvolvidas; conhecer os conteúdos e metodologias utilizadas para a efetivação das práticas de educação em saúde e caracterizar os espaços onde tais práticas eram desenvolvidas. Trata-se de uma pesquisa qualitativa, de caráter descritivo-exploratório realizada junto a nove equipes localizadas na zona urbana do município. Foram investigados 28 profissionais que atuam nessas equipes, dentre os quais elencamos: quatro médicos, oito enfermeiros e dezesseis cirurgiões dentistas. Fez-se uso da entrevista semiestruturada e da observação baseada em princípios etnográficos. Os dados foram analisados com base na técnica de análise de conteúdo de Bardin. O estudo obedeceu aos aspectos éticos contidos na Resolução 196/96 que regulamenta as Pesquisas Envolvendo Seres Humanos. Os resultados apontam que as concepções e práticas de educação em saúde dos profissionais da ESF são orientadas por uma educação bancária , pautadas pela transmissão e reprodução de conhecimentos. As temáticas são desenvolvidas de forma verticalizada, dissonantes da realidade de vida e saúde dos usuários. As práticas educativas são ofertadas majoritariamente por enfermeiros e estudantes de graduação em estágio na USF. Em sua maioria não são planejadas em equipe, e estão direcionadas à prevenção de doenças, distanciando-se da promoção da saúde. As principais dificuldades apontadas para a efetivação da educação em saúde dizem respeito à dificuldade de trabalhar em equipe, à falta de apoio da gestão, à estrutura física inadequada e a pouca adesão dos profissionais as práticas educativas. Portanto, a educação em saúde praticada na ESF não consegue instrumentalizar os sujeitos para que estes tenham autonomia e possam tornar-se sujeitos de suas vidas, de sua história. A prática educativa centrada na transmissão de conhecimentos ainda é uma realidade presente na ESF, constituindo-se em um desafio a ser superado

Superando a aridez do semi-árido: encontros entre saúde mental e saúde da família na formação de médicos no alto sertão paraibano

A atenção primária à saúde é um importante cenário para o cuidado em saúde mental por suas características e pelo trabalho no território contribuir para a superação do modelo manicomial de atenção. Esta pesquisa partiu do questionamento sobre como acontece a atenção em saúde mental na atenção básica nas unidades em que se desenvolve a Residência de Medicina de Família e Comunidade em um município do sertão paraibano. Objetivou investigar as demandas de saúde mental e práticas de cuidado no contexto de ESF e da RMFC do município de Cajazeiras a partir do discurso dos profissionais ali inseridos e discutir estratégias de qualificação do cuidado em saúde mental nessa realidade. Utilizou-se abordagem qualitativa em que foram realizados grupos focais envolvendo profissionais de duas equipes da ESF e uma equipe de NASF. Os dados produzidos nos grupos foram analisados a partir do referencial da análise do discurso de inspiração foucaultiana. Como resultados evidenciou-se que os profissionais percebem a demanda em saúde mental na atenção básica principalmente na forma de sofrimento psíquico inespecífico e transtornos mentais graves. A atenção a essas pessoas não consegue superar a medicalização que é identificada por esses profissionais. A prática asilar persiste como alternativa para os casos de transtornos mentais graves, sendo limitada a incorporação do paradigma da desinstitucionalização como referencial para a prática profissional. Além disso, a relação com a rede de saúde encontra vários limites destacando-se a dificuldade de produção de continuidade e integralidade do cuidado. A partir disto, analisa-se a formação médica e sua capacidade de garantir o cuidado integral na atenção às demandas de saúde mental. No campo da pesquisa, dois modelos de formação se encontram. Os residentes participantes ou graduaram-se em Cuba ou em escola médica brasileira orientada pelas Diretrizes Curriculares Nacionais. Percebe-se então que a graduação, ao incorporar questões relativas à integralidade do cuidado, não é suficiente para gerar bons profissionais para o SUS. Considera-se necessário somar às mudanças na graduação a perspectiva da Educação Permanente em Saúde no mundo do trabalho, o envolvimento dos profissionais com a transformação das práticas de atenção à saúde e a construção da perspectiva da integralidade e da atenção psicossocial por dentro da Residência de Medicina de Família e Comunidade como importantes estratégias para a formação de médicos generalistas aptos para a atenção às demandas de saúde mental

A condição de saúde do trabalhador moto-taxista do município de Caicó-RN no contexto da precarização

The restructuring process has caused several changes in the workplace since the 1970s in Brazil these changes were more significant during the 1990s, with the implementation of neoliberal policies and the submission of the country's determinations of the IMF and World Bank . In this context, expression wins the increase in structural unemployment and the growth of informality as a mitigating practice the lack of formal employment. At present the activity of mototaxi driver has grown in the municipalities of small, medium and large size of the country. In Caicó / RN, as well as other municipalities, this activity has been presented as an alternative livelihood in the face of rising unemployment. Considering that this is a precarious and risky activity, we wondered about which health conditions of workers in the municipality of mototaxi driver Caicó in the context of job insecurity? What is the perception that this employee has about the health-disease process and its relationship to your work? How to setup the access of motorcycle taxi drivers the right to health and social security? The research sought to examine the health conditions of the workers of the municipality of mototaxi driver Caicó / RN in the context of job insecurity. From the methodological point of view the study worked with documentary research, semi-structured interview and questionnaire with open and closed questions with a sample population of motorcycle taxi drivers of the city, in the period August-September 2013 The results revealed that these workers are if constantly exposed to various risks inherent to the profession as well as the space in which it conducts its business activities, in this case the traffic being traffic accidents and urban violence one of the greatest risks identified by motorcycle taxi drivers in the present study

Acolhimento prescrito x real: uma análise sobre as relações entre trabalhadores e usuários na estratégia saúde da família

User embracement has been proposed as a tool that contributes to humanize the nursing, to increase the users’ access to the services, to ensure the resolvability of claims, to organize the services and promote the strengthening of the links between them and the health professionals. In the city of Recife, this practice has been fomented by the municipal government and its implementation is guided by normative acts, with evaluation matrices and proposition of goals, based on a model created by the public administration. This study intended to analyze the relation between the prescribed user embracement and the real one and their interferences with the relations of reciprocity between workers and users in the health units of basic attention in Recife. Four units of the Family Health Strategy at the Sanitary District IV of the city of Recife – PE were taken as an investigation field. The investigation had a qualitative character, so, Interviews were performed involving professionals and users whose speeches were recorded by the voice digital mode and literally transcript. The obtained speeches were analyzed mostly through the Discourse of the Collective Subject methodological approach, being also used, but on a smaller scale, the technique of thematic analysis, in the dialogic way, with theoretical contributions and official documents related to the theme. The results pointed that in most of the health units the professionals execute the proposed protocols and consider that these have a positive influence for the working process in user embracement, however, factors such as the excessive demand, the physical structure of the units, little resolvability of the reference network, singularities of the units, among others, have appeared, hampering the accomplishment of the prescribed, creating, thus, a negative influence on the working process of the user embracement. The reciprocal relations have also suffered the influences of these factors, which made difficult, therefore, the circulation of gift. Meanwhile, other factors such as access, resolvability, sheltering attitude and responsabilization, potentiated the reciprocal exchange between professionals and users. The findings demand the prescriptive acts and the reciprocal relations of the user embracement to be directly influenced by the singularities present in each community, by the human variabilities and by factors connected to the structure and working process, so it shall be operated with caution in order to provide a real user embracement with quality

A preceptoria na estratégia saúde da família: o olhar dos profissionais de saúde

The proposal of teaching-service integration from work experience brings a challenge to the professionals involved in health services: to combine their healthcare practice to the preparation of new professionals in accordance with the national health model. In Recife, the assistance network is known as school network, since it provides all its health equipment for Higher Education Institutions, in special for professionals who work as preceptors, making this activity an important component of the services network. The objective of the present study was to analyze preceptorship experience herein Multidisciplinary Residences in Health in the look of health professionals. This is a qualitative descriptive study, involving physicians, dentists, and nurses that have worked as preceptors for at least two years in multidisciplinary residency linked to two Higher Education Institutions. A semistructured interview was used as research instrument and data were processed by using the software Alceste 4.9. Results indicated four semantic classes which were divided into two axis. Axis 1, composed of class 4, and Axis 2, composed of classes 3, 2 and 1. Categorization considered the relation between classes. It was observed that in class 4 work overload is a dilemma for professional participation in preceptorship. This is noted by the words manage, time, patient, give, and complicated. However, it is also observed that the preceptorship involves positive learning and teaching actions, reinforced by the words say, explain, and discuss. Class 2 shows the preceptorship as an experience exchange, a positive moment that provides theoretical upgrade to the preceptor, associated to the professional practices performed by the binominal preceptor-student in health services and communities. In this perspective, everyone is benefited since preceptorship is structured according to dynamic aspects of knowledge, experienced in settings permeated by people´s health necessities. In class 3, potentialities of this practice are shown, and personal compromise is the main reason of acting as a preceptor in this network of education/attention, demonstrated in the words reason, formation, to like and professionals. Last, but not the least, class 1 suggests the importance of preceptorship and one of the strategies to create the National Politics of Humanization, from the teachingservice-community integration, observed in the words: arrives, university, fundamental, manner, partnership, service, and student. Besides, it rates perspectives and challenges for the improvement of the preceptorship in health services. Integrating teaching and service can enhance the proposals of changes concerning the healthcare model practiced in services, but this relation is still superficial. The preceptor is an actor in action, playing real life roles, and that is when he becomes essential to seek training with the profile defended in the proposed training of a professional who is capable of learning to learn

Avaliação da atenção humanizada ao abortamento em maternidade-escola, em Natal, Rio Grande do Norte

Unplanned pregnancy is experienced by millions of women worldwide. Such fact increases the risk of abortion-related morbimortality, which represents a serious public health problem. This study aims to evaluate the advances and challenges of the implementation of Humanized Abortion Care at the Maternity-School in Natal, state of Rio Grande do Norte. The research was evaluative, was preceded by an Evaluative Study, and resulted in a Case Study. The intentional sample totaled 102 subjects (60 users, 39 professionals and 3 managers). The collection techniques included documental analysis, semi-structured interview and observation with a field diary. The documental analysis was descriptive, while the Content Analysis by Bardin was used for semi-structured interviews and field diary. The Evaluative Study observed that Humanized Abortion Care is an evaluative program with preparation and pact of the logical model, of the matrix of indicators and evaluative questions. The Case Study showed that users were satisfied with the problem-solving capacity and access to the service; however, is also showed that they pointed out inadequacy in terms of environment, qualified hearing and reproductive planning. Professionals reported that the inefficiency of service consists of infrastructure and environment, which are considered inefficient and inadequate to humanized care, especially regarding patient accommodation, the lack of hospital beds, the reduced number of rooms in the surgical center and the lack of laboratory inside the maternity. Moreover, reproductive planning does not consist of an institutionalized practice in the service, and integrality with other services or partnership with the community is not in place. The Maternity Board emphasizes that the excessive demand of patients is one of the reasons that hinders the appropriate implementation of the technical standard. We then conclude that although satisfied regarding problem-solving capacity in terms of service and ease of access, there is room for improvement in qualified hearing systems, in the creation of a system to promote team work, implementation of ombudsman and satisfaction surveys. The right of shared choice did not prevail among users and health professionals with regard to the option of uterine evacuation procedure. Environment was the most mentioned category as that requiring more changes, seeing as a limited factor for the development of humanized and welcoming practices. Health professionals do not establish a periodic routine of planning practices, and such practices are not aligned with the Technical Standard. Incorporation of guidelines and availability of a plurality of methods and possibilities of choices for family planning are required. There is no institutionalization of reference and counter-reference, or partnerships with the community, which makes integrality of care not viable. The Standard needs to be included in the action plans of managers as one of the priorities in the construction of care strategies for women's health, in order to enable, allied to other initiatives, the real integration among safe conduct service, primary care network and social organizations. As a result, respect for human rights and adequate humanized care, as a way of attention and prevention of abortion, can be secured.