Praxiologia, representação social de menopausa e práticas educativas de enfermeiras na estratégia saúde da família

This research, whose theme is related to climacteric, aims to know the social representation of menopause developed by the nurses working for Estratégia Saúde da Família (Family Health Strategy) in João Pessoa PB, as well as identifying its structure and verifying the way it interferes with the assistance and educational practices to the climacterial user. In the theoretical level, it is based on a model that articulates the social representations theory, the central nucleus complementary theory and the central concepts of Pierre Bourdieu s praxiology: habitus, cultural capital, social field and symbolic power. A hundred and forty-seven female nurses who work for Estratégia Saúde da Família (Family Health Strategy) in João Pessoa (PB) took part in this research, and the data collection period was from February 2008 to March 2009. As to the methods and techniques, we used the method to determine the central nucleus based on the free association of words, a questionnaire to identify certain regularities that constitute the nurses habitus, and the semi-structured interview to explore opinions and attitudes when facing assistance situations and educational practices and to collect other relevant information. The data analysis was developed, when referring to the free associations, with the help of the EVOC software, which is a group of articulated programs which carry out the statistical analysis of the evocations and the identification of the possible elements of both the central nucleus and the peripheral system of the social representation. As to the questionnaire, we used the descriptive statistical analysis and the analysis of correlation between the variables. The interviews were submitted to a categorical analysis of the content. The EVOC result indicated that the cognition hormone was the only element of the central nucleus of the social representation of menopause. Due to its symbolic value and structuring power, this central nucleus ensures the strict and, at the same time, flexible character of the representational content. The analysis of the social advancement, of some fundamental features of the group habitus, as well as the analysis of its insertion in the health field and of the attitudinal opinions and dispositions concerning the assistance given to the climacterial user, and the analysis of the pedagogical dimension of this assistance, all these analyses lead to the conclusion that the nurses who took part in this research share a social representation of the menopause resulting from the association of different technical and scientific knowledge. These derive from the biomedical pattern as well as from hegemonic values which disqualify old age and overvalue youth, from pedagogical conceptions arising from patterns that are presently regarded as authoritative and old-fashioned and from cultural references (responsible for the semantic variations concerning the central nucleus) which are specific to the subgroups the nurses belong to. This research enables the creation of opportunities for discussion between active nurses working for Estratégia Saúde da Família, and the nurses who are teachers at institutions of higher education, aiming at linking theory to practice, so that they can find ways of thinking about the climacteric and working, in a more comprehensive way, with users who are experiencing this stage of life

Dificuldades e/ou facilidades vivenciadas pelos profissionais que compõem a Estratégia de Saúde da Família

Descriptive and quantitative study, with the objective of review the positive and negative aspects experienced by professionals working in the Family Health Strategy (ESF) of Ceará-Mirim town, at Rio Grande do Norte state. The population included 190 healthcare professionals that integrate the family healthcare staff and the data-collection occurred in a meeting at their workplace, with the implementation of a questionnaire. Results were organized in Microsoft Excel spreadsheet software, with descriptive statistical analysis in tables, graphs and tables through frequencies, averages values and standard deviations. There is a predominance of females (n = 137) and higher rates in almost all professions, and higher average age (38.9%, SD = 7.8) and income wage (average = 10) in the medical category. Regarding the more developed activities, for physicians and nurses are the healthcare actions in the Unit, the oral hygiene for dentists, the immunization for auxiliary nurses (Aux-N), educational meeting for the dental office assistants (ACD), and home visitations to community-based health workers (ACS). About the easiness of work, 93.2% said to be presence of professionals with a personal profile in public healthcare; about the difficulties, 86.8% of professionals cited the unavailability of material, followed by salary range reported by nurses (80.9% ), dentists (80.0%), physicians (73.3%), ACS (83.1%), and Aux-N (90.5%). In relation to working conditions, the unavailability of materials was the most mentioned, with the exception of dentists who reported improvement in wages. We still identify among these difficulties: the drugs availability regarded as first grade obstacle by ACS and physicians, the type of contracts in second grade cited by the ACD and dentists and, in third grade, the salary range cited by dentists and auxiliary nurses. It is concluded that the difficulties and easiness faced by ESF professionals are divergent among themselves. For physicians and nurses, whose healthcare actions become directed to specific groups, the individual and the family, their difficulties relate to the unavailability of materials. For dentists, whose actions more quoted were topical application of fluoride and supervised toothbrush, their greatest difficulty is the salary range. As to the Aux-N, ACD and ACS, for all of them the unavailability of materials has hindered the implementation of their activities in ESF

Prática do enfermeiro do Programa Saúde da Família PSF na promoção da saúde do adolescente

Attention to the health of adolescents, based on paradigm flexneriano, needs to be overcome. Since the International Conference of Ottawa (1986), the literature is developing a discussion of the promotion of health, based on the paradigm of social production in health, suggests a design to overcome the health care traditional practices. Program Health of the Family PSF has this purpose to transmute the model of existing assistance, where the nurse is an essential element to the work done in the program. Around this context, it is our purpose to analyze the practice of nurse of the PSF for the promotion of health of adolescents, produced by a search of descriptive quantitative approach with the inclusion of qualitative data. Interviews were conducted with 9 nurses 3 units of health of the family USF, Mossoró-RN and applied questionnaires with 74 teenagers aged between 15 and 19 years old, with some nearby public schools where USF operate these nurses. The quantitative descriptions were transformed on tables, pictures and graphics using the program Excel (Microsoft) and the qualitative were worked through the technique of analyzing the content of Bardin (2004). The review was realized using the reference to promote health brought by the study. The results show that the most common problems that happen with teenagers are the drugs (33,8%), pregnancy (27,0%) and political problems-socio-economic-cultural issues (24,3%). Adolescents are spontaneous demand and rarely seek the USF. The actions presented by the nurses as, lectures and groups, are nothing comparing to the macro-problems presented by adolescents, and verticalized irregular. The nurses know the promotion of health generally, not explaining how operate it from its daily practice. Concluded that the practice of nurse of the PSF has not yet reach the promotion of health of the adolescent, being necessary to scheduling modules on the subject to continuous training of teams, professionals from USF, as well as teachers and other staff of schools, giving space to the participation of academic. The discussions should be socialized with the community to discuss possibilities of confrontation of the problems, which also require socio-structural changes. This research can contribute as work-diagnosis, which experienced the reality of care in nursing PSF to a specific group

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

Condutas de profissionais que realizam a consulta pré-natal na Estratégia Saúde da Família quanto à detecção, tratamento e acompanhamento da gestante com sífilis

The objective of this exploratory descriptive quantitative study was to analyze the behaviors in the detection, treatment and followup of the pregnant woman with syphilis, by health professionals that conduct the pre-natal consultation in the Family Health Strategy, as to the adherence to the recommendations of the Ministry of Health. The study was conducted in nine municipalites of the Trairi region in the state of Rio Grande do Norte. Data were collected during the months of July through September 2007, by means of a questionnaire with a population of 53 health professionals, 30 nurses and 23 physicians. Data were analyzed by descriptive statistics. The results were organized in three major items: knowledge of the health professionals about the symptomatology of syphilis and their actions in the detection of the disease; actions in the treatment of the pregnant woman with syphilis; and the actions of followup of the desease. We identified that 81,2% of the professionals have knowledge about the symptomatology of syphilis in the pregnant woman;79,2% request the VDRL exam in the adequate intervals and approximately 50% conduct the treatment in conformity with the recommendations of the Ministry of Health. For the followup care of the infected woman, 79,2% request a monthly VDRL examination, 69,8% explain the disease to the pregnant woman, and 20,7% affirm that they conduct a proper reception to the woman.We conclude that the majority of the health professionals have knowledge of the detection, treatment and followup of the pregnant woman with syphilis. However, the actions of some professionals diverge from the conduct procedures recommended by the Ministry of Health, as to the requesting of the examinations, medication prescription and notification of the iesease. This indicates the need for improved

A aprendizagem na convivência:o estágio curricular em enfermagem

This is an analytic research of a qualitative nature whose purpose is to examine the learning process involving students of the Nursing Program of the Universidade Federal do Rio Grande do Norte UFRN who are attending the Supervised Clerkship in Nursing (SCN) in Family Health Strategy (FHS), based on learning through daily living. In order to do this, a historical overview of this academic activity in the teaching of nursing was presented, and the importance of FHS as the scene where professional health education takes place was discussed. For the empirical investigation, ten eighth-semester students involved in clerkship activities at family health units in the Western Sanitary District of Natal, Rio Grande do Norte, were interviewed. The theoretical approach relied, as epistemological presupposition, on the ideas of educator Humberto Maturana who showed that learning, both in nature and among human beings, takes place within dialogic living relationships wherein acceptance of the other, affectivity (love) and dialoguing are essential stimuli to learning. Students discourses gradually became part of the analytic categories that had been established beforehand. There has been verified that the students went through meaningful learning encouraged by all who shared the living environment, that is: nurse/instructor, teacher/supervisor, family health staff, and the community. Several feelings were involved in the process, such as joy, satisfaction, self-reliance, affectivity and, in the opposite direction, sadness, indignation, a feeling of impotence, and fear. The learning of interpersonal relationship was describe as the most relevant of the academic experiences and, therefore, thus emphasizing the relevance of affectivity to the learning process as Maturana points out. It is suggested that the teaching of nursing keep on giving priority to family health units as the Basic Care educational scene, with attention to the importance of placing the students in welcoming environments, in such a way as to encourage learning

Saúde da família: uma estratégia de mudança no processo de produção dos serviços de saúde

The purpose of this study is to analyze, from the point of view of nurses, changes that took place in the process of providing health services after the introduction of the Family Health Program (FHP). It is na investigation of qualitative nature that uses semi-structured interviews as a main empirical approach tool. Six nurses from the city of Caicó, Rio Grande do Norte, who were working with basic care before the introduction of the FHP, within basic care, were: adscription and ties with the community; hospitality and the humanizacion of care-giving; decrease in cases of inpatient treatment; strengthening of the prevention of injuries and health promotion; improvemente of health indicatiors, finally, actions that point towads meeting the principles of wholeness, equity and universality as a declaration of the Brazilian National Health Care System (SUS). Nevertheless, in spite of all recognizable positive aspects, the FHP has some weaknesses, such as: the difficulty posed by colletive work; the mismatch between professional education and the demands of the current health standard; a poor physical infrastructure of the Basic Health Units; a high heath staff turnover and precarious work conditions. In addition to this, some strategies that can be used to help improve the process of providing health services have been pointed out, such as, coordination between sectors, continuous education, making work conditions less precarious and improving the means whereby heathy service management is conveyed,Tthus, finally, we understand that the FHP does bring forward meaningful changes to the process of provinding health services to strengthen the Brasilian National Health Care System (SUS), in spite of the fact that it lies within a scenario of adversities that can be overcome through the collective endeavor of the several social actors

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

Entre flores e espinhos: a atuação do técnico em enfermagem na estratégia saúde da família

It is about a study of an exploratory/descriptive type with a qualitative approach whose aim was to analyze the actuation of nursing technicians in Family Health Strategy (FHS), taking into consideration the defined attributions by the Ministry of Health (MH). Thus, it was sought to identify what activities they carry out, the difficulties encountered, what contributed to their professional performance, and what vision they have about FHS and about themselves in the context. Based on the assumption that the practice of Nursing Technician is not still geared to completeness and that the developed actions by this professional are predominantly individual and curative. We know that FHS proposes the work organization as a team, with territory definition, prioritization of promotion actions, protection and recovery of the individual/family/community health, choosing as a central point the establishment of entails between the professionals and the same ones. However, the team work pass through interdisciplinary, tying and competence, starting making the difference in the way of thinking and doing health. To the accomplishment of this study were interviewed twenty one Nursing Technicians of Family Health Units from Sanitário Oeste district in Natal-RN, using semistructured instrument. From the analysis, three empiric categories emerged: starting from the first, The reality of a dream: what FHS is for the Nursing Technician, we obtained two classifications: one inherent to the own conception they have about FHS, nominated The realization of a dream in the possible and another that corresponds to what they think about FHS, while project that doesn't take place fully, denominated of The beauty of a dream that doesn't take place. The second category was The FHS: a dream built in the daily of Nursing Technician treats of the day by day information of that professional; the activities they perform and how those are established. This created three other items, to know: The role of a Nursing Technician: a project that became routine; The pre-determined role of a Nursing Technician: the scale as factor of (non-)autonomy; and, Knowledge about the practice in FHS: challenges that are presented to the role of Nursing Technician. The third category, denominated of Charms and disenchantment in the beginning of a new practice, it is related to the facilities or difficulties in professional's actuation and how he sees himself in the context. From it emerged the "flowers" and the "thorns" found on the construction of a dream, which gave this study the title. The results indicate that, being considered the characteristics of researched professional category, it becomes fundamental the resizing of labor relations in FHS, being imperative that new glances is conducted, so that the way as those Nursing Technicians interacts with the families can become compatible, together with the team, as well as to return the attention for their possibilities and limits in face of the work process in FHS. Besides, it is necessary changes in the professional formation, so that it can guarantee the conceptual bases in the construction of new practices, seeking to answer to the model of current attention.

O processo de trabalho e a composição técnica do trabalho do enfermeiro no cuidado à saúde da criança em unidades de saúde da familia

With the trajectory that the problems related to child health are taking in our society, particularly with regard to infant mortality, beyond the process of decentralization of health and the implementation of the Family Health Strategy in the cities, where it has increased considerably performance of nursing staff in Primary Health Care, they can be considered essential factors for reflections on the care of nurse dispenses the health of these children. In order to check how it is organized the working process of the nurse in caring for these children in USFs as well as the difficulties found in the dynamics of this work, this research aimed to analyze the work processes of nurses in care Child Health in USFs, with emphasis on technologies used in producing care. This is a research exploratory and descriptive with qualitative approach, based on the theoretical reference in about Work Process and Composition Technique of Work. The data were collected through semi-structured interviews of 11 nurses who, at the moment, perform their functions for more than 01 year at USF. The guiding questions were based at theoretical reference. To analyze the results, was used the referential of content analysis, and was refer to thematic analysis. In situations that were involved closed questions of the interview, was used the aid of SPSS 15.0 program for Windows. The results indicated that the process of nurse work in health care of children, focuses on the preventive character, whose focus of the actions are healthy children, following the routines and protocols established by the Ministry of Health with a view to maintaining health them. When analyzing the data through theoretical references of Composition Technique of Work found that the core technologies of daily tasks of the nurse are directed for the use of technology soft-hard and hard, and the reason established between the Dead Working and Alive Working, there is prevalence of the first against the second in the production of this care. These situations contribute to the explanation of the emergence problems related to adhesion of mothers / caregivers to monitoring the CD, due to character prescriptive and normalizer of actions. The results also suggested the presence of "vanishing lines" in the make of nurses, confirming the self-governance of health professionals in daily work. These "vanishing lines" express the own execution of the Work Live in action, guided by the use of soft technologies, however, was not characterized as a process of technology transition. So, to get a better resolution to the problems related to child health, the nurse has reorganize your work process by focusing on the execution of work live in action.

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

A organização do dots em um distrito sanitário de Natal/RN, 2009

Tuberculosis is an ancient disease that remains a serious problem of Public Health, requiring a pressing attention. Advances in the knowledge and technology available to control it has not been sufficient to significantly impact on morbidity and mortality, especially in developing countries. To enable patient compliance with TB treatment, preventing the abandonment of this to ensure the correct use of medicines has been suggested the DOTS (Directly Observed Treatment - Short course) or directly Observable Short Course Treatment. This study focuses on the incorporation of two technical components of the DOTS strategy at the Family Health, namely, active search for respiratoy symptoms and Supervisioned Treatment (ST). The West Sanitary District was considered best suited to be the focus of study because it is assumed that those sites that were better structured would provide better information about the situation of the strategy in the municipality. Its purpose is to analyze the organization of DOTS as the active search for respiratory symptoms and Directly Observed Therapy in Health Teams Family belonging to a Health District in the city of Natal, Brazil. An exploratory descriptive study with a quantitative approach which involved health professionals from 11 units of Family Health, West Sanitary District, Natal, Rio Grande do Norte. We interviewed 62 professionals on the professional category, their involvement in the DOTS strategy, managers' contributions to the sustainability of the strategy, actions Search for symptomatic diagnosis and supervised treatment of TB cases and difficulties and facilities for the sustainability of the DOTS strategy. It is concluded that the actions taken by the professionals of the FHS West Health District are organized in more supervised treatment, a fact noted in their perceptions about DOTS

Ações de detecção precoce do câncer de mama realizadas por profissionais da estratégia saúde da família

This study is an exploratory descriptive study with a quantitative approach. The objective was to identify the actions for the early detection of breast cancer conducted by the health professionals of the Family Health Strategy in the Trairi region of the State of Rio Grande do Norte, Brazil. The research was conducted in nine municipalities of the region. Data were collected by means of a questionnaire with 52 Family Health Strategy professionals, 30 nurses and 22 physicians, that work in the region. Analysis was conducted using descriptive statistics. The results were organized and discussed in three areas: Knowledge about the early detection of breast cancer; Actions for early detection detection of breast cancer, and Difficulties experienced in the screening actions for breast cancer. The results indicate that these professionals (100%) have knowledge of the signs and symptoms of breast cancer and that the majority (96,2%) conduct screening actions in accordance with the recommendations of the Ministry of Health. However, a considerable number (55,8%) of these professionals encounters difficulties while conducting the screening procedures in his work setting. The difficulties varied from those of a personal nature to those of access to the procedure, such as the unavailability of sufficient quotas of screening exams. We conclude that the majority of health professionals execute the screening actions for breast cancer in their work settings according to the recommendations of the Ministry of Health, even though they encounter difficulties in the conclusion of the mammography and ultrasound exams, essential procedures in the early detection of breast cancer. We understand that these professionals demonstrate knowledge of secondary prevention even though they do not execute all the actions necessary for early detection primarily because they are impeded by the blockage of access to exam quotas. We conclude that, in spite of the difficulties experienced, the procedures for the early detection of breast cancer are being executed by the majority of the Family Health Strategy professionals in the Trairí region, specifically the clinical examination of the breast, orientation of breast self examination, requests for mammography and ultra sound examinations. Measures are needed that can mediate the difficulties, that will permit the realization of secondary prevention procedures with the population at risk in the region. We suggest training and actualization courses on the complete screening process that includes a wide discussion of the new legislation that provides the mammography exam for women over 40 years. We believe that the acquisition of such a work perspective for the early detection of breast cancer, along with knowledge of health vigilance and of breast cancer, will enhance integral health care of women that constitutes an aim of the nurse and the family health team

Tuberculose: conhecimentos, representações sociais e experiências da doença na visão do portador

Tuberculosis is considered one of the most ancient human diseases, cases were registered 3900 years before Christ, and it is currently regarded as a serious public health problem in the world due to several factors such as income mismanagement, precarious standard of life and some sort of prejudice comprised by the word tuberculosis. Taking this into consideration, it was developed a descriptive and exploratory study aiming at analyzing the social representations of tuberculosis made by its patient from the Unidades de Saúde da Família (Family Health Units a public health program) in Campina Grande City PB, in relation to the decentralization of the policies that administrate the disease. It was interviewed 34 tuberculosis patient that were being treated from 2007 to 2008. The age group of the interviewees varied from 10 to 60 years old, but most of them were between 36 and 60 years old (58,8%, n=20), some were young adult and adult (21 35 years old), with 11 (32,3%) respondents, and, less frequent, children and teenagers (11 20 years old), with 03 (8,8%) participants. Data was collected through semi-structured interview. The questions that guided the research were elaborated based on the operational recommendations of DOTS strategy; that is: access to laboratory examinations; medication guarantee; directly observed treatment. Besides that, the experiences of the patient were considered in their relation with the family and the different social groups. The analysis of the discursive material was submitted to the Analyse Lexicale par Context d un Ensemble de Segments de Texte software - ALCESTE 4.7. Data interpretation showed five categories for the social representations of the tuberculosis patient that participated in DOTS strategy: 1) the accessibility of the health assistance service; 2) the patient perspective of the disease; 3) the change in the operation of the productive life; 4) the signals and symptoms of the tuberculosis disease; 5) the rearrangement and mechanisms used to face the disease. The Central Nucleus reveals that tuberculosis is a transmissible disease that can be prevented by people through educational practices, health promotion, active search for symptomatic respiratory and control of the carriers communication; these mechanisms should be incorporated to the routine of all participants of the family health groups. The Intermediate Elements, based on quotidian life, as well as the individual experiences of the tuberculosis patient, reveals prejudiced attitude and beliefs that lead to isolation and restriction of interpersonal relationship. Peripheral Elements were constituted by themes that showed the patient feelings of indignation because of the social barriers they had to face in the Family Health Units during the treatment. These elements demonstrate a negative perspective of the representation concerning the accessibility, i.e. inadequate structure of the health service; long distance to the Health Centre, this factormakes it difficult for the patient to continue the treatment; scheduling delay; and limited service regarding other requests (doctor, dentist etc). One expects to contribute for the construction of a new perspective of the health question between the different agents who make the assistencial institutions and formation of professionals, either in central or local scope

Histórias de vidas de Usuários de psicofármacos: o desafio do cuidar para a enfermagem

Study of qualitative approach using the oral history methodology, in modality oral history of life, which aimed to: tell the stories of lives of users of psychotropic drugs for prolonged period of time, in Family Health Unit Santarém (FHU Santarém), Natal-RN-Brazil; identify possible causes which influence and trigger, respectively, use of psychotropic for prolonged period of time; search for greater knowledge about this problem of public health; contribute with the planning and development of nursing cares, to users of psychotropic drugs for prolonged period of time, as well as in Mental Health Care, integrally, in perspective of Family Health Strategy (FHS). It was used as a baseline survey, the coverage area of family health team, from FHU Santarém, which belongs to Health District North II, from Municipal Health Secretariat, in Natal-RN-BR. Eight employees who use psychotropic drugs for prolonged period of time were interviewed. They volunteered to narrate their life stories, which were analyzed by using the thematic modality, since the study is focused on the question of the use of psychotropic drugs for prolonged period of time. The thematic axis crisis, prejudice and care, defined by the categorization of common elements, found through successive and careful readings of narratives, were used to analyze these stories of lives. The study found that users of psychotropic drugs for prolonged period of time are affected by mental health crisis, feeling need to be heard, as well as the existence of social prejudice towards people with mental disorders, and non-completion of development of managed care, by the family health team, and particularly, the nursing care to people suffering from mental disorders and users of psychotropic drugs for prolonged period of time. It is proposed that, in the search of development and planning of nursing care to users of psychotropic drugs for prolonged period of time, and in mental health care, integrally, in FHS, the nurse can think and make a drawing about manners of performing nursing care to this clientele through the use of consultation of nursing, conducting home visits, collective construction of spaces for listening and socialization, which can be used as possible paths for the construction of such care