Solvability of mental health care in the Family Health Strategy: social representation of professionals and users

Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.


Evaluation of prenatal care in unit with family health strategy

We analyzed prenatal care (PN) provided at a unit of the Family Health Strategy Service in São Paulo, according to the indicators of the Program for the Humanization of Prenatal and Birth (PHPB). We compared adequacy of PN in terms of sociodemographic variables, procedures, examinations and maternal and perinatal outcomes. Cross-sectional study with data from records of 308 pregnant women enrolled in 2011. We observed early initiation of PN (82.1%), conducting of a minimum of six consultations (84.1%), puerperal consultation (89.0%); to the extent that there is a sum of the actions, there is a significant drop in the proportion of adequacy. Prenatal care was adequate for 67.9%, with a significant difference between adequacy groups in relation to gestational age and birth weight. Prenatal care deficiencies exist, especially in regards to registration of procedures, exams and immunization. The difference between adequacy groups with respect to perinatal outcomes reinforces the importance of prenatal care that adheres to the parameters of the PHPB.


MEDICAL STUDENT IN THE FAMILY HEALTH STRATEGY ON THE FIRST YEARS OF COLLEGE: PERCEPTION OF GRADUATES

There is a lack of knowledge about the effective value of the experience gained by medical students who participate in the Family Health Strategy (Estratégia Saúde da Família (ESF)) during the early stages of their medical training. This teaching strategy is based on learning by experiencing the problems that exist in real life. This study proposed to understand the value of this teaching strategy from the viewpoint of the students who had participated, after their graduation. The method adopted was a qualitative study conducted through interviews with students who graduated in the years 2009, 2010 and 2011. The data analysis used the hermeneutic dialectic technique as its model. The graduates considered that this experience enabled them to understand the organization and functioning of the health service and the context of the daily life of the users. This experience facilitated the doctor patient relationship, the development of clinical reasoning and the bond with the user. However the students emphasized that a lack of maturity prevented them gaining a higher level of benefit from the experience. Therefore, although the structure of the course is permeated by advances and challenges, it was concluded that this experience contributed to the student's learning of certain essential elements of medical training.

Family health nursing care: weaknesses and strengths in the Unified Health System

OBJECTIVETo analyze the weaknesses and strengths of nursing care in the Family Health Strategy and its interfaces with the Unified Health System network.METHODA qualitative study performed by means of semi-structured interviews and systematic observations, with the participation of a nursing team of 15 people from October of 2012 to January of 2013.RESULTSStrengths that were emphasized: the nurse's versatility in conducting users within the unit and the health system, therefore directly acting upon access to these services. The nurse is the main subject that participates in the care processes for the person, family and social groups. Weaknesses that were highlighted: fragile embracement and low resolution of users' and families' problems.CONCLUSIONThe nursing care process in health units still lacks collective articulation, involvement of the team, and decentralization of the decisions.

Family Health Strategy professionals' view on the effects of Hansen's disease training

OBJECTIVEEvaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training.METHODSA qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results.RESULTSThere were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support.CONCLUSIONThe low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

Managerial nursing competencies in the expansion of the Family Health Strategy

Abstract OBJECTIVE To relate the managerial competencies required of nurses with the process of change experienced in the expansion of the Family Health Strategy (FHS). METHOD A qualitative research conducted in primary health care in a southern Brazilian city, through interviews with 32 managerial and clinical nurses. The interviews were processed by IRAMUTEQ software. The resulting classes were examined under five managerial competencies to promote change. RESULTS The four classes obtained from data were: the Family Health Strategy expansion process; confrontations and potentialities; mobilization for the change; innovations in medical and nursing consultations. The classes were related to one or more competencies. CONCLUSION The expansion of the Family Health Strategy requires managerial competencies of implementing and sustaining change, negotiating agreements and commitments, using power and influence ethically and effectively, sponsoring and selling new ideas, and encouraging and promoting innovation.

Between the processes of strengthening and weakening of the Family Health Strategy

This was a qualitative study with the purpose of designing a meta-model for the work process of the Family Health Strategy (FHS) team. It was based on the experience of six sample groups, composed of their members (physicians, professional nurses, dentists, dental assistants, licensed technical nurses and community health agents) in a city in São Paulo state, Brazil, totaling 54 subjects. Six theoretical models emerged from non-directive interviews. These were analyzed according to Grounded Theory and submitted to the meta-synthesis strategy, which produced the meta-model between the processes of strengthening and weakening of the FHS model: professional-team-community reciprocity as an intervening component. When analyzed in light of the Theory of Complexity (TC), it showed to be a work with a vertical and authoritarian tendency, which is largely hegemonic in the tradition of public health care policies.

Importance of physical therapy in the family health strategy: integrative review

Objective: to analyze the importance of physical therapy in the Family Health Strategy (FHS). Methodology: integrative literature review, guided by the research question << What is the importance of physical therapy in the FHS? >>. The survey was conducted in the Virtual Health Library and in the website Google Scholar in November and December 2012. The inclusion criteria were: fully available scientific study, published between 2007 and 2012, with free access, and having at least one of the DeCS selected in the title. Results: we found out that the importance of physical therapist’s action at the FHS has been recognized both by professionals included in the teams and users of health care units, showing that, by means of the physical therapist’s preventive and clinical action, the costs and demands in the tertiary care can be reduced. Conclusion: the population and the professionals recognize the physical therapist’s positive impact on the FHS.

Implementation of physiotherapeutic shares in the prevention of diabetes complications in a Family Health Strategy

Introduction In the Family Health Strategy (FHS), the treatment of Diabetes Mellitus (DM) includes education and lifestyle change strategies. Physiotherapists have a key role in this health setting. Objectives To implement actions of evaluation and guidelines for patients with type 2 DM who attend a Family Health Strategy (FHS), regarding diabetic foot and the practice of regular physical exercise in the control and prevention of the complications of Diabetes Mellitus. Methods 17 individuals from an FHS were evaluated, with the following procedures: clinical and anthropometric parameters, inspection, a questionnaire on diabetic neuropathy, tests of vibratory and tactile sensitivity, muscle function, range of motion, functional analysis, questions about exercise practice and guidance regarding controlling blood glucose and foot care. Results Deformities, dry skin, calluses, dehydration, ulceration, cracking and brittle nails were found. Peripheral neuropathy was not observed; tactile sensitivity was altered in the heel region and the vibratory sense was absent in 5% of individuals. A decrease in functionality of ankle movements was verified. Of the participants, 76% were sedentary, 24% knew about the benefits of practicing regular exercise, 25% had undergone a medical evaluation prior to performing physical exercise and, of these, 25% were supervised by a qualified professional. Discussion The implementation of physiotherapy actions in diabetics from an FHS was important for highlighting the presence of risk factors for diabetic complications. Conclusions Individuals attending the FHS need more information and programs for the prevention of diabetic complications.

CARING FOR TUBERCULOSIS PATIENTS IN THE FAMILY HEALTH STRATEGY: THE NURSES' PERCEPTIONS

The objective of this study was to analyze the nurses' perceptions regarding tuberculosis control, according to the theoretical axis of comprehensive healthcare and the concepts of attachment and teamwork. This qualitative study involved 13 nurses from the Family Health Strategy of a priority city in the metropolitan region of Joao Pessoa, Paraiba, Brazil. Data were collected in focal groups and subjected to thematic content analysis. Factors that strengthen tuberculosis control were: supervised treatment, free medication and the provision of supplies. Weakening factors were: worker's turnover, the lack of encouragement for patients and incipient educational actions. The factors that, according to the nurses, weaken tuberculosis patient care should be reviewed by administrators, workers, users and educators with a view to redefining healthcare activities that strengthen attachment, comprehensive healthcare and teamwork.

Cartographic notes on the work in the Family Health Strategy: relationships between workers and the population

The objective of this intervention study was to map instituted and instituting movements present in the work of the Family Health Strategy in the development of their care practices. The theoretical framework is based on institutional analysis, using the schizoanalytic approach. Group meetings were carried out with the staff to discuss how they provided collective care in continuing health education. The study subjects were professionals from the team and students who were engaged in academic activity in the service. The average attendance was twelve people per meeting, and there were a total of eight meetings from March to July 2010. Data were grouped into two immanent strata: the relationships of the team and the relationship with clients. The strata point to the intersection of education and legal institutions and the social and technical division of labor. Collective thinking in groups appeared to be effective in denaturalizing established processes and interrogating places, knowledge and practices.

A TRAINING COURSE ON BIOETHICS FOR FAMILY HEALTH STRATEGY PROFESSIONALS IN SANTO ANDRE, SP

This case report presents the experience of a training course on bioethics for nurses and physicians of the Family Health Strategy in Santo Andre, SP. This study is based on problem-based learning and deliberative bioethics, and aimed at presenting the deliberation procedure as a means of handling ethical issues. Contents were addressed in a cross-section manner through five sequential activity sessions at two different moments of concentration with one dispersion interval. In the first moment of concentration, key concepts and deliberative bioethics contents were developed. The second involved deliberation sessions on moral conflicts, which were selected and prepared during the dispersion interval. Participants evaluated the deliberation as an appropriate instrument to deal with the ethical issues they are faced with. Problem-based learning was an effective educational strategy for continuing education in deliberative bioethics.

The effects of professional factors on the quality of life of family health team nurses

The objective of this study was to identify the professional factors affecting the quality of life of nurses working in the family health teams in the Macro Health Region, referred to as the South Triangle, in the State of Minas Gerais. This is a descriptive, cross-sectional study. The participants were 90 nurses, who answered a questionnaire containing the professional variables and the Quality of Life assessment instrument - WHOQOL-100. The results showed a negative impact regarding the number of jobs, unstable jobs, excessive workload and job dissatisfaction in the nurses' Quality of Life domains. There is a need to (re)define the public policies that control the working conditions of these professionals. Actions that contribute towards improving nurses' Quality of Life are important, considering their strong influence on the quality of the healthcare that is delivered.

Family Health Strategy Professionals Facing Medical Social Needs: difficulties and coping strategies

Professionals of Family Health Strategy (FHS) work in communities where there are complex medical social problems. These contexts may lead them to psychological suffering, jeopardizing their care for the users, and creating yet another obstacle to the consolidation of FHS as the primary health care model in Brazil. The study investigated the difficulties and coping strategies reported by health professionals of the FHS teams when they face medical social needs of the communities where they work. Focus groups and semi-structured interviews were carried out with 68 professionals of three primary care units in the city of Sao Paulo (Southeastern Brazil). Drug dealing and abuse, alcoholism, depression and domestic violence are the most relevant problems mentioned by the study group. Professionals reported lack of adequate training, work overload, poor working conditions with feelings of professional impotence and frustration. To overcome these difficulties, professionals reported collective strategies, particularly experience sharing during team meetings and matrix support groups. The results indicate that the difficulties may put the professionals in a vulnerable state, similar to the patients they care for. The promotion of specialized and long term support should be reinforced, as well as the interaction with the local network of services and communities leaders. That may help professionals to deal with occupational stress related to medical and social needs present in their routine work; in the end, it may as well contribute to the strengthening of FHS.

Cooperative interventions and the interaction of Community Health Agents within the Family Health team

This qualitative study examines the social relationships between the Community Health Agents (CHAs) and the Family Health team (FH), highlighting cooperative interventions and interactions among workers. A total of 23 participant observations and 11 semi-structured interviews were conducted with an FH team in a city in the interior of Sao Paulo, Brazil. The results revealed that CHAs function as a link in the development of operational actions to expedite teamwork. These professionals, while creating bonds, articulate connections of teamwork and interact with other workers, developing common care plans and bringing the team and community together, as well as adapting care interventions to meet the real needs of people. In communication practice, when talking about themselves they talk about the community itself because they are the community's representatives and spokespersons on the team. The conclusion is that the CHA may be a strategic worker if his/her actions include more political and social dimensions of work in healthcare.