Estudo representacional da participação familiar nas atividades dos centros de atenção psicossocial no município de Natal-RN

Comprehending social representations of users relatives of Psychosocial Care Centers (CAPS) from Natal-RN, about their participation in the activities of these services, was the purpose of this study. The research instrument used was a semi-structured interview, led to 28 relatives of users of East and West CAPS II, East and North CAPS-ad, involved in the Relative Therapeutic Group, in Relative Meeting, in the Assembly of Users, Technicians and Relatives, according to the therapeutic schedule of each health services, between August to November 2007. Data obtained in family and users identification were characterized with the aid of charts and boards in absolute and/or percentage values. The discursive material from the guide from interviews was submitted to the informational resource ALCESTE (Analyse Lexicale par Contexte d'un Ensemble of Segments of Texte), and analyzed on the basis of the Theory of Social Representations and Central Nucleus Theory. Most of the relatives were women, married, aged over 50 years, who participated for more than two years in CAPS activities, and a coexistence of more than 11 years with the user. From the classification system of ALCESTE were selected categories, identified by: Category 1, Treatment Improvements and Expectations; Category 2, Living User Before and After; Category 3, Activities Relevance, Contradictions and Suggestions; Category 4, Guidelines -- Psychopharmacology and Medicalization; Category 5, Family Participation and Activities; and Category 6, Therapeutic Conditions Thanks, Tips and Vulnerability. The social representation of the family exists in the desire for change, identifying that we need to promote change by the continuity of therapeutic activities and overcome the detected inconsistencies, targeted by strengthening and by the stability of improvements in living and health conditions of users, experienced in CAPS treatment. The central nucleus had corresponded to positive changes in health and living conditions of users, and the peripheral elements were constituted by family conducts before and during treatment, and the expectations of changes in activities, especially in workshops. Despite this family participation be considered important, it still does not meet conditions to promote the inclusion of family, under an emancipating point of view, capable of causing in subject the hope for autonomy, initiative, individual and collective growths, a closer and active involvement in therapeutic activities, in workshops and discussions

Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Serviço de atendimento móvel de urgência (SAMU) e a assistência às urgências psiquiátricas

The objective of this work which is characterized as an applied research, with a qualitative exploratory approach and has case study character has been the analysis of the conceptions and dealings of health professionals of SAMU in Natal RN about the attendance of psychiatric urgencies. The information was collected between the months of March and April of 2010, by means of semi-structured interviews, performed with 24 health professionals integrating of SAMU-Natal as well as the usage of direct observation technique, performed in the institution's medical regulation room. Both the number of professionals involved in the interviews and the bringing about of the observations, were determined by saturation methods in qualitative research's information collecting. The interviews and observations were transcribed and submitted to contents analysis technique , more specifically, to thematic analysis, which made possible to reach the deepest levels, that go beyond what has simply been manifest in the speech of the interviewed, getting to the relations among the categories and social structures of the issue of the research. Keeping this in mind, three analysis categories have been built, namely: conceptions and concepts of psychiatric urgencies shared by health professionals in SAMU-Natal; attendances to psychiatric urgencies in SAMU-Natal; and the Brazilian Psychiatric Reformation under the view of the SAMU-Natal's health professionals. Reflection about the analyzed information revealed discussions pertaining to the stigma and prejudice on mental illness, and also, pointed out to some hindrances which impair the attendance to individuals in mental suffering in SAMU-Natal. The interviewed health professionals' conceptions on the individual in psychical crisis involve concepts of unpredictability, aggressiveness and risk, stigmatizing elements and historically associated to the social hazard ideology and need for mentally sicks' segregation. The predominance of these conceptions, seen in health professionals speech, had identifiable reflexes on assistance to psychiatric demands performed by SAMU-Natal, namely: indiscriminate request for military police's presence during psychic crisis intervention, neglect about occasions that involve mental health patients, as well as repetitive assisting practice directed on physical contention, and transportation to psychiatric hospital. Associated to it, the professionals have shown distorted and reductionist understanding about Brazilian Psychiatric Reformation, and, in the majority, haven't lent credibility to present model of attention to mental health, based on psycho-social treatment, pointing their speech to a need for psychiatric patient's internment. In this sense, we notice that the hospital-centered and excluding model conceived by classical psychiatry still remains alive in these health professionals' mentality as a reference to psychiatric urgency's assistance. Therefore, the research revealed a sequence of elements, that make us think about the challenges that health sector and society must face to realize Brazilian Psychiatric Reformation's principles and guidelines

Acompanhando o crescimento e o desenvolvimento da criança : uma intervenção integrada entre enfermagem e família

The accompanying the growth and development of the child is the guiding line of basic health measures directed at this public, acting within the scope of health monitoring and inferring positively in the rate of infant morbidity and mortality, which are still a preoccupation worldwide and in Brazil. However, mostly, this practice is based on the biomedical model of care, individualized, with emphasis on the medicalization and complaints, favoring the passivity of users. Given this issue, aim to develop accompanying the growth and development of the child in a Basic Unit Family Health, through a collective approach of medical care next to a health team, especially nurses and caregivers. This is a qualitative study, with the research-action method. Involved the four nurses and twenty-six of children's caregivers of the area of Basic Unit Family Health of Cidade Nova, in Natal, in the period from February to July 2010. The results were analyzed following the direction of the thematic analysis of Freire. In the situation analysis of the current reality of the accompanying the growth and development the children in the Basic Unit Family Health, through participant observation and applying a questionnaire to the nurses, we realize that despite these professionals have a knowledge tied to the paradigm of health promotion, in practice the monitoring of child is done through individual consultations in outpatient room, based on complaints brought by caregivers, with little solvability in actions employed. Given the need for change in medical care model, we decided jointly, in the focal group, for the collective monitoring of children's the growth and development, featuring then this proposal to the multidisciplinary team, discussing the participation of professional categories and planned collectively the actions. In the implementation stage of collective action, we contemplate the execution by the caregivers of anamnesis and physical examination, recording data in the Child Health Handbook and discussion of clinical findings, under the supervision of nurses and facilitators. In the evaluation, we found that this collective accompanying strategy allowed to caregivers learn new knowledge, exchange experiences, assistance in home care, beyond reduce the waiting time for medical care and creating opportunity of more time for debate about the children‟s health situation, differing of ambulatory care. As difficulties, we face with a high rate of defaulters (53.8%), lack of motivation and passivity of the users, little participation of other health professionals and nurses' involvement in other activities, technical and bureaucratic in the moment of care. Thus, we note also a strong rooting of individual clinical model on the way of thinking and acting of nurses and caregivers

Identificação de crianças e adolescentes com suspeita de câncer: uma proposta de intervenção

Unlike adult cancer, where cells usually originate from epithelial tissue and is linked to environmental factors, malignant tumors in childhood are mostly of embryonic origin and have a phase of rapid proliferation. When not started chemotherapy at this stage, the tumor increases in size, reducing their growth rate, thus reducing the response to chemotherapy. Childhood cancer is in Brazil, the second cause of mortality among children and adolescents from one to nineteen. His impact on the ranking of diseases becomes significantly important to public health since the first issue is related to accidents and violence. Many children are still sent to the centers of high complexity for cancer treatment with advanced stage disease. The delay in referral to diagnosis can be family, or the difficulty of access to the health sector, or the characteristics of the disease and lack of health staff regarding theme of childhood cancer. Before this problem, we aimed to assess the performance of health teams in the identification of child and adolescent symptoms of cancer in primary care, through the action research methodology, which includes the teaching-learning, seminars, describing the actions of the group and discussing the activities after the training. This study involved thirty-seven health professionals who provide care for children and adolescents in the USF Felipe Shrimp II, the Support Center for Children with Cancer and the pediatric hospital UFRN during the period from March to December 2010. The data were analyzed simultaneously to evaluate actions, following the direction of the analysis of ideas Freires, having as theoretical reference the primary health care. The diagnosis of current reality, as knowledge of the health team targeted for early identification of signs and symptoms raised through questioning, presented as generative themes: resistance to change, awareness of the need for apprehension of knowledge; prior knowledge through the media, fragmentation of the healthcare network, interfering with the operation of the reference and counter, the stigma of death, among others. The selected themes enabled the choice of content for the preparation of four seminars, such as implementation of collective action for discussion problematical. The teaching-learning process has allowed the study participants awareness of the problem and work through the knowledge acquired by interfering in decreasing the time interval between the identification of signs and symptoms of cancer and early specialist treatment. Their difficulties we are faced with a diagnosis of terminal cancer and associated with delayed access to laboratory tests and imaging necessary for the diagnosis of neoplasms. Thus, we find that when the team is consciously involved in the education process from identification of the problem situation, there may be significant changes in daily activities through awareness of being. However, we also realize that acquisition of knowledge and interest of the team are not enough, since to be efficiency of our service, we need an organization of cancer care network operating in the state of Rio Grande do Norte

Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Produção artesanal : análise do método de intervenção de design no artesanato potiguar sob o ponto de vista dos atores envolvidos no processo

This work presents an analysis of the method of intervention used in the craft of design by SEBRAE in Rio Grande do Norte under the viewpoint of the actors involved, especially the craftsmen and design consultants. The research methodology used was based on the ergonomic work analysis - AET, applying observational techniques and interactive. Data tabulated from the matrix to include comments were analyzed in order to allow the generation of qualitative and quantitative information. The results of this research allow us to affirm that for the process of innovation through the design of intervention are satisfactory for all involved, it is necessary that the bonds of interaction are established and the joint actions in the innovation process to bear fruit in favor sustainability of artisan groups

Ética e clínica na atenção psicossocial: contribuições da psicanálise de Freud e Lacan

O objetivo central é discutir a possibilidade de uma ética pertinente ao conjunto de ações atualmente realizadas sob o enfoque da Atenção Psicossocial no campo da Saúde Mental Coletiva. Utilizando o método do ensaio, partirei da análise de algumas proposições importantes sobre a ética na Saúde Mental, presentes na literatura recente, e da experiência de vários anos no campo da Atenção Psicossocial como trabalhador, como assessor clínico-institucional do Ministério da Saúde e como formador de psicoterapeutas. Duas vertentes de análise são consideradas: éticas disciplinares, chamadas éticas da psiquiatria, incluindo uma tentativa importante de complementá-las criticamente sob o enfoque da ética do cuidado, e éticas fundadas em concepções psicanalíticas do sujeito e seu sofrimento, que destacam as dimensões do sujeito como entre social e como entre subjetivo ou entre sentido. Com base nas diretrizes do Sistema Único de Saúde e na psicanálise do campo freudiano, procura-se fundamentar a ética da Clínica na Atenção Psicossocial como ética do cuidar-se - base necessária para a construção do protagonismo dos sujeitos do sofrimento na produção do sentido necessário à superação do sofrimento e demais impasses que motivaram a procura de ajuda, e para a possibilidade de seu reposicionamento no entre social e no entre sentido; componentes da saúde em sintonia com a subjetividade singularizada referenciada nos Ideais socioculturais e no devir desejante. Demonstra-se que essa ética exige dos trabalhadores do campo a superação dialética dos modos de produção de saúde e subjetividade em sintonia com o Modo Capitalista de Produção e seus derivados autoritários.

A atenção em Saúde Mental em municípios de pequeno e médio portes: ressonâncias da reforma psiquiátrica

A partir da análise da Política Nacional de Saúde Mental formulada nos últimos anos e das experiências desenvolvidas após 1987 no país, procura-se compreender como o Sistema Único de Saúde tem contribuído ao avanço da reforma psiquiátrica nos municípios; verificar como a assistência oferecida nesses municípios está viabilizando os princípios da reforma psiquiátrica e a melhora das condições de vida dos usuários, bem como pesquisar o papel dos trabalhadores e gestores na construção de novas práticas de cuidado em Saúde Mental. A análise das práticas discursivas aponta que os vários segmentos sociais envolvidos na Saúde Mental conhecem os princípios e propostas da reforma psiquiátrica. No entanto, as gestões municipais não assumem integralmente as propostas do Ministério da Saúde para a área, sob a alegação de falta de recursos financeiros para a contrapartida exigida. Os usuários e familiares têm aos poucos assumido as novas propostas de intervenção, mas os mecanismos de participação e organização popular ainda são incipientes. Por fim, deve-se destacar que, para uma efetiva consolidação das propostas atuais da reforma psiquiátrica, é necessário um maior compromisso dos gestores com a atenção em Saúde Mental, maior investimento nas equipes multiprofissionais, o estímulo à organização e à participação dos usuários e familiares e a integralidade dos dispositivos de saúde, de assistência social e de cultura existentes nas cidades.

Estudo psicossocial de um seminário teológico: a formação do clero católico em análise

Este artigo apresenta dados preliminares e discussões de uma investigação em psicologia social sobre a produção da subjetividade eclesiástica. Utilizando o instrumental teórico da análise institucional, estudamos o dispositivo pedagógico seminário. Nosso campo de pesquisa é um seminário católico de teologia, onde vivem 50 seminaristas em regime de internato, na etapa final de preparação para o sacerdócio, os quais, uma vez ordenados, passarão a ocupar posições de relevância que consistem na coordenação de comunidades paroquiais amplas. Os dados foram obtidos por meio da observação do cotidiano institucional. Apresentamos algumas conclusões preliminares. Encontramos fortes contradições entre os discursos oficiais e as práticas cotidianas no seminário teológico.

Violência e abuso sexual na família

Trata-se de relato de experiência de supervisão e atendimento de famílias que sofreram violência intrafamiliar, encaminhadas para atendimento psicológico após denúncia ou suspeita de abuso sexual infantil cometido por parentes próximos. O texto examina essa experiência à luz de reflexões surgidas nessa prática, diante dos conflitos, impasses e dificuldades vividos por profissionais e famílias envolvidos no problema. A abordagem de intervenção aqui proposta tem três características principais: 1) baseia-se no enfoque psicossocial 2) propõe o atendimento familiar conjunto, envolvendo toda a família, inclusive o agressor; e, 3)introduz a perspectiva de gênero, fator historicamente preponderante na construção de relações de violência e dominação-exploração dentro da família.

O psiquiatra na atenção psicossocial: entre o luto e a liberdade

No Brasil, vemos surgir, a partir da década de setenta, diversas propostas inovadoras no campo da atenção à saúde mental. A partir de então, multiplicam-se no país ambulatórios de psicologia e psiquiatria, hospitais-dia, residências terapêuticas e diversos núcleos/centros de atenção psicossocial. Transformados em política pública, os centros de atenção psicossocial espalham-se pelo país, preconizando um atendimento ambulatorial, interdisciplinar e de orientação territorial. Geralmente formado sob os auspícios de um grande hospital, o psiquiatra que se propõe a trabalhar, a partir da ótica psicossocial, imerso em uma pequena cidade, vê-se exposto às diversas contradições e ilogicidades do discurso psiquiátrico clássico. Os variados saberes locais são uma ameaça ao saber psiquiátrico medicamente constituído. Respostas, antes fáceis no interior do hospital, têm variadas implicações no território e adquirem uma complexidade para a qual o psiquiatra não se encontra preparado. Assim, este trabalho tenta demonstrar a dissonância entre essas duas espécies de psiquiatria: a clássica (afinada com a biologia, com a normatividade e com a instituição) e a psicossocial (que se volta para respostas localmente construídas e que se afina com o homem, em uma dimensão muito além do seu corpo).

Prevenção da síndrome metabólica em crianças obesas: uma proposta de intervenção

OBJETIVO: Analisar o efeito de 12 semanas de intervenção envolvendo prática de atividade física, orientações alimentar e psicológica sobre fatores de risco para o desenvolvimento da síndrome metabólica em crianças e adolescentes obesos. MÉTODOS: Estudo longitudinal com 23 crianças e adolescentes obesos, com idade entre seis e 16 anos (12,0±3,2 anos). Foram mensurados: gordura corporal total e de tronco, glicemia, colesterol total e triglicérides, pressão arterial sistólica e diastólica. Os jovens foram submetidos a três sessões semanais de 60 minutos de exercício físico (atividades esportivas recreativas, ginástica, circuitos e caminhadas), durante 12 semanas. O teste do qui-quadrado foi usado para comparar dados categóricos daqueles que apresentaram valores acima das recomendações para cada fator de risco. O teste t para dados pareados foi aplicado para comparar os dois momentos do estudo. RESULTADOS: em indivíduos com alterações metabólicas no início do estudo, observou-se, após a intervenção, a diminuição de 11,6% na glicemia (105 para 93mg/dL; p=0,046) e de 24,9% no triglicérides (217 para 163mg/dL; p=0,013); porém, não houve diferenças na pressão arterial e no colesterol total. CONCLUSÕES: O programa de exercício físico aplicado nas crianças e adolescentes foi eficiente para melhorar os valores de glicemia e triglicérides.

A intervenção do poder judiciário no acesso a medicamentos no Rio Grande do Norte: uma análise sob a ótica das políticas nacionais de medicamento e de assistência farmacêutica

The present study aimed to evaluate the inclusion of the principles of the National Medicines Policy - PNM and the Pharmaceutical assistance - PNAF in the prosecution of lawsuits involving medicines. To fulfill this necessity , data collection was performed on the website by the Tribunal Rio Grande do Norte - TJ RN ( Rio Grande do Norte Court) , in 2012 . It was obtained 115 judgments, which were analyzed in order to generate Monitoring Indicators from lawsuits and conduct content analysis proposed by Bardin (2006). The results showed that : a) 100 % of the decisions were favorable to the author , b) 76 % of decisions were requests by the trade name of the drug , c) only one drug (eculizumabe) had not granted by ANVISA , d) 36 % of drugs were present in the list of standard medicines in SUS , 16 % of primary care block and 20 % of specialized component , e) 76 % of the decisions presented the request of at least 01 non-standard medicine. With regard to decentralization of PNM and PNAF we observed a commitment to this principle at judicial decisions, to see that municipalities and states are often forced to buy medicines of responsibility from another federal entity or other tertiary units as CACONs and UNACONS. The content analysis revealed that the argument from the judges used when you utter their decisions was that the right to health is recognized by Brazilian law as a fundamental right and should be guaranteed by the State for all its citizens. So, health is more than budgetary constraints of federal entities, which are severally liable for lawsuits , regardless the medication requested belongs or not to a particular block of a pharmaceutical assistance funding. Given these data, it is observed that there are gaps in the judgment when it comes to the insertion of the words and principles of PNM and PNAF, creating then the need for greater dialogue between the executive and judicial, so that they may consider relevant the effectiveness and application of such principles to minimize the negative consequences of the phenomenon of health judicialisation. Keywords: Judicialisation, Medicines, Public Policy, Pharmaceutical Care

Diagnóstico do usuário no aprimoramento dos serviços de tecnologia da informação: um projeto de intervenção para o Ministério Público do Estado do Rio Grande do Norte

The information tecnology (IT) has, over the years, gaining prominence as a strategic element and competitive edge in organizations, public or private. In the judiciary, with the implementation of actions related to Judiciário Eletrônico, information technology (IT), definitely earns its status as a strategic element and significantly raises the level of dependence of the organs of their services and products. Increasingly, the quality of services provided by IT has direct impact on the quality of services provided by the agency as a whole. The Ministério Público do Estado do Rio Grande do Norte (MPRN) deployments shares of Electronic Government, along with an administrative reform, beyond these issues raised, caused a large increase in institutional demand for products and services provided by the Diretoria de Tecnologia da Informação (DTI), a sector responsible for the provision of IT services. Taking as starting point strategic goal set by MPRN to reach a 85% level of user satisfaction in four years, we seek to propose a method that assists in meeting the goal, respecting the capacity constraints of the IT sector. To achieve the proposed objective, we conducted a work in two distinct and complementary stages. In the first step we conducted a case study in MPRN, in which, through an internal and external diagnosis of DTI, accomplished by an action of internal consulting and one research of the user satisfaction, we seek to identify opportunities of change seeking to raise the quality perceived of the services provided by the DTI , from the viewpoint of their customers. The situational report, drawn from the data collected, fostered changes in DTI, which were then evaluated with the managers. In the second stage, with the results obtained in the initial process, empirical observation, evaluation of side projects of quality improvement in the sector, and validation with the managers, of the initial model, we developed an improved process, gazing beyond the identification of gaps in service a strategy for the selection of best management practices and deployment of these, in a incremental and adaptive way, allowing the application of the process in organs with little staff allocated to the provision of information technology services