Avaliação do coordenador municipal das equipes da Estratégia de Saúde da Família

O presente trabalho teve por objetivo avaliar o trabalho do Coordenador Municipal do Município onde atua, analisando o instrumento de Avaliação para Melhoria da Qualidade da Estratégia da Saúde da Família. Consideraram os elementos de estrutura, de processo e de resultado, tendo como foco de análise o serviço de saúde e as práticas assistenciais. A unidade de análise (componente nuclear) escolhida foi a GESTÃO. Elencou-se as atividades desenvolvidas, determinando as subdimensões temáticas dos instrumentos. Para cada subdimensões [sic] foram propostos e validados padrões de qualidade. Após realização da auto-avaliação, percebe-se a capacidade do coordenador de planejar, organizar o trabalho, além de liderar e de manter um bom relacionamento com os membros das equipes. A falta de definições nas atribuições leva ao acúmulo de atividades, prejudicando o resultado do trabalho gerencial.

A importância dos grupos de educação em saúde na atenção básica/Estratégia Saúde da Família

O trabalho de grupos de educação em saúde é uma alternativa para as práticas assistenciais individuais. Estas ações favorecem o aprimoramento de todos os envolvidos, não apenas no aspecto pessoal como também no profissional, por meio da valorização dos diversos saberes e da possibilidade de intervir criativamente no processo de saúde-doença. Por estas razões que nasce o interesse em buscar o conhecimento e a expansão destes conhecimentos, por meio do trabalho em grupos. O objetivo deste estudo foi verificar na literatura a importância dos grupos de educação em saúde na atenção básica. Entre fevereiro a agosto de 2013, para elaboração deste trabalho foi realizada uma revisão bibliográfica em artigos, livros e manuais disponíveis na internet, através da base de dados LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde), Scielo (Scientific Electronic Library Online) e trabalhos de TCC do CEABSF (Curso de Especialização em Atenção Básica em Saúde da Família) e utilizando educação em saúde, promoção à saúde, saúde da família, ações coletivas e atenção básica como palavras-chave para selecionar os artigos. Onde foram selecionados artigos publicados nos últimos 20 anos. Os resultados são percebidos, nos grupos de educação em saúde, quando são utilizadas dinâmicas de grupo com encontros temáticos, com temas previamente definidos, privilegiando a interação comunicacional, para que haja a troca de conhecimentos e saberes, pois os sujeitos se transformam e auxiliam na transformação dos outros, buscando a autonomia, a cidadania e a interdisciplinaridade. Para atuar nesses grupos a equipe deve acreditar, gostar e construir ações educativas, visando suprir lacunas que interferem no autocuidado e estreitam as relações entre os pacientes e agentes de saúde. Desta forma pôde-se concluir que os ganhos, através do trabalho em grupos de educação em saúde na atenção básica, são indiscutíveis, principalmente quando há consciência da necessidade da combinação entre a difusão do conhecimento, a habilidade para planejar e lidar com as pessoas, e ainda, a atitude para a manutenção dos grupos e a identificação dos problemas.

Atenção humanizada à saúde da mulher: questões da prática assistencial para médicos

A atenção básica é estruturante e organizadora de práticas de cuidado, favorecendo a produção de vínculo, o trabalho em equipe e a produção da cidadania, haja vista sua necessária ação sobre o território, o qual deve considerar exigências técnicas, interesses e necessidades das populações. Partindo deste pressuposto, entende-se que o planejamento das ações da Estratégia da Saúde da Família deve estar voltado para prevenir e cuidar de doenças e problemas acometidos em determinados grupos. Desta forma, o trabalho torna-se mais eficiente e eficaz. Neste material são apresentadas práticas assistenciais para médicos voltadas à humanização da atenção em saúde da mulher, levando em consideração peculiaridades pertinentes ao cuidado, prevenção e promoção da saúde deste grupo específico

Propostas de enfrentamento ao uso de drogas por adolescentes em uma equipe Saúde da Família , Frutal - MG

Consumo de drogas por adolescentes vêm provocando graves problemas sociais e em âmbito familiar, caracterizando-se como uma questão de saúde pública. Objetivou-se elaborar projeto de intervenção para apoiar a equipe de saúde da família Carlos Alberto Vieira, Frutal/MG, na abordagem ao uso de drogas entre jovens e apoio aos seus familiares. Método empregado baseou-se no Planejamento Estratégico Situacional de Saúde, através do diagnóstico situacional de saúde e processo participativo para a construção das propostas de intervenção. O uso de substâncias entorpecentes e de drogas deve ser percebido em sua complexidade, considerando sua dinâmica própria para cada cenário. De forma geral, as propostas abrangem: o apoio familiar, a ampliação de práticas assistenciais da equipe de Saúde da Família que oportunizem a socialização, estímulo à mudança de estilo de vida, garantia de acesso ao tratamento adequado pela ordenação do fluxo assistencial e mobilização social para maior compromisso das ações governamentais no enfrentamento desta realidade. A equipe de saúde tem a missão de auxiliar na construção de condutas solidárias, que cooperem efetivamente na prevenção e no tratamento dos efeitos que o consumo de drogas provoca nos jovens, na sua família e dentro da comunidade em que vivem. É preciso evidenciar que o abuso de álcool e de outras drogas, por sua gravidade e abrangência, não admite soluções apenas no campo da Saúde, mas deve envolver uma abordagem amplamente intersetorial, que trate dos problemas da violência urbana e das injustiças sociais

Plano de ação para o acolhimento dos usuários atendidos na UBS Sátyro Coelho de Moraisem Arceburgo - MG

O termo acolhimento tem se constituído em um dos pilares para o processo de humanização da atenção no contexto do Sistema Único de Saúde, com o objetivo de promover mudanças nas práticas assistenciais, individuais e coletivas. Entende-se acolhimento como a recepção do usuário pela equipe de saúde, desde sua chegada, ouvindo sua queixa, permitindo que ele expresse suas preocupações e ao mesmo tempo, garantindo atenção resolutiva e a articulação com os outros pontos de atenção da rede de serviços de saúde para a continuidade da assistência. Este estudo teve como objetivo elaborar um plano de ação a partir do problema prioritário e nós-críticos identificados pela equipe de saúde da família, considerando a sua governabilidade, viabilidade técnico-científica e recursos disponíveis. O plano de ação proposto é uma ferramenta de gestão, que visa direcionar a proposta de intervenção para a precariedade do acolhimento na unidade de saúde da família. Com isso, melhorar a qualidade do acolhimento pelos profissionais de saúde e à consequente satisfação dos usuários.

A atenção primária a saúde e o ensino: tensionamentos e potencialidades nas práticas pedagogico-assistenciais

Pós-graduação em Saúde Coletiva - FMB

Apontamentos sobre as práticas psicológicas desenvolvidas nas entidades assistenciais que atendem a crianças e adolescentes pobres

Notes on the psychological practices developed in social work entities that serve poor children and adolescents We understand that psychology, along with Pedagogy is part of the assumptions that compose the multidisciplinary field that comprises the socioeducative action of social work entities that serve poor children and adolescents considered in “personal and social risk”. What kinds of Psychology practices could be found in these institutions? We find evidence that the age minority logic still in force in many social work entities - that implement predominantly disciplinary and repressive, correctional and shaping forms of care, - dispense with psychology as a social transformation practice. When we find professional psychologists in social work entities, it is not uncommon for them to develop extremely traditional, psychotherapeutic, patologization actions for the individual, and to promote actions of orthopedic behavior, and therefore they may be called "technicians of conduct." This psychology is not aligned with the citizen and empowering perspective proposed by the Statute of Children and Adolescent, based on the fundamental concept of the social subject of rights.

A percepção de valor de uma biblioteca médica digital para o embasamento das condutos assistenciais adotadas em um hospital privado no Rio de Janeiro

Este estudo foi desenvolvido em um hospital privado, no Rio de Janeiro, com o intuito de demonstrar o valor de uma biblioteca médica digital, como ferramenta de suporte para fundamentação científica das condutas assistenciais adotadas pela equipe médica, que resultaram em glosas técnicas e perda de faturamento para a instituição. Para isso, por meio do método revisão integrativa, foi coletada a literatura clínica referente às glosas, ocorridas durante o período de janeiro a setembro de 2014, e analisada sob a perspectiva do modelo conceitual apresentado pela Cochrane (LEFEBVRE et al., 2011) que identifica o nível da evidência científica e estabelece o seu grau de recomendação para a prática clínica. Durante a análise de conteúdo, considerando as técnicas propostas por Bardin (1977), foram identificadas as evidências científicas que conferem valor à prática assistencial, conforme proposto pelo modelo conceitual. Além disso, o valor dos itens glosados foi incluído na análise dos resultados, reforçando a tendência do estudo para a validação do modelo conceitual que recomenda a prática clínica baseada em evidências científicas para geração de resultados mais efetivos e de melhor custo/benefício na saúde. Com base nos achados, são discutidas as implicações teóricas e práticas, assim como sugestões para futuros estudos sobre o tema.

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

Humanização hospitalar, ambiente físico e relações assistenciais :a percepção de arquitetos especialistas

The creation of the Humanization Program of Hospital Care and the increasing number of academic works and journal articles that discuss more humane practices in the health care services express the emphasis given to the theme in Brazil. In these discussions, however, it is not usual to find reference to architecture as a relevant factor in the humanization of hospitals, even though it is known that the physical structure of the building may help the recovering of the patients; elements such as gardens, the use of colors and open spaces may soften the impact caused by the hospital routine on patients. Considering the contribution the architectural project may bring to the humanization of hospitals, the aim of this study was to verify how the architects perceive the hospital humanization process. Besides having searched for subsides in informal interviews with health professionals, in visits to hospitals and in related seminars, the study was based on semi-structured interviews with architects of Natal, Rio Grande do Norte, who are specialists in this kind of projects. The content analysis of the interviews showed that physical space and attendance are essential to the humanization process. Those professionals see two humanization tendencies: while private hospitals have the structural physical appearance considered as humanized, public hospitals emphasize the humanization in attendance, fact that illustrates the contradictions in Brazilian health system. The interviewees consider the post-occupancy evaluation of the building as a learning exercise that contributes to new projects, but surprisingly they do not mention the patients opinion as part of it. Two annoying facts have emerged from the interviews, as also seen in preliminary stages of the study: rare are the works that focus on the person-environment relationship, and the definition of humanized hospital environments is still broad and inaccurate. This suggests the need of new studies in order to better understand how the two factors shown in this study attendance and physical space interact towards a true hospital humanization

A humanização no parto e no nascimento: os saberes e as práticas no contexto de uma maternidade pública brasileira

The practice of medicine related to the gestational processes tend to be organized according to the context and the place of work, being thus dependent of the conditions both social and economical, and of the physical structure and the functionality of the services. The high mortality rate in this process has diminished, since 1986, the study made by the World Health Organization (WHO) as to the technical aspects and the social inequalities that influence this situation in different geographical contexts. This culminated recommendations that proposed the reorientation of the dynamical practice of medicine, with a focus on the safety of maternities. Brazil adopted, in the year 2000, the suggestions of the OMS, emphasizing the humanization as the main reason for these actions. However, this discussion tends to not consider the problems caused by the social inequalities and the epidemiological and social conditionings that define the actions of the Unified Health System (Sistema Único de Saúde SUS). In this area, this research seeks to analyze the practices, cares taken, and the universal symbol that promotes and rewards the assistance to the birth of children by the SUS. Besides the analysis of the public documents that deal with this subject, an ethnographic study was developed in a maternity in Natal/RN, considered a model of humanization after receiving the Galba de Araújo prize in 2002. In this stage, the methodological strategies were observed, and the focus of the individual interviews with workers and users of this service. In the analysis of the data, it became evident that the different professional workers and women who gave birth, tend to show concern of the standards the delimit production and reproduction of the practice of medicine, as they favor the absence of a critical posture of the actions destined to the population. Besides this, if became evident that the institutional difficulties associated to the economical, cultural, and political problems also difficult the involvement and the reflection of the workers in favor of assisting changes of the process. There is also a utilization of a perspective prescriptive of humanization in the everyday life of the social workers, without reflection of its meaning. Some workers present, in their statements, a preoccupation with the social and economical aspects that affect the practice of medicine, and with the limitations of the humanization discourse that disarticulates the necessities of those involved in the process of formation, and soon tend to return to the discussion of humanization while a kind practice characterized by the minimization of the interventionist actions. Now the users of the system show themselves before the dynamic of the services, submitting themselves to what is offered while assistance, without questioning and/or reflecting about their usual shortages. Therefore, to think of changes in the know and do of the practice of medicine destined to the birth of children implies reflection on the quotidian production of these practices and of the social contexts that influence the process of assistance in the practice of medicine. Herein it would be possible to predict the appropriation, by different workers concerning their exasperations and necessities, making them active in the pursuit of their rights as citizens

Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

As éticas nas práticas de atenção psicológica na assistência social

This study presents different modalities of ethics - guardianship, interlocution, social action, care and finally the ethics of listening to the subject's unconscious desire - as analyzers of the care practices conducted by psychologists in the field of Social Assistance. In an institutional approach, cases found in the literature are presented, in a questioning way, which can be considered examples of the practices performed by psychologists and other workers who operate in a wide variety of healthcare establishments. It was concluded that psychologists may encounter, in the field of Freudian/Lacanian psychoanalysis, consistent theoretical-technical and ethical-political instrumentals to guide institutional performance in an effective and informed way so as to include the individual as a citizen and also as the subject of the unconscious.

Assistência social e práticas institucionais no atendimento a andarilhos de estrada

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A regionalização como instrumento de governança pública em saúde no estado do Paraná: análise dos vazios assistenciais como subsídio à ação do estado

Everyone has a right to health and the State’s duty is to provide it. SUS (unified health system) main principles are universalization, integrality and equality which are based on the decentralization, regionalization and hierarchization directives and shows the importance of a territorial perspective for planning healthcare actions. Decentralization was the strategy chosen to implant SUS, since municipalities were in charge of providing and organizing the municipal healthcare services. Nevertheless regionalization, that’s to say service, institution and practice integration, was not performed satisfactorily, thus jeopardizing the health system decision making process and causing disputes between municipalities over financial resources instead of developing an interdependent and cooperative net. This way, it is important to analyze if health regionalization has a good potential for being used as public governance tool. The present study aims at giving answers to the following research problem: What are the contributions of regionalism to the State of Paraná public governance applied to health? Besides that, it also aims at assessing the State of Parana health regionalization to identify healthcare gaps and help the State actions through public governance principles applied to healthcare. Therefore, the study used a quantitative-qualitative, exploratory and descriptive research, plus secondary data concerning bibliographic and documental research. The present study analyzed the current hospital bed distribution by compared to the ideal distribution allowing the identification of healthcare gaps in the regional healthcare centers, besides considering medical specialties in the State of Paraná. The study conclusion is that health regionalization is an important tool for reducing healthcare gaps concerning hospital beds permitting the use of seven to ten public governance principles applied to healthcare, as established in the present study, and shows health regionalization is an important pubic governance tool.