Prática do acolhimento à pessoa idosa na atenção básica: uma estratégia de humanização

The aging of the population already is a fact, before considered a phenomenon, today, is part of the reality of the majority of the societies in the world. The present study it has as objective to analyze the practical one of the shelter developed for the team to multidiscipline for the elderly in the Strategy of Health of the Family. One is about a descriptive and exploratória inquiry, developed by means of quantitative boarding. The population of this study consisted of nineteen teams that work in the inserted ESF in the urban zone of the city of Sousa-PB, understanding a complete of 133 professionals. The collection of date was carried through through a questionnaire contends closed questions, referring to the partner-demographic date e, specific open questions. The main results indicate that the professionals of Health of the city of Sousa, PB, that had participated of this study had consisted in a complete of 76. Amongst these, 20% are nurses, followed of the odontólogos in 6%; 35% are ACS and technician of nursing with 19%. The age of the interviewed ones meets in the age band enters, 21 and 30 years, in 43%. The majority is of the feminine sex with a 84% total. Already in accordance with civil state 34% is married. If treating to the wage, the doctor has of greater of 12 wages. The participants present the percentile greater of formed time of with referring 33% of 1 the 3 years of formation. E finally, the changeable time of performance, if had detached 39% of the participants with 08 the 11 years. With regard to as if it processes the reception and attendance to the person in the ESF, we can observe that, with priority attendance was prominence with 27% of the participants, followed of a considerate attendance with 26%. Already in relation to the actions that are developed daily in the ESF, these they are come back toward the HIPERDIA with 40%, followed of actions ruled in orientation with 27%. Some actions they are carried through in accordance with the aged necessity of each (13%) and through visits domiciliary (9%). It was asked to them as the shelter was facilitated in the UBS, these had told that it is through the attention that is excused the aged one (35%), and finally, as this made it difficult age, in its majority with 37% they had not wanted to answer, followed of the lack of understanding with 26%. With this study it was possible to conclude that the practical one developed for the professionals of the ESF of the city of Sousa, PB with the elderly, is characterized by an assistance ruled in the clinical aspect, little focused in the actions that to permeate the PNH

Conhecimento dos enfermeiros do Hospital Universitário Onofre Lopes sobre sistematização da assistência de Enfermagem

Nursing as a profession goes in search on quality of their care through new frameworks, trying to break postures of the health care system so fragmented in the care. To change professional practices, it is necessary to build their own knowledge grounded on Nursing Care System. The aim of this study was to analyze the influence of nurses' knowledge on care systematization in nursing in the University Hospital Natal-RN. It is an analytical descriptive study carried out at the Onofre Lopes University Hospital (HUOL), Natal-RN, 2010, the sample was composed of 40 active nurses working in hospitalization units of the hospital, the inclusion criteria were being in the monthly scale sector and agree to participate in the study. The non-participant observation and another interview were used for collecting data, statistical analysis was descriptive and inferential with reliability test, Pearson test, chi-square and Fischer, the variables that correlated were analyzed in a model Multiple logistic , calculating odds ratio. The results were: predominance of female professionals (90%), predominantly in the age range 39-46 years (37.5%), nurses who have the undergraduate degree at the Federal University of Rio Grande do Norte (80%), and who have expertise training as a minimal degree (62.5%). Among the surveyed, the knowledge showed significance with the graduation time (p = 0.018) and time working in HUOL (p = 0.036). The majority of the professionals surveyed do not know which organ is responsible for the SAE legislation (52.5%), aware of the steps needed to build the nursing diagnosis (92.5%), understand the characteristics of nursing planning (90% ). However the same professionals do not perform physical examination in patients (50.0%) did not classify the clinical findings (68.4%), and identify the problems encountered as a classification (13.2%). The planning of nursing care is carried out by verbal order of nurses (82.5%), 41% of the professionals assess only the intervention stage, in other words, the actions taken. Regarding the practical application of nursing records 53% of nurses do not realize records, 30.8% is incomplete, the other held notes (p = 0.003). The nurses know the nursing process (90% of appropriate responses), despite the actions defined by the theory are not applied in practice. Investigators believe the condition of the hospital teacher (22.5%) could positively affect the implementation of the SAE associated with the interest of professionals (20%). Of the respondents, 17.5% accept as truth the lack of facilities to assist the SAE implementation in the hospital. It was concluded that nurses know the theory that underlies the SAE and the nursing process, but do not develop the service know as well, there is need for action to boost the SAE implementation as practice of nurses in the hospital investigated

Qualidade de vida de pessoas com úlcera venosa: associação dos aspectos sociodemográficos, de saúde, assistência e clínicos da lesão

Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients´ quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients´ QOL. The study´s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universitário Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury

Trajetória de vida de ex-portadores de hanseníase com histórico asilar

Hansen's disease, despite significant advances regarding the diagnosis, treatment and control still carries an immense burden of stigma as a result, mainly of its socio-historical marked by prejudice and isolation of patients, translated by suffering, abandonment and psychosocial problems. Thus, the study set out to rescue the life stories of former leprosy patients with a leprosarium history; recovering the life trajectory stories of these former patients and to identify common factors to these life stories. Exploratory-descriptive study with a qualitative approach, using the Life History Research Methodology. The sample was composed by twelve former leprosy patients who lived while undergone treatment in the Colony Hospital St. Francisco de Assis, located in Natal, Rio Grande do Norte. The network was composed without considering sex and age limit, patients that lived in the Colony Hospital for at least six months and who agree to participate freely in the study. The subjects with special physical needs (hearing) or mental disabilities and those who do not agree to participate were excluded. A semi-structured interview was used to data collection, the interviews were recorded in the household context of individual, residents in neighborhoods Felipe Camarão, Km 6 and Jardim America, more precisely at Nova Vida village, all located in that district. The data collected were subjected to the technique of thematic content analysis. This study had obtained an appropriate consent of the UFRN Research Ethics Committee under the protocol No. 016/2010. After extensive and careful readings of life stories we identified three themes that guided the data analysis: behavioral stages, social exclusion and, stigma and prejudice. Thus, it is clear that the practice of compulsory confinement of patients in nursing homes and the mythical image of Hansen's disease as being ugly and deformed, contributed to solidifying the historical stigma surrounding the disease and its patients, raising in society and family attitudes and feelings of exclusion, prejudice and fear. Moreover, there are remarkable stories in the lives of these interviewed reporting suffering, denials, anger that reverberate to this day, affecting negatively the social and family reintegration of these individuals. As a result, we see the need for managers and local health professionals, especially nurses, rethink existing strategies for social rehabilitation of the patient and ex-leprosy patient aiming to suppression unjust and harmful stigma rooted in image and stories of these individuals

Representações sociais sobre a prática do cuidado para enfermeiros da saúde indígena: um estudo transcultural

The desire to research on this subject arisen from the experience as nursing in the indigenous health, where I observed that many professionals from all regions of Brazil chose to work within this zone. It was notorious the nurse s difficult to settle in only one place for a long length of time. Probably due to health care in indigenous zones happens from a cultural confront. This confront materialize because both sides are imbued with their own culture: in one hand the nurse professional with its scientific knownledgment on the other the indigenous with their rituals and peculiars habits. In this context nurses should delineate and negotiate the reality through symbolic representations of life, and then make questions on the new reality. In this way, this study set out with the aim of apprehends the nurse s social representations of transcultural care in indigenous health. This knownledgment is important to avoid possible conflicts, shocks, difficulties and health care incongruence within this context. The data collect was carried out on a range of non structured interview guided by a pre-elaborated questionnaire with four questions and a hand drawing related to nurse s health care in the indigenous health. This research had a sample of 17 nurses from the Indigenous Sanitary District of Manaus in the Amazon State. To interpret data we used the Discourse of the Collective Subject, which findings were presented in three chapters: characterization of participants, discussion on themes prevalent in discourse; social representation of nursing care through infographics. The analysis revealed that the care in the indigenous health is challenging because the native people imbued in its world are perceived and processed according to the nurse s cultural lens, leading to materialize of some strangeness and adaptation difficulties, especially in the first contacts. The Social Representation on nursing practice, in many cases, is projected and contrived on the basis of scattered believes and on perception derived from common sense. The findings shows that representions are essential to mitigating the initial strangeness and help nurses to better situate themselves in the new universe. The nurse s practice in the indigenous health care should merge into each other. From the Social Representations is possible to perceive that assimilation, also comprehension on indigenous health system and its traditional knowledge are important to developing strategies to improve access and quality of care for indigenous peoples. After analysis the nurse s discourses and drawings, it is possible to represent the nurse s practice in the indigenous health as anthropophagism, since nurses should literally consuming its patients culture, digesting it and seize it as means to provide culturally congruent care. We highlight the urgent need for preparation and training of professionals to work more effectively with indigenous peoples

A busca de sintomáticos respiratórios de tuberculose na prática e perspectiva do agente comunitário de saúde nos distritos sanitários de Natal

The objective of this work - which is characterized analyze the search for symptomatic tuberculosis in practice and perspective of the Community Health Agent (ACS) in the districts of Natal. Methods: This is a cross-sectional study. The study population was 646 professionals, and conducted a probabilistic random sampling, stratified by districts. The data were collected from one instrument to collect data based on Primary Care Assesment Toll (PCAT) and analyzed by descriptive statistics. The sample consisted of ACS was 87% female. Among the study participants 58% completed high school and 120 months of exercise training (95% CI 111.9 to 129.5) on average. 90% were USF. The average follow-up of cases found were 2 cases of TB since the beginning of the career of the ACS and the last three years the average is presented in a case accompanied. The ACS received satisfactory ratings on the bond of trust with the user, so as access to homes in the community. The ACS reported for denying the fear of being positive result was the biggest reason for not performing the sputum. All units have a professional that responds to the Tuberculosis Control Program. Regarding the structural capacity of primary care settings for the diagnosis of TB, we observed satisfactory levels in different districts of pots for sputum collection, however, a point that deserves attention from managers is lack of materials for packaging sputum. Fear of positive result was one of the reasons for the refusal of sputum collection, followed by alcoholism. With regard to TB suspects, all responded that ACS always suspect when the user has TB coughs, but in all districts were noticed at low delivery of requests for applications for smear. BSR in TB control, is characterized in practice as a complex action goes beyond technical expertise and contact with the family that breaks with the Cartesian. The BSR is part of the ACS can perform them from the daily visits. We conclude that the ACS is difficult to achieve. This practice should not be the privilege of this actor, but the entire team of primary care. We must rethink the practices of TB care, seeing the health surveillance while aegis of the working process of primary care teams for early diagnosis and thereby reduce TB in communities

Registro de enfermagem no prontuário em um hospital universitário: uma busca pela humanização do cuidado

T he aim of this study is to analyze the view of nurses about nursing records in the patient chart, in perspective of the record of humanized care. This is a case study, with qualitative approach. For its achievement, was sought and granted authorization from the direction of the Hospital Universitário Onofre Lopes (HUOL) and the Ethics Committee in Research of HUOL as Statement No. 422/10. During data collection, interviews were conducted with 20 nurses of the institution. The data analysis was based on the theoretical framework of Minayo to thematic content analysis, grounded in authors who work with themes, nursing records and quality care. With the empirical material, we constructed a framework of analysis, which was identified four categories thus nominated, "Reading and learning from those who register," "nursing records and quality of care," "the essence of nursing records" and "intention and action on the record of the subjective aspects of the patient." The results show that the records are insufficient, even in the case of the procedures performed with the patients often do not inform about the aspects that deal with the subjectivity that surround it, and admit that the records do not represent a parameter for evaluating the quality of care at least at that institution. In summary, the respondents recognize the importance of valuing subjectivity of the patient in their treatment, yet admit to neglect this aspect as significant for comprehensive health care, humane and quality

Comunicação dos enfermeiros com usuários do gênero masculino: um estudo representacional

Communication is seen as vital function. Through it, individuals and organizations relate to each other, the environment and the shares of their own group, influencing each other to turn facts into information. The user of the male part of a group of patients whose health policy is still in development. This fact can create insecurity in the nurse to establish a process that promotes disease prevention, promotion and / or recovery of health for that user. Aiming to elucidate this, the present study aimed to: apprehend the social representations of nurses communication with the users were male, looking for disease prevention, promotion and recovery of his health; identify the factors that influenced, positively or negatively on the effectiveness of nurses communication with the users were male and investigate the strategies used by nurses to clarify communication with the users were male. In order to achieve the goal raised, this study was a descriptive, exploratory and qualitative approach. Was based on theoretical and methodological framework social representations of Denise Jodelet and Serge Moscovici. The project has, through no Parecer nº 649/10, approval of the Ethics and Research HULW. During data collection, we used a semi-structured script and a diary interviews with 24 nurses in basic health units of district-Mangabeira Health District III, the city of João Pessoa (PB). The results were analyzed using the technique of content analysis according to Bardin (2007). Classifying the research subjects and identified three categories and five nuclei of the central ideas. The categories identified: the grasp of the RS communication of nurses with male users, identifying factors that influence the effectiveness of nurses' communication with users and male research on the strategies used by nurses to the elucidation of the communication with male users. The nuclei of the central ideas found: social representations of nurses' communication with the users of the male is externalized as difficult, different, difficult, not technical (knowledge) specific, with a dubious sense in relation to its therapeutic action, the factors examined as positive in this communication were based on the connection between professional and user look in detail and not mechanistic, in preventive actions, the dynamics of care, accessibility, participatory care, humanization, and qualification service. Whereas served as negative factors for the communication, signed on the behavioral differences of men, the feminization of nurses, lack of training for professionals in relation to the subject, prescriptive conduct and prejudice (concerns) sociocultural. Another related consolidated core strategies employed for the occurrence of such communication. Given these results, it was realized the importance of social representations for the consecration of a single language, the common understanding of reality on the nurse's communication with the user in male and determination of changes in the behavior of nurses and the user to the establishment of more effective strategies for obtaining a therapeutic communication between them

Qualidade de vida em gestantes no contexto na Estratégia Saúde da Família

The pregnancy as a process in woman's life requires several biological, psychological, relational and socio-cultural changes for the preparation for motherhood. By modifying its capacity and, at the expense of these factors, it is observed that the physical, social and emotional problems experienced by women during pregnancy can affect their quality of life, especially related to health. It had as objectives of this research verifying the quality of life of women in the context of the Family Health Strategy in a municipality in Paraíba, in order to characterize the sociodemographic aspects, lifestyle habits, and obstetric care of pregnant women and to characterize the fields of quality of life of pregnant women according to the WHOQOL-bref. This is a descriptive exploratory study with cross-sectional and quantitative approach. The population consisted of 120 pregnant women in primary care in the municipality of Sousa-PB. Data collection occurred over a period of two months by the own master's degree student and two nursing students in applying a standard form about sociodemographic characteristics, and obstetric care and the WHOQOL-bref instrument. The data collected were organized into an electronic database of the Microsoft Excel application, coded, tabulated and presented in tables, charts and figures with their respective percentage distributions. Of the surveyed, the predominant were age group of 20 to 25 years, Catholic religion, with a steady partner, low education, no employment, wage income of 01 minimum wage. As for the data and obstetric care, almost all had never aborted and reported to the care received as excellent. The most frequent complaints were back pain and in lower abdomen. Regarding quality of life according to the WHOQOL-bref, dissatisfactions that predominated in the areas were in the physical pain and discomfort, sleep, rest, energy and fatigue. In the psychological domain, body image and appearance, memory, concentration and negative feelings. In the field of social relationships, sexual activity and the environment domain, the greatest dissatisfaction with facets scored: financial resources, leisure opportunities and transport. It is concluded that the quality of life of the users interviewed were deemed unsatisfactory for these facets, indicating that assistance to this target audience should be done comprehensively and holistically, in order to accommodate the affected facets to improve the quality of life pregnant women attended in primary care

Diagnósticos de enfermagem em pacientes no pós-operatório imediato de prostatectomia de um Hospital Universitário de Natal-RN

The characterization of the nursing diagnoses in prostatectomized patients is important to provide an unique nursing language, facilitating the communication between professionals and patients. The objective of this study was to analyze the nursing diagnoses of patients in the immediate prostatectomy postoperative period. This is a cross-sectional and descriptive study, developed at the surgical-clinic of Onofre Lopes University Hospital, in the Natal City RN - Brazil. The sample was composed of 50 patients included by the criteria: have presented a diagnosis of a benign prostatic hyperplasia or a prostate cancer, have been subjected to a prostate surgery at the mentioned hospital, and have been in the immediate postoperative period at the moment of the data collection. The exclusion criteria were: haven t been in an appropriate physical and mental condition, have presented a brain vascular disease, a lung disease, an advanced liver disease, a heart disease or a extensive coronary artery disease. The data collection instruments were: the script of an interview and physical examination. The data collection period was between November 2010 and April 2011. The data were organized in two phases: the diagnostic process and the construction of the database. The project was approved by the Ethics Committee of the Federal University of Rio Grande do Norte The results showed that most patients came from the countryside, was living with partners, had an average of 67.78 years, was pensionerthose with low schooling, Catholic and often did not perform preventive examinations of prostatic disease. The patients showed an average of 9.48 nursing diagnoses, defining characteristics 21.70 and 20.72 related or risk factors per patient. We identified 30 nursing diagnoses, of which 7 were above the 75 percentile: Risk of falls, Impaired ambulation, Risk of infection, Self-care deficit bath / hygiene and dress up and Risk for deficient fluid volume. The top six nursing diagnoses were in all patients, and therefore could not apply any statistical test. The others ND were associated with their defining characteristics and related or risk factors. We conclude that the nursing diagnoses identified in this study contribute to the progress of the nursing care to the prostatectomized patients in post-surgery period, allowing the deployment of nursing actions for the effective resolution of identified problems

Educação em saúde em hanseníase: estratégia na educação básica, Parnamirim/RN

Leprosy is an ancient disease that still stands as a public health problem worldwide, especially in the considered developing countries. Of these, Brazil still has large areas of endemicity. The disease remains high among those younger than 15 years old. In this group, the national index achieves 0.6 every 10 000 inhabitants and reaches 2 in the North and Midwest of Brazil. Therefore, the plan of the Ministry of Health is to prioritize the fight against disease in critical areas, providing early diagnosis and timely treatment, especially for patients under 15 years old. This research aimed to: identify the knowledge of students from three schools of basic education in Parnamirim/RN about the risk of getting ill in leprosy; conduct them health education on this topic. An exploratory-descriptive study with quantitative and qualitative nature. Data collection consists of two steps: questionnaire and health education on leprosy. The study was approved by the Research Ethics Committee (REC) of UFRN through the opinion nº 204/2009. Quantitative data obtained were organized, categorized, typed and submitted to the Microsoft Office - Excel for quantitative analysis with simple percentage. Qualitative data were subjected to a content analysis according to Bardin. The sample consisted of 164 students of basic education, most of which is: 1st year of high school, from 11 to 15 years, in the afternoon shift, female gender, skin color white and residents in the municipality of Parnamirim/RN. Still, each student living with four people curiously did not respond in relation to occupation of the father. But the same answered their mother as a housewife and a family income of one to less than four minimum wages. There have been significant results compared the performance of health education in leprosy. Initially, students possessed little knowledge about leprosy. Subsequent to health education, most knew the answer about the disease, transmission, cause, where to get help in case of suspicion of leprosy and the need for the people who lives with leprosy patients to also seek for help, the understanding about if it is treatable or not. Content analysis has established the following themes: axis I, what I do not know about leprosy: cure, fear and prejudice. Axis II, what I know about leprosy, we identified: cure, effectiveness of health education and social exclusion in the past. It is considered the scope of the proposed objectives by matching the effectiveness of health education on leprosy in basic education in Parnamirim/RN; emphasizes, therefore, the importance of understanding the knowledge of public school students. It is expected of them to detect early cases of leprosy in their communities; encourage adherence to treatment as quickly as possible; prevent disability; reduce the stigma surrounding the disease.

Entre o sol e a liberdade impera a violência: formação de redes para a ação a partir da estratégia saúde da família

The research aimed to analyze the feasibility of forming a network of municipal services to prevent and treat child victims of violence from the Basic Health Units in the Family Mossoró / RN. The research is a qualitative approach and was developed in the form of action research. The population was composed of representatives of institutions of the child and primary care professionals. Data were collected through questionnaires, workshops and semi-structured interview. The results were analyzed from data collected through the questionnaire designed to assess the material, lectures, dialogues and assessments with the team and presented in accordance with the findings of the research. The study was approved by the Ethics in Research UFRN with protocol No. 158/2010, CAAE: 0176.0.051.000-10. Situational diagnosis in the participants answered a questionnaire to characterize and then launched the guiding question of the focus group FHS While professional what your perception towards violence against children? It was felt the fear and ignorance on the part of the unit staff on how to prevent and to refer cases of violence against children and adolescents in the area of coverage of the unit and also realized that the professionals felt victims of occupational violence before the violence has reached proportions that the area of the unit. Mind the need to change strategies to work to combat violence, we plan to conduct focus group workshop to complete the questionnaire, training for protection against occupational violence, and meeting with other bodies responsible visor protecting children and adolescents to draw the flowchart of the victims in safety net. The next moment training to fill the notification form professionals were interested in learning and use this tool to combat violence. At the third meeting in Unity, meeting with representatives of the Child Protection Council, the professional unit showed interest in interacting with the agency to expose and combat violence against children and adolescents. Due to difficulties in the physical structure of the unit was not possible to continue the research and planned every moment, and then completed the data collection with interviews with the participating professionals, to assess the meetings. Therefore, it is considered that action research has also achieved its goals because the team was involved in the collective construction of a proposed change in the practices of referral and prevention of violence against children and adolescents. This involvement was favored using the principles Freirian during the course of the study. However, it is assumed that the network was not fully implemented because it is known that it is in a continual process of improvement and must continue evolving with the unit team.

Redução de danos e o saber-fazer de profissionais de um CAPS ad em Natal-RN

The present study had as a main objective to analyze how the professionals at a CAPS ad unit in Natal-RN conceive the knowledge-practice process with regard to the Harm Reduction Policy (HRP) towards alcohol and other drugs. For the accomplishment of this proposal, it was intended: 1) Verifying the possibilities and limits of the HRP implementation at a CAPS ad unit in Natal-RN; 2) Relating the professionals knowledge at a CAPS ad unit in Natal in regard to the Harm Reduction Policy; 3) Enumerating the HRP programmatic actions at the institution. The research had exploratory, descriptive and qualitative approach aspects, guided by the concepts of biopower and self care proposed by Michel Foucault. Data collection occurred in June and July 2011, in which the focal group technique was used. After that, collect field material was analyzed through the content analysis method proposed by Minayo. The results showed some conceptual and practical approach between the harm reduction strategy and the knowledge-practice of the professionals at this CAPS ad unit. The discursive models about drug usage, especially the moral-legal model, still have a significant role in the daily lives of these professionals, being amplified by some demands of their jobs or even through the instituted discourse. The individuals recognize the need for less prohibited practices and more socializing ones, identifying them with the Harm Reduction (HR) logic, when there is a coherent and well-founded understanding about HR among the professionals. Distorted and reductionist views about HR as considering the simple instrumental function of this strategy (distribution of basic supplies) among the professionals, represent one of the main barriers for its implementation. There are few programmatic activities that are related to the RD strategy at this CAPS ad unit which makes a more effective appropriation by the working team difficult to reach. The working processes and the postures adopted by this CAP ad unit professionals have been showing that many of their practices and conceptions were modified to the detriment of new necessities emerged from the demands. Consequently, the self care notion is revealed which brings the need for the valorization of these care agents roles, that is, their collective and individual contribution.

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Viabilidade do processo de enfermagem no contexto hospitalar

The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others.