Objective: To analyze the clinical practice of nurses in the interprofessional context of the Family Health Strategy. Method: Case study in a basic health unit of the city of São Paulo with a professional team of the Family Health Strategy and of the Family Health Support Center. Direct observation and interviews with thematic analysis and triangulation were conducted. Results: Four empirical categories were identified: interprofessional actions guided by the logic of the user's health needs; interprofessional actions guided by the logic of expediting service; interprofessional actions with a biomedical approach and interprofessional actions with an integral/holistic approach. Six interprofessional actions that indicated the expansion of the clinical practice of the Family Health Strategy's nurses were also identified. Conclusion: The results express the world trend of interprofessional practice and expansion of the scope of practice of different professions, particularly that of nurses, which requires consolidation based on the population's health needs.
Introduction: In this study we propose to analyze the work of the basic healthcare nurse in the context of the relationship between workers of the family healthcare team and the support nucleus of the family healthcare (NASF-núcleo de apoio à saúde da família) to acknowledge how the participation of the nurse in the promotion of interprofessional actions occurs. Objective: Identify the interprofessional actions where the nurse takes part and analyze the ideas of the healthcare professionals of the healthcare basic units (UBS-unidades básicas de saúde) on nurse participation in interprofessional actions and in teamwork. Method: Case study with a qualitative approach conducted in a UBS of the southern area of the municipality of São Paulo. Data collection through direct observation of the work of the teams, and interviews based on the critical incidents technique, with 15 professionals of a Family Health Team, Buccal Health, and NASF. For the analysis, thematic analysis and triangulation were applied. Results: Eight types of interprofessional actions where the nurse takes part were identified: Shared visits, nurse visits that turns into a shared visit, shared care, a space for exchanges and articulation opportunities, discussion of issues, care coordination, referrals by the nurse to other professionals, and referrals of the other professionals to the nurse. The results have shown the predominance of shared visits with physicians and NASF professionals, and that the whole of interprofessional actions are guided by two different reasoning: Reasoning of the health needs of the user, and reasoning of speeding up the care, or a combination of both. Regardless of the action guidance, two approaches, also different, were identified: Biomedical or integral healthcare. Conclusion: The interprofessional actions observed point to integrated teamwork and collaborative practice characteristics, with the nurse action standing out as an agent of information delivery and convergence, and their participation in the interprofessional action, mainly in relation with the clinical practice. The interprofessional actions guided by the reasoning of health needs have shown the predominance of the approach ruled by the search of integrality, and in the interprofessional actions, directed by the reasoning of speeding up care, biomedical approach has prevailed, with focus on disease and their related aspects. The actions developed together by nurses and NASF professionals, point to its action as a matrix and technical and pedagogical support resource, for they represent the extension of the approach of health needs of the user as well as the permanent education of the involved.
Recebido em: 21/05/2014 -Aprovado em: 30/06/2014 -Disponibilizado em: 30/07/2014 RESUMO: O estudo objetivou identificar os determinantes sociais, culturais e institucionais que interferem no acesso do homem aos serviços de atenção primária à saúde. Trata-se de um estudo descritivo de abordagem qualitativa. A coleta de dados foi realizada por meio da entrevista semi-estruturada, no período de maio a junho de 2013 na Estratégia de Saúde da Família de Montes Claros-MG. Os sujeitos do estudo foram dez homens que nunca procuraram os serviços da atenção primária. A análise dos dados foi baseada na técnica de análise do discurso. Os resultados encontrados demonstraram que as dificuldades vivenciadas pelos homens para a ausência ou baixa procura pelos serviços da atenção primária estão subdivididas em duas categorias: barreiras socioculturais e institucionais. Dentre as barreiras socioculturais destacam-se à construção da identidade de gênero, o entendimento sobre saúde, a crença inadequada sobre os serviços disponibilizados de saúde e a vergonha de expor o corpo a terceiros. Já as barreiras institucionais estão associadas à demora no atendimento, a horários inadequados e à inexistência de programas específicos para população masculina. Este estudo reforça a necessidade de se trabalhar a inserção do homem nas atividades da atenção primária a saúde. Palavras-chave: Saúde do homem. Acesso aos serviços de saúde. Masculinidade. Atenção Primária à Saúde. Gênero e Saúde. ABSTRACT:The study aimed to identify the social, cultural and institutional determinants that affect the man to primary care services to health access. This is a descriptive qualitative study. Data collection was conducted through semi -structured interviews in the period May-June 2013 in Family Montes Claros -MG Health Strategy. The subjects were ten men who never sought the services of primary care. Data analysis was based on the technique of discourse analysis. The results showed that the difficulties experienced by men to the absence or low demand for primary care services are divided into two categories: socio-cultural and institutional barriers. Among the sociocultural barriers include the construction of gender identity, the understanding of health, inadequate beliefs about the health services available and the shame of exposing the body to a third party. Have institutional barriers are associated with delay in treatment, the inappropriate times and the lack of specific programs for male population. This study reinforces the need to work the inclusion of man in the activities of primary healthcare.
Objective: to characterize the sociofamily profile of black-skinned children and adolescents with mental health problems and to intersectionally describe who assumes responsibility for their care. Method: a descriptive and exploratory study with a quantitative approach, developed in the Psychosocial Care Center for Children and Adolescents from the North region of the municipality of São Paulo. The data were collected from 47 family members of black-skinned children and adolescents, using a script with predefined variables submitted to statistical analysis. Results: a total of 49 interviews were conducted: 95.5% women with a mean age of 39 years old, 88.6% mothers and 85.7% black-skinned. Family income comes from wages for all the male caregivers and for 59% of the women. Among the black-skinned female caregivers, 25% live in their own house, whereas this percentage is 46.2% among the brown-skinned ones. Of all the caregivers, 10% have a job, 20% live in transferred properties, 35% in houses of their own and 35% in rented places. The social support network is larger among white-skinned people (16.7%), followed by brown-skinned (3.8%), and absent among black-skinned individuals (0%). Conclusion: those responsible for the care of black-skinned children and adolescents monitored by the CAPS-IJ are almost entirely women, black-skinned (black or brown) “mothers or grandmothers”, with unequal access to education, work and housing, constitutional social rights in Brazil.
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