OBJECTIVE:To analyze home care practices of outpatient and hospital services and their constitution as a substitute healthcare network.

RESUMENEl estudio tiene como objetivo entender la formación de las enfermeras para el cuidado integral. Los datos fueron obtenidos de entrevistas con profesores, estudiantes y enfermeras del servicio sometidos a análisis de discurso. Fue reconocida la comprensión de la integralidad del cuidado en la perspectiva de un modelo de atención a la salud que tiene como orientación el cuidado centrado en el usuario. Suscitaron reflexiones sobre las tecnologías y la forma de organización del trabajo, expresadas por una tensión permanente: Clínica versus Salud Colectiva, como desafío para la integralidad del cuidado. Se identificó que construir la integralidad en la formación implica asumir el actuar en salud como principio educativo en una nueva forma de aprender-enseñar en salud, que rompe con el saber formateado y descontextualizado. Se concluye que la integralidad se toma como objeto de reflexión en el movimiento de cambio en las prácticas pedagógicas y que se refleja en la atención a la salud. DESCRIPTORESAtención integral de salud. Educación en enfermería. Atención a la Salud. ABSTRACTThis study has the objective of understanding the training of nurses for comprehensive health care. It used data from interviews with teachers, students and service nurses submitted to discourse analysis. There is an understanding of comprehensive care in the training of nurses from the perspective of establishing a healthcare model in which care is directed to the patient. There are reflections regarding the technologies and the form of organization of the work, expressed in a permanent tension: Clinical versus Collective Health as a challenge for comprehensive care. It was identified that building completeness in the formation implies assuming acting in health as an educative principle in a new form of learning-teaching in health, which breaks up with pre-formed, out-of-context knowledge. The conclusion is that comprehensive health care is taken as an object of reflection in the movement for change in the pedagogical practices, and that it is reflected in health attention. KEY WORDS

This study addressed the integrative and complementary practices developed at a reference service in the metropolitan region of Belo Horizonte/MG, Brazil. It analyzed how the practices developed in this service were organized and focused on their relationship with health promotion and how they fitted into the Brazilian National Health System (SUS). The results indicated that these practices could be useful resources for health promotion, especially because they establish new understanding of the health-illness process, in a more holistic and empowering manner. However, to boost them within the fields of health promotion and SUS care, challenges relating to organizing and expanding the services need to be surmounted and professionals within the reference services and specialized support for integrative and complementary practices within primary healthcare need to be brought closer together, so as to construct a common field of care.

Objective: analyze scientifi c production on nursing practice in home care. Method: integrative review employing databases LILACS, BDENF, IBECS, and MEDLINE. Studies in Spanish, English, and Portuguese were included, regardless of publishing date. Results: after analyzing 48 articles, it was found that nursing practice in home care is complex, employing a multitude of actions by using three technologies: soft; soft-hard especially; and hard. Challenges related to the home-care training process are reported in the literature. Nurses use knowledge from their experience and scientifi c recommendations in conjunction with their refl ections on the practice. Conclusion: home nursing practice is fundamental and widespread. Relational and educational actions stand out as necessary even in technical care, with a predominant need for home-care training. Descriptors: Nurse's Role; Home Care Services; Home Care Services, Hospital-Based; Home Health Nursing; Nursing. RESUMO Objetivo: analisar a produção científi ca acerca da atuação do enfermeiro na atenção domiciliar em saúde. Método: realizou-se uma revisão integrativa da literatura por meio de consulta às bases de dados LILACS, BDENF, IBECS e MEDLINE. Foram incluídos estudos em espanhol, inglês e português, não delimitando data de publicação. Resultados: analisados 48 artigos, identifi cou-se que a atuação do enfermeiro na atenção domiciliar possui complexidade e diversidade de ações com uso de tecnologias leves, leveduras especialmente, e duras. Destaca-se que desafi os relacionados ao processo formativo para a atenção domiciliar estão relatados na literatura. O enfermeiro utiliza conhecimento experiencial e recomendações científi cas aliados à refl exão na prática. Conclusão: a atuação do enfermeiro no espaço domiciliar é fundamental e ampla. As ações relacionais e educacionais se destacam, sendo necessárias inclusive nos cuidados técnicos, predominando a necessidade de formação para a atenção domiciliar. Descritores: Papel do Profi ssional de Enfermagem; Serviços de Assistência Domiciliar; Serviços Hospitalares de Assistência Domiciliar; Enfermagem Domiciliar; Enfermagem. RESUMEN Objetivo: analizar la producción científi ca sobre la actuación del enfermero en atención domiciliaria de salud. Método: se realizó revisión integrativa de la literatura mediante consulta de las bases de datos LILACS, BDENF, IBECS y MEDLINE. Fueron incluidos estudios en español, inglés y portugués, sin delimitar la fecha de publicación. Resultados: analizados 48 artículos, se identifi có que la actuación del enfermero en atención domiciliaria posee complejidad y diversidad de acciones, con uso de tecnologías blandas, blandas-duras (especialmente) y duras. Se destaca que los desafíos relacionados al proceso formativo para atención domiciliaria están narrados en la literatura. El enfermero utiliza conocimiento empírico y recomendaciones científi cas, aliados a la refl exión en la práctica. Conclusión: la actuación del enfermero en el ámbito domiciliario es amplia y fundamental. Las acc...

The study aims to build a general overview of the Nursing Graduation Programs in Brazil, in the decade of the National Curriculum Guidelines for Nursing Graduation, period 2001-2011. This is an exploratory, descriptive study, based on data from the e-MEC, Higher Education Census, ENADE. The results evidenced: the privatization of the Nursing Graduation Programs, the oversupply of courses and places day and night; sharp expansion of the number of vacancies for distance learning, not meeting the minimum quality criteria evaluated by ENADE, among other respects. It is recommended that strategies for the regulation of the expansion already installed must be defined, in addition to the revision of indicators drawn from the INEP Single Form, to meet the necessities of nursing, as an specific area, particularly with regard to: the number of vacancies, integration with the local and regional health system and the SUS, education in health care, teaching practical activities, working arrangements and experience of the faculty of the course. It is recommended, though, the immediate intervention of the MEC in the poles of Distance Education, suspending the training of nurses in that modality of education.

This is a qualitative study aiming to analyze the healthcare model for children with chronic conditions in Primary Health Care. The study subjects were nurses, nurse technicians and auxiliary nurses working in 16 basic health units in the city of Belo Horizonte, Minas Gerais. Data were collected through semi-structured interviews and later analyzed from the critical perspective, seeking to identify the common themes in the empirical material. Data revealed how primary health care professionals identified and reached children with chronic conditions, as well as how they presented the care actions performed. However, the development of a model of care for children with chronic conditions in primary health that considers their specific health needs constitutes a challenge.

Most educational initiatives were not actively oriented toward health promotion, understood as the strengthening of autonomy and self-management of health processes, social engagement, and employment of dialogic teaching approaches. However, some progress has been made moving away from hegemonic models of education in primary health care.

ObjectivesTo assess home care programs implemented in three cities and to identify components indicating the integration of these programs into the reform of health care. Methods An exploratory descriptive study with a qualitative approach was carried out in the cities of Marília and Santos, state of São Paulo, and Londrina, state of Paraná, Brazil. Empirical data was obtained from interviews with five nurses and one social worker who worked in home care services, and through analysis of reports on these programs. The data was analyzed using the discourse analysis technique. ResultsThe findings show the importance of home care services as a strategy for dehospitalization and humanization of care. Components were identified showing that home care focused on building up a health care model based on light technology, and multiprofessional and intersectorial work. It was found that, despite advances in the implementation of home care services, there are obstacles for an effective health care model change, such as ineffective referral and counter-referral mechanisms and complex relationship of health care providers with service users, their families and caregivers. Conclusions Care provided by home care programs is a strategy to decentralized care based on hospitals and to build up a new approach focused on health promotion and prevention, reducing risks and humanizing care. Strategies must be drawn up to allow its implementation in the public health network.