Cuidados prestados à mulher na visita domiciliar da “Primeira Semana de Saúde Integral”

Abstract

RESUMO Objetivo Avaliar o cuidado prestado à mulher na visita domiciliar da “Primeira Semana de Saúde Integral”. Método Estudo transversal realizado em serviço especializado do Recife, Pernambuco. Entre setembro e dezembro de 2013, 190 puérperas cadastradas na Estratégia Saúde da Família responderam a um questionário para verificar a existência de associação entre a visita domiciliar e as variáveis investigadas, utilizando o teste Qui-quadrado, com nível de confiança de 95%. Resultados Predominou idade de até 29 anos (68,5%) e risco gestacional alto (59,5%), sendo 46,9% primíparas. Na primeira semana pós-alta, 42,1% receberam visita. Constatou-se associação entre atenção pré-natal em nível local e visita na primeira semana (p=0,049). A participação do enfermeiro na visita estava associada à maior realização de exame de mama (p=0,000), abdômen (p=0,000) e investigação de condições emocionais (p=0,029). Conclusões Evidencia-se a necessidade de instituir um planejamento rotineiro para efetuar a visita domiciliar programática, priorizando as puérperas de risco.

Ações do programa de puerpério na atenção primária: uma revisão integrativa

“…Most studies were quantitative (76.7%) (33), and 37.2% (16) are evaluative, 20.9% (9) qualitative, 13.9% (6) cross-sectional, 11.6% (5) clinical trial, 7% (3) cohort and the same quantity of quasi-experimental, and one was descriptive. Regarding evaluation of methodological quality, 12.5% (2) of the 16 evaluative papers were rated excellent, 56.25% (9) very good and 31.25% (5) good, with two value judgments 18,19 . The others were classified by level of evidence, predominantly at level IV, 59.3% (16), followed by level III, 22.2% (6) and level II, 18.5% (5); and regarding CASP, most were classified as very good, 51.8% 14, 25.9% (7) as excellent and 22.2% (6) as good.…”

“…Four studies indicate a low level of HV 18,21,25,33 , and the same occurs more frequently in Brazil when it comes to family health facilities, performed mainly by Community Health Workers 18,25 . HV are more likely when the team monitors women during the prenatal period 18,33 .…”

“…Regarding Brazilian studies that evaluated the indicator of puerperium consultation up to 42 days postpartum, a low achievement was observed, varying from 16.8% to 58% [24][25][26] . A lack or little flexibility of prior scheduling of puerperal consultation 11,18 and hosting the First Comprehensive Health Week 18,21 were identified. Studies indicate that active search for defaulting women is performed in more than half of the studies, but it is not a systematic practice for all puerperae 11,20,21,25 .…”

“…Brazilian studies indicate that the most common activities carried out in the puerperium by health professionals, besides encouraging breastfeeding, are guidelines on contraception methods 18,25 , food and nutrition 18,21 and use of ferrous sulfate 18 . Less frequent actions are cytopathology of the uterine cervix 24 , clinical breast examination 18,24 , investigation of women's emotional state, orientation regarding return to sexual intercourse, evaluation of lochia and examination of the genital region 18 . A national study that evaluated puerperal care among adolescents classified it as adequate for 43.2% of the users, and the other ones received intermediate or inadequate care, considering in this evaluation the consultation of puerperal review, home visit in the first week after childbirth, clinical and gynecological evaluation, guidance on family planning, and guidance on breastfeeding 25 .…”

“…Of the 42 studies selected for the review, nine addressed the topic of home visits (HV) in the postpartum period, four of them national 18,21,25,32 and five international [33][34][35][36][37] . Four studies indicate a low level of HV 18,21,25,33 , and the same occurs more frequently in Brazil when it comes to family health facilities, performed mainly by Community Health Workers 18,25 . HV are more likely when the team monitors women during the prenatal period 18,33 .…”