Equipe de enfermagem: percepção sobre a doença de Chagas

Abstract

O Sistema Único de Saúde enfrenta desafios em relação à doença de Chagas devido ao elevado número de portadores crônicos no Brasil. Os enfermeiros e auxiliares/técnicos de enfermagem são os profissionais que prestam acolhimento e encaminhamento dos portadores nas Unidades Básicas de Saúde. Objetivou-se analisar a percepção da equipe de enfermagem sobre a doença de Chagas e serviços de saúde relacionados nos municípios da microrregional de saúde de Itaúna, Minas Gerais. Foram aplicados questionários semiestruturados aos profissionais de enfermagem. Os profissionais dominam aspectos relacionados aos vetores, sintomas, exames diagnósticos e fluxo de exames. Há ausência de ações de promoção à saúde voltadas a doença, problemas no rastreamento dos portadores na Atenção Primária à Saúde, e ausência de capacitações para os profissionais abordando o manejo clínico da doença. Sugere-se a realização de capacitações com foco técnico/clínico voltadas à equipe de enfermagem, e implantação de ações de promoção a saúde nos municípios.Descritores: Atenção Primária à Saúde, Estratégia de Saúde da Família, Serviços de Saúde. Nursing team: perception of Chagas diseaseAbstract: The primany health care in Brazil, faces challenges in relation to Chagas disease due to the high number of chronic carriers in Brazil. Nurses and nursing assistants / technicians are professionals who provide care and referrals to patients in Basic Health Units. The objective of this study was to analyze the perception of the nursing team about Chagas disease and related health services in the municipalities of the micro health region. Itaúna, Minas Gerais. Semi-structured questionnaires were applied to nursing professionals. Professionals master aspects related to vectors, symptoms, diagnostic tests and flow of tests. There is an absence of health promotion actions aimed at disease, problems in tracking patients in Primary Health Care, and an absence of training for professionals addressing the clinical management of the disease. It is suggested to carry out training with a technical/clinical focus on the nursing team, and to implement health promotion actions in the municipalities.Descriptors: Chagas Disease, Family Health Team, Primary Health Care, Health Services. Equipo de enfermería: percepción de la enfermedad de ChagasResumen: El Sistema Único de Salud enfrenta desafíos en relación con la enfermedad de Chagas debido a la gran cantidad de portadores crónicos en Brasil. Las enfermeras y los asistentes / técnicos de enfermería son profesionales que brindan atención y derivaciones a pacientes en Unidades Básicas de Salud. El objetivo de este estudio fue analizar la percepción del equipo de enfermería sobre la enfermedad de Chagas y los servicios de salud relacionados en los municipios de la región de micro salud. Itaúna, Minas Gerais. Se aplicaron cuestionarios semiestructurados a profesionales de enfermería. Los profesionales dominan aspectos relacionados con vectores, síntomas, pruebas de diagnóstico y flujo de pruebas. Hay una ausencia de acciones de promoción de la salud dirigidas a la enfermedad, problemas en el seguimiento de pacientes en Atención Primaria de Salud y una falta de capacitación para profesionales que aborden el manejo clínico de la enfermedad. Se sugiere llevar a cabo capacitación con un enfoque técnico / clínico en el equipo de enfermería e implementar acciones de promoción de la salud en los municipios.Descriptores: Atención Primaria de Salud, Estrategia de Salud Familiar, Servicios de Salud.

Chagas Disease and Primary Health Care in Brazil

“…However, in a recently published study carried out in some of the municipalities of the state of Minas Gerais, Brazil, the low number of patients aff ected by Chagas disease in the municipal basic health units (Unidades Básicas de Saúde, UBSs) was pointed out during focus groups by the coordinators of the "Estratégias de Saúde da Família" (ESF, Strategies of Family Health) of the PHC [8]. In another study, also conducted in the same municipalities and by the same research group, but this time involving interviews of nursing teams, most participants claimed to have never provided care to patients aff ected by the disease [9]. These fi ndings are interesting, and, at the same time, intriguing, as Minas Gerais was once one of the states with the highest prevalence of Chagas disease in Brazil [10].…”

“…Therefore, a great number of people with chronic disease were expected to be using the PHC services in these municipalities. Yet, according to the authors [8,9], one of the possible explanations for the low number of records of people aff ected with the infection in endemic areas could be related to the absence of a more redundant approach by health professionals during interviews and screening of patients, contrary to the recommendations for clinical follow-up of these patients in PHC [7].…”

“…From these pioneering studies on the relationship between Chagas disease and PHC, it was evident that there was a failure in the identifi cation of those aff ected with Chagas disease, be it acute, chronic symptomatic, or in the indeterminate phase, when the users entered the health care system, that is, PHC, the service which supplies the majority of care for neglected diseases, and that, therefore, should be the fi rst detection site for those aff ected. This failure is found throughout the health care system, from the moment when the health professional should focus attention on the individual, and stresses the importance of a better approach and interpersonal relationship, as the patient, when looking for the health facility, is found to be most fragile and often has diffi culties in reporting their complaints/symptoms clearly [8,9]. Furthermore, this failure to identify diseased individuals may also be related to the lack of knowledge of health professionals about the epidemiology of the disease, which makes more detailed interviews diffi cult, and involves not only the "diseased individual", but also encompasses the environment which that individual inhabits (i.e., whether they live in an endemic area).…”

“…Furthermore, this failure to identify diseased individuals may also be related to the lack of knowledge of health professionals about the epidemiology of the disease, which makes more detailed interviews diffi cult, and involves not only the "diseased individual", but also encompasses the environment which that individual inhabits (i.e., whether they live in an endemic area). In fact, in the work of Rodrigues, et al (2020ab) [8,9] there are also reports of a lack of training of health professionals in PHC in relation to Chagas disease, with the repercussion that the symptoms and signs of the disease are not recognized, or and that there is ignorance of eco-epidemiological aspects related to the vectors of it, such that these professionals are not prepared to detect it.…”

“…Another serious gap that became evident from the studies of Rodrigues, et al (2020ab) [8,9] was the disarticulation between PHC and the public health surveillance sector with regard to the resolution of actions and services aimed at Chagas disease in the municipalities of Minas Gerais studied.…”