Cássia Regina Gotler Medeiros

A rotatividade de enfermeiros e médicos: um impasse na implementação da Estratégia de Saúde da Família

The research analyzed the causes for turnover rate of doctors and nurses in family health strategy teams with at least two years of implementation on March 2006 in Vale do Taquari, Rio Grande do Sul State. It is a quantitative and qualitative study identifying 31 teams in 25 towns, and the turnover rate was established by year from 1999 to 2005 by professional category. There was no turnover for doctors and nurses in 1999 and 2000. Doctor turnover was 5.9% in 2002; 32.1% in 2003; 25.8% in 2004; and 64.5% in 2005. Regarding nurses, it was 27.7% in 2001; 47% in 2002; 17.8% in 2003; 41.9% in 2004; and 22.6% in 2005. The analysis of semi-structured interviews with 7 doctors and 7 nurses appointed as main causes for turnover: poor work links, fragmented education, authoritarian way of managing, no links with the community, and poor work conditions. Thus, it is necessary to make changes regarding labor links, work conditions, and education for health workers and managers, seeking for the integrality in health practices.

Liderança transformacional na enfermagem

Este estudio cualitativo tuvo por objetivo verificar si los conceptos de Liderazgo de Cambio estan presentes en la practica de enfermeria de un hospital mediano, del interior de Rio Grande do Sul. Los sujetos han sido 11 enfermeros jefes de los diversos sectores del hospital, que trabajan hace uno o mas anos en la organizacion investigada. El instrumento utilizado ha sido una entrevista semiestructurada. Los datos han sido analisados a traves del metodo de analisis de contenido, del cual surgieron 5 categorias: significado de liderazgo; habilidades esenciales para el ejercicio del liderazgo; ejercicio de las habilidades de liderazgo en las acciones a diario de los enfermeros; participacion en la organizacion en el desarrollo del liderazgo; y resistencia de los enfermeros al proceso de cambios. Se ha verificado que algunos de los conceptos son identificados y percibidos como importantes, aunque no esten totalmente presentes en las acciones a diario de los enfermeros.This qualitative research aimed at verifying if the presuppositions of Transformational Leadership are present in the nurses practice in a medium size hospital in the countryside of Rio Grande do Sul. The researched people were eleven head nurses in different sectors of the hospital, who have been working for one year or more in the inquired medical institution. The tools used for the research was a semi-structured interview. The data have been analysed through content analyses method, in which five categories emerged: the meaning of leadership; essential abilities for leadership activity; leadership ability in everyday nurse activity; participation of the Institution in leadership development; and the resistance of nurses to the changing process. Some of the presuppositions are identified and noticed as important, although not totally present in everyday activity of nurses.Este estudo qualitativo objetivou verificar se os pressupostos da Lideranca Transformacional estao presentes na pratica de enfermeiros de um hospital de medio porte do interior do Rio Grande do Sul. Os sujeitos foram 11 enfermeiros chefes de diversos setores do hospital que trabalham ha um ou mais anos na Organizacao pesquisada. O instrumento utilizado foi uma entrevista semi-estruturada. Os dados foram analisados por meio do metodo de analise de conteudo, do qual emergiram 5 categorias: significado de lideranca; habilidades essenciais para o exercicio da lideranca; exercicio das habilidades de lideranca no cotidiano dos enfermeiros; participacao da Organizacao no desenvolvimento da lideranca; e resistencia dos enfermeiros ao processo de mudanca. Verificou-se que alguns dos pressupostos sao identificados e percebidos como importantes, embora nao estejam totalmente presentes no cotidiano dos enfermeiros.

Processos de trabalho na equipe Estratégia de Saúde da Família

A Estrategia de Saude da Familia pressupoe a redefinicao do modelo de atencao a saude, caracterizando-se pelo trabalho interdisciplinar e em equipe. Este estudo buscou conhecer os processos de trabalho em uma Equipe de Saude da Familia. Caracteriza-se como pesquisa qualitativa. Foram entrevistados dez membros da equipe. Os resultados apontaram que a enfermeira desenvolve inumeras funcoes, que poderiam ser compartilhadas, sobrecarregando-a e dificultando a realizacao das atribuicoes inerentes a sua profissao. O planejamento e realizacao das acoes geralmente sao feitos em equipe, porem alguns profissionais envolvem-se mais nestas atividades. Acredita-se que a equipe precisa refletir sobre seus processos de trabalho e rever a divisao das tarefas, para que cada um exerca suas atribuicoes e desenvolva um trabalho integrado.The Family Health Strategy requires a redefinition of the health care model, characterized by interdisciplinary team work. This study is aimed at knowiong the work processes in a Family Health Team. The research was qualitative, and 10 team members were interviewed. Results demonstrated that the nurse performs a variety of functions that could be shared with other people; this overloads him/her and makes inherent job task execution difficult. Task planning and performing are usually done in teams, but some professionals get more involved in these activities. It was concluded that there is a need for the team to reflect upon work process as well as reassess task assignment, so that each individual is able to perform the work and contribute for an integrated work.

As parteiras e o cuidado com o nascimento

En este estudo hemos tenido el objetivo de conocer el cuidado con el nacimiento hecho por parteras, en la mitad del siglo pasado. Es un estidio de abordaje cualitativo, ulizandose la analisis de contenido. Fueron entrevistadas cuatro partera. Han surgido cinco categorias: motivacion para ser partera; aprendizaje del trabajo de ser partera; contextualizacion del trabajo de partera; desarrollo del cuidado; compensacion del trabajo. Las parteras han buscado la ocupacion por una necesidad institucional y de trabajo. Han aprendido en cursos y con la practica. En las viviendas las condiciones eran precarias y realizaban la mayoria de los partos en el hospital. Seguian los cuidados indispensables a la madre y al hijo. Cuentan que tenian mucha paciencia para que el parto fuera normal. Han realizado su trabajo con desprendimiento, pues la compensacion venia por el reconocimiento social.This study aimed at knowing the care in childbirths conducted by midwives by the middle of 20th century It is a study of qualitative approach using as reference the Content Analysis. Four midwives were interviewed. Five categories emerged: Motivation to be a midwife; learning to be a midwife; positioning the midwifes work; developing care; work compensation. Midwives sought this occupation for institutional and job need. They learned the work in courses and practice. At home, conditions were poor, and in hospitals, they conducted the majority of the childbirth. They took the necessary care for mother and child. They have reported to be patient so that mothers could have normal childbirth. They conducted with selflessness because social recognition was their compensation.

Escolha da via de parto pela mulher: autonomia ou indução?

This study aimed to assess the perception and preference of pregnant and postpartum women for vaginal and cesarean section. Cross-sectional survey of exploratory, quantitative and qualitative approach, which occurred in four Basic Health Units (BHUs) of a small citys of Taquari Valley. The sample consisted of 81 pregnant women, which means 20.88% of annual births, and 28.72% of pregnant women registered in System Information Program for Humanization of Prenatal and Birth of the Ministry of Health (SISPRENATAL); of these, 75% (n=61) would prefer the vaginal and 25% (n=20), abdominal delivery. These data indicates that the preference reported by pregnant women is not influencing the type of delivery, because the rate of cesarean delivery in the municipality in question is 89%. Three postpartum women who underwent abdominal delivery and for these vaginal birth is more risky during labor were interviewed. It is clear that one is necessary to perform more humanized care in prenatal and delivery care, along with medical recommendations, so that it can reduce the cesarean delivery and induce abdominal delivery and the belief that this offers less risk in parturition.

Avaliação da Rede de Atenção à Saúde de pequenos municípios na ótica das equipes gestoras

Estudo de caso com objetivo de analisar a Rede de Atencao a Saude em dois municipios de pequeno porte, baseado nos elementos institucionais que configuram o padrao de interdependencia em rede e na analise de atributos que indicam o nivel de integracao da rede de servicos de saude. Foram realizados grupos focais com equipes gestoras dos municipios, bem como entrevistas com informantes-chave da gestao regional e do servico de referencia regional hospitalar, analisadas pelo metodo de interpretacao de sentidos. A analise expos uma rede parcialmente integrada e relacoes de interdependencia que apresentam interesses divergentes e pouca confianca entre os atores, dificultando a governanca.

As vivências da família no retorno ao lar com o primeiro filho

Objective: With the purpose of subsidizing the nursing care to the growing family, this study aimed to identify the situations the family experiences when they come home with their first child, extending the focus of the binomial mother-child in the puerperal period to the whole family in the household. Materials and Methods: A qualitative study and a descriptive-exploratory method were used. Five families were observed for a certain period of time after childbirth. Results and Data Analysis: The analysis of contents revealed the following categories: family changes; organization of the daily life; the care among family members; the family’s feelings and perceptions; family relations; and family needs. The connection of the family with health professionals, acquired through interaction and trust, is considered to facilitate the educational actions and the continuity of the process of providing health services to the families. Final Considerations: It is recommended that the health services develop actions which consider the families in this stage of the family’s vital cycle and that this reference is included as part of the nurse’s academic training.

Liderazgo de cambio en enfermería

Este estudio cualitativo tuvo por objetivo verificar si los conceptos de Liderazgo de Cambio estan presentes en la practica de enfermeria de un hospital mediano, del interior de Rio Grande do Sul. Los sujetos han sido 11 enfermeros jefes de los diversos sectores del hospital, que trabajan hace uno o mas anos en la organizacion investigada. El instrumento utilizado ha sido una entrevista semiestructurada. Los datos han sido analisados a traves del metodo de analisis de contenido, del cual surgieron 5 categorias: significado de liderazgo; habilidades esenciales para el ejercicio del liderazgo; ejercicio de las habilidades de liderazgo en las acciones a diario de los enfermeros; participacion en la organizacion en el desarrollo del liderazgo; y resistencia de los enfermeros al proceso de cambios. Se ha verificado que algunos de los conceptos son identificados y percibidos como importantes, aunque no esten totalmente presentes en las acciones a diario de los enfermeros.This qualitative research aimed at verifying if the presuppositions of Transformational Leadership are present in the nurses practice in a medium size hospital in the countryside of Rio Grande do Sul. The researched people were eleven head nurses in different sectors of the hospital, who have been working for one year or more in the inquired medical institution. The tools used for the research was a semi-structured interview. The data have been analysed through content analyses method, in which five categories emerged: the meaning of leadership; essential abilities for leadership activity; leadership ability in everyday nurse activity; participation of the Institution in leadership development; and the resistance of nurses to the changing process. Some of the presuppositions are identified and noticed as important, although not totally present in everyday activity of nurses.Este estudo qualitativo objetivou verificar se os pressupostos da Lideranca Transformacional estao presentes na pratica de enfermeiros de um hospital de medio porte do interior do Rio Grande do Sul. Os sujeitos foram 11 enfermeiros chefes de diversos setores do hospital que trabalham ha um ou mais anos na Organizacao pesquisada. O instrumento utilizado foi uma entrevista semi-estruturada. Os dados foram analisados por meio do metodo de analise de conteudo, do qual emergiram 5 categorias: significado de lideranca; habilidades essenciais para o exercicio da lideranca; exercicio das habilidades de lideranca no cotidiano dos enfermeiros; participacao da Organizacao no desenvolvimento da lideranca; e resistencia dos enfermeiros ao processo de mudanca. Verificou-se que alguns dos pressupostos sao identificados e percebidos como importantes, embora nao estejam totalmente presentes no cotidiano dos enfermeiros.

Clínica-escola: apoio institucional inovador às práticas de gestão e atenção na saúde como parte da integração ensino-serviço

O texto apresenta a implementacao de um servico-escola que tem como proposta a formacao de profissionais da saude em consonância com as Diretrizes Curriculares Nacionais. A Clinica Universitaria Regional de Educacao e Saude (CURES) envolve cursos da area da saude de um Centro Universitario situado na regiao do Vale do Taquari/RS, Brasil, articulando as redes de cuidado de quatro municipios. Neste trabalho relata-se o apoio institucional nas acoes das equipes da rede de cuidados. A insercao no contexto locorregional tem se mostrado um potencial formativo para estudantes e docentes, ressaltando o compromisso e a corresponsabilizacao no cuidado. A “narrativa de formacao” foi o recurso metodologico utilizado, problematizando as acoes da CURES no apoio institucional as equipes. A indissociabilidade entre tecnica e politica / teoria e pratica tem permeado as atividades e reflexoes, resultando em modificacoes no processo ensino-aprendizagem em saude.The text presents the implementation of a school-service that proposes health professionals’ education in line with the National Curriculum Guidelines. The Regional University Clinic of Education and Health (CURES) involves health courses offered by a University Center located in the region of the Taquari Valley, in the state of Rio Grande do Sul (Southern Brazil), linking the care networks of four cities. This paper reports on the institutional support that is present in the actions of the care network teams. Inclusion in the local and regional context has shown an educational potential for students and teachers, highlighting commitment and co-responsibility in care. The “education narrative” was the methodological approach that was employed to analyze the actions of CURES concerning institutional support to the teams. The inseparability between technique and policy/theory and practice has permeated activities and reflections, resulting in changes in the teaching-learning process in the field of health.

Clínica-escuela: apoyo institucional innovador para las prácticas de gestión y atención en la salud como parte de la integración enseñanza-servicio

O texto apresenta a implementacao de um servico-escola que tem como proposta a formacao de profissionais da saude em consonância com as Diretrizes Curriculares Nacionais. A Clinica Universitaria Regional de Educacao e Saude (CURES) envolve cursos da area da saude de um Centro Universitario situado na regiao do Vale do Taquari/RS, Brasil, articulando as redes de cuidado de quatro municipios. Neste trabalho relata-se o apoio institucional nas acoes das equipes da rede de cuidados. A insercao no contexto locorregional tem se mostrado um potencial formativo para estudantes e docentes, ressaltando o compromisso e a corresponsabilizacao no cuidado. A “narrativa de formacao” foi o recurso metodologico utilizado, problematizando as acoes da CURES no apoio institucional as equipes. A indissociabilidade entre tecnica e politica / teoria e pratica tem permeado as atividades e reflexoes, resultando em modificacoes no processo ensino-aprendizagem em saude.The text presents the implementation of a school-service that proposes health professionals’ education in line with the National Curriculum Guidelines. The Regional University Clinic of Education and Health (CURES) involves health courses offered by a University Center located in the region of the Taquari Valley, in the state of Rio Grande do Sul (Southern Brazil), linking the care networks of four cities. This paper reports on the institutional support that is present in the actions of the care network teams. Inclusion in the local and regional context has shown an educational potential for students and teachers, highlighting commitment and co-responsibility in care. The “education narrative” was the methodological approach that was employed to analyze the actions of CURES concerning institutional support to the teams. The inseparability between technique and policy/theory and practice has permeated activities and reflections, resulting in changes in the teaching-learning process in the field of health.