Clarissa Terenzi Seixas

Internação domiciliar no Sistema Único de Saúde

OBJETIVO: Analisar o funcionamento dos Programas de Internacao Domiciliar implantados em tres municipios, identificando elementos que sinalizam a insercao desses programas na mudanca da atencao a saude. METODOS: Estudo descritivo-exploratorio com abordagem qualitativa realizado em Marilia e Santos, SP, e em Londrina, PR. Os dados empiricos foram obtidos por meio de entrevistas realizadas com cinco enfermeiras e um assistente social que atuam nos servicos de Internacao Domiciliar e da analise de documentos dos referidos programas. Para o tratamento dos dados das entrevistas foi utilizada a tecnica de analise de discurso. RESULTADOS: Os achados permitem afirmar a importância do servico de Internacao Domiciliar como estrategia para a desospitalizacao e humanizacao do cuidado. Identificaram-se elementos que caracterizam a pratica nos servicos de Internacao Domiciliar voltada para a construcao de modelo assistencial com enfase nas tecnologias leves e na atuacao multiprofissional e intersetorial. Pode-se constatar avancos na implantacao de servicos de Internacao Domiciliar, bem como obstaculos para que a mudanca do modelo de atencao se processe. Dentre esses, destaca-se a ineficiencia dos mecanismos de referencia e contra-referencia e dificuldades na relacao dos profissionais da equipe de saude com usuarios, familiares e cuidadores. CONCLUSOES: O cuidado com os Programas de Internacao Domiciliar representa uma estrategia na reversao da atencao centralizada nos hospitais para a construcao de nova logica com enfoque em promocao e prevencao a saude, diminuicao de riscos e humanizacao da atencao e, como tal, devem ser engendradas estrategias para permitir sua implantacao na rede publica.OBJECTIVES To 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. RESULTS The 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.

Practices in community health toward equity: contributions of Brazilian nursing.

Although Brazil stands out as the eighth largest economy in the world, this country is burdened by huge social and economic inequalities. One of its greatest contemporary challenges is the construction of social policies, including healthcare, that seek to adjust social, economic, and cultural distortions. In the light of this scenario, Brazilian nursing has an important role in the defense of health with equity and quality of life, taking on a caring-based practice. However, to respond to these challenges in a propositional way, the nursing profession needs to reconsider its role and its purpose.

Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura

Objective: analyze scientific 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 scientific recommendations in conjunction with their reflections 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.Objetivo: analizar la produccion cientifica sobre la actuacion del enfermero en atencion domiciliaria de salud. Metodo: se realizo revision integrativa de la literatura mediante consulta de las bases de datos LILACS, BDENF, IBECS y MEDLINE. Fueron incluidos estudios en espanol, ingles y portugues, sin delimitar la fecha de publicacion. Resultados: analizados 48 articulos, se identifico que la actuacion del enfermero en atencion domiciliaria posee complejidad y diversidad de acciones, con uso de tecnologias blandas, blandas-duras (especialmente) y duras. Se destaca que los desafios relacionados al proceso formativo para atencion domiciliaria estan narrados en la literatura. El enfermero utiliza conocimiento empirico y recomendaciones cientificas, aliados a la reflexion en la practica. Conclusion: la actuacion del enfermero en el ambito domiciliario es amplia y fundamental. Las acciones relacionales y educativas se destacan, siendo necesarias incluso en los cuidados tecnicos, manifestandose la necesidad de formacion para atencion domiciliaria.

Nursing practice in home care: an integrative literature review

Objective: analyze scientific 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 scientific recommendations in conjunction with their reflections 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.Objetivo: analizar la produccion cientifica sobre la actuacion del enfermero en atencion domiciliaria de salud. Metodo: se realizo revision integrativa de la literatura mediante consulta de las bases de datos LILACS, BDENF, IBECS y MEDLINE. Fueron incluidos estudios en espanol, ingles y portugues, sin delimitar la fecha de publicacion. Resultados: analizados 48 articulos, se identifico que la actuacion del enfermero en atencion domiciliaria posee complejidad y diversidad de acciones, con uso de tecnologias blandas, blandas-duras (especialmente) y duras. Se destaca que los desafios relacionados al proceso formativo para atencion domiciliaria estan narrados en la literatura. El enfermero utiliza conocimiento empirico y recomendaciones cientificas, aliados a la reflexion en la practica. Conclusion: la actuacion del enfermero en el ambito domiciliario es amplia y fundamental. Las acciones relacionales y educativas se destacan, siendo necesarias incluso en los cuidados tecnicos, manifestandose la necesidad de formacion para atencion domiciliaria.

Actuación del enfermero en atención domiciliaria: una revisión integrativa de la literatura

Objective: analyze scientific 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 scientific recommendations in conjunction with their reflections 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.Objetivo: analizar la produccion cientifica sobre la actuacion del enfermero en atencion domiciliaria de salud. Metodo: se realizo revision integrativa de la literatura mediante consulta de las bases de datos LILACS, BDENF, IBECS y MEDLINE. Fueron incluidos estudios en espanol, ingles y portugues, sin delimitar la fecha de publicacion. Resultados: analizados 48 articulos, se identifico que la actuacion del enfermero en atencion domiciliaria posee complejidad y diversidad de acciones, con uso de tecnologias blandas, blandas-duras (especialmente) y duras. Se destaca que los desafios relacionados al proceso formativo para atencion domiciliaria estan narrados en la literatura. El enfermero utiliza conocimiento empirico y recomendaciones cientificas, aliados a la reflexion en la practica. Conclusion: la actuacion del enfermero en el ambito domiciliario es amplia y fundamental. Las acciones relacionales y educativas se destacan, siendo necesarias incluso en los cuidados tecnicos, manifestandose la necesidad de formacion para atencion domiciliaria.