Elma Lourdes Campos Pavone Zoboli

Bioética e atenção básica: um perfil dos problemas éticos vividos por enfermeiros e médicos do Programa Saúde da Família, São Paulo, Brasil

This is a qualitative empirical study of descriptive ethics conducted with nurses and physicians working in the Family Health Program (FHP) in the city of Sao Paulo, Brazil. The objective was to identify ethical problems experienced by these professionals, who were asked to record ethical problems they had faced through a short written description of such events. The results revealed ethical problems involving patients and their families, the health team, organization, and the health system. The study addresses ethical issues permeating daily health care practice and requiring immediate solutions, rather than the classical dilemmas usually found in bioethics literature. The peculiarity of ethical problems in primary care may hinder their identification as such and jeopardize the relationships upon which the FHP is built.

Images of a ‘good nurse’ presented by teaching staff

Nursing is at the same time a vocation, a profession and a job. By nature, nursing is a moral endeavor, and being a ‘good nurse’ is an issue and an aspiration for professionals. The aim of our qualitative research project carried out with 18 nurse teachers at a university nursing school in Brazil was to identify the ethical image of nursing. In semistructured interviews the participants were asked to choose one of several pictures, to justify their choice and explain what they meant by an ethical nurse. Five different perspectives were revealed: good nurses fulfill their duties correctly; they are proactive patient advocates; they are prepared and available to welcome others as persons; they are talented, competent, and carry out professional duties excellently; and they combine authority with power sharing in patient care. The results point to a transition phase from a historical introjection of religious values of obedience and service to a new sense of a secular, proactive, scientific and professional ...Nursing is at the same time a vocation, a profession and a job. By nature, nursing is a moral endeavor, and being a ‘good nurse’ is an issue and an aspiration for professionals. The aim of our qualitative research project carried out with 18 nurse teachers at a university nursing school in Brazil was to identify the ethical image of nursing. In semistructured interviews the participants were asked to choose one of several pictures, to justify their choice and explain what they meant by an ethical nurse. Five different perspectives were revealed: good nurses fulfill their duties correctly; they are proactive patient advocates; they are prepared and available to welcome others as persons; they are talented, competent, and carry out professional duties excellently; and they combine authority with power sharing in patient care. The results point to a transition phase from a historical introjection of religious values of obedience and service to a new sense of a secular, proactive, scientific and professional identity.

Conceito e prática da integralidade na Atenção Básica: a percepção das enfermeiras

O objetivo deste estudo e debater o discurso das enfermeiras sobre o conceito da integralidade em saude e como operacionalizar na pratica a integralidade na Atencao Basica. Considerando a integralidade como um dos pilares do SUS e tomando a forca de trabalho em enfermagem como um contingente consideravel de pessoas para operar na construcao do SUS, considerou-se importante identificar as bases conceituais e praticas que direcionam o trabalho das enfermeiras para a construcao da integralidade na saude. Neste estudo qualitativo exploratorio, foram entrevistadas 10 enfermeiras que atuam na atencao basica em tres municipios do interior do estado de Sao Paulo. Os dados foram coletados atraves de entrevistas semiestruturadas e analisados segundo a tecnica do discurso do sujeito coletivo. Os resultados mostraram que as concepcoes que as enfermeiras possuem sobre integralidade estao diretamente relacionadas a prestacao de assistencia e que estas profissionais colocam a integralidade em pratica ao executar seu processo de trabalho cotidiano.

Entendimento do termo de consentimento por pacientes partícipes em pesquisas com fármaco na cardiologia

Correspondencia: Luiz Antonio Machado Cesar • Rua Constantino de Souza, 1580 Campo Belo 04605-004 Sao Paulo, SP Brasil E-mail: lucesar@cardiol.br, dcllucesar@incor.usp.br Articulo enviado el 27/01/09; revisado recibido el 25/05/09; aceptado el 23/06/09. Resumen Fundamento: En ensayos clinicos, el Formulario de Consentimiento Informado (FCI) es fundamental para que se preserve la etica, sin embargo por su complexidad el puede no comprenderse completamente. En este estudio, evaluamos la comprension del FCI por parte del paciente.

Enfermeiros e usuários do Programa Saúde da Família: contribuições da bioética para reorientar esta relação profissional

OBJETIVO: Identificar problemas eticos vividos por enfermeros en la atencion basica, con miras a contribuir para perfeccionar la relacion profesional-usuario. METODOS: Estudio de etica descriptiva, empirico, cualitativo realizado en el Programa Salud de la Familia de Sao Paulo, con entrevistas semi-estructuradas y analisis de contenido. RESULTADOS: La dimension etica en la atencion basica lidia con situaciones rutinarias de la practica cotidiana. Es urgente el redireccionamiento de la sensibilidad de los enfermeros para la percepcion de la sutilidad de los problemas eticos en las relaciones con los usuarios en la atencion basica. CONCLUSION: La ponderacion y especificacion de los principios de la autonomia, no maleficencia, justicia y beneficencia, enriquecidas por otros enfoques de la bioetica, pueden contribuir en la construccion de la ciudadania y promocion de la salud.Resumen pt: Objetivo: Identificar problemas eticos vividos por enfermeiros na atencao basica, com vistas a contribuir para aprimorar a relacao profissionalusuario. M...

A redescoberta da ética do cuidado: o foco e a ênfase nas relações

The author presents a discussion of the meanings, the historical aspects and the different explanatory frameworks for the ethics of care. The main purpose is to contribute to the debate concerning the core role of care in nursing and nursing ethics. It also addresses the opposition between feminine and feminist ethics as an explanation for the secondary role of the ethics of care.RESUMO Este artigo tem por objetivo resgatar os sentidos, os aspectos históricos e as distintas estruturas explicativas da ética do cuidado, a fim de contribuir para o debate acerca do cuidar como bem interno e razão de ser da enfermagem. Também introduz o contraponto da ética de cunho feminino e da abordagem feminista da ética, explorando as possíveis motivações para o lugar periférico que tem cabido à ética do cuidado.The author presents a discussion of the meanings, the historical aspects and the different explanatory frameworks for the ethics of care. The main purpose is to contribute to the debate concerning the core role of care in nursing and nursing ethics. It also addresses the opposition between feminine and feminist ethics as an explanation for the secondary role of the ethics of care.

Tomada de decisão em bioética clínica: casuística e deliberação moral

In the ethical problems in clinics it is required to appreciate the situation through the use of organized and systematized procedures to assess the situation for decision-making, in order to decrease the typical uncertainty areas of the conflicts of values and duties found in clinics and to reach practical, wise and responsible resolutions. There are several procedures for decision making in clinical bioethics. The article presents the casuistry and deliberation. The aim is to describe the methods based on the publications of its proponents. Both procedures begin with the understanding of the clinical case and consider in the proposed resolution the circumstances and peculiarities of each situation without losing sight of the objective image of ethical duties.En los problemas eticos de la clinica es necesario evaluar la situacion con el uso de procedimientos sistematizados y organizados para la toma de decision, con el fin de disminuir las areas de incertidumbre tipicas de los conflictos de valores y deberes descubiertos en la clinica y llegar a resoluciones practicas, prudentes y responsables. Existen varios procedimientos para la toma de decision en bioetica clinica. El articulo presenta la casuistica y la deliberacion. El objetivo es describir los metodos desde las publicaciones de sus proponentes. Ambos procedimientos comienzan con la comprension del caso clinico, considerando en las resoluciones las circunstancias y particularidades de cada situacion, sin perder de vista la imagen objetivo de los deberes eticos.

Capacitação em bioética para profissionais da Saúde da Família do município de Santo André, SP

This case report presents the experience of a training course on bioethics for nurses and physicians of the Family Health Strategy in Santo André, SP. This study is based on problem-based learning and deliberative bioethics, and aimed at presenting the deliberation procedure as a means of handling ethical issues. Contents were addressed in a cross-section manner through five sequential activity sessions at two different moments of concentration with one dispersion interval. In the first moment of concentration, key concepts and deliberative bioethics contents were developed. The second involved deliberation sessions on moral conflicts, which were selected and prepared during the dispersion interval. Participants evaluated the deliberation as an appropriate instrument to deal with the ethical issues they are faced with. Problem-based learning was an effective educational strategy for continuing education in deliberative bioethics.Relato de experiencia sobre la capacitacion en bioetica para enfermeros y medicos de la Estrategia Salud de la Familia, Santo Andre-SP. Enfocada en la problematizacion y bioetica deliberativa, objetivo presentar el procedimiento de deliberacion para coadyuvar el manejo de problemas eticos. Se trabajaron transversalmente los contenidos en cinco secuencias de actividades, en dos momentos de concentracion, intercalados por uno de dispersion. En la primera concentracion, se desarrollaron conceptos llave y contenidos de la bioetica deliberativa. En la segunda, hubo sesiones de deliberacion para situaciones de conflictos morales seleccionados y preparados durante la dispersion. Los participantes evaluaron la deliberacion como un instrumental adecuado para lidiar con las cuestiones eticas que viven. La problematizacion se mostro efectiva como estrategia educativa en la capacitacion permanente en bioetica deliberativa.

Bioética e saúde coletiva: convergências epistemológicas

This is a theoretical discussion about the epistemological statute of bioethics based on its convergences with public health, linked as scientific areas that came from the context of the second epistemological rupture, which questioned the critique to common sense inherent in modern science. The reapproximation with common sense in the second rupture means considering the determinants of environment and subjectivity in the methodology. Emerging from the second rupture, public health and bioethics include the social and subjective determinants in their analysis, with an enlarged and complex vision of human health and human actions involving environment, life and health. This requires a transdisciplinary focus in their approaches. What is the meaning of these premises for the epistemological statute of bioethics in its convergence with public health? As ethics, bioethics needs to be critical, but not aprioristic. The criticism of bioethics needs to come from the facticity of the social determinants expressed by the health iniquities. The only way to integrate criticism and facticity is hermeneutics, interpreting the significances constructed in the reality and become critical therefrom. This is the epistemological statute appropriate to bioethics in its convergence with public health.

A construção de tecnologias de atenção em saúde com base na promoção da saúde

The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of Sao Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of Sao Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of São Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.