Fabiana Villela Mamede

Assistência pré-natal: competências essenciais desempenhadas por enfermeiros

Pesquisa com objetivo de analisar as competencias essenciais desenvolvidas, na pratica, pelos enfermeiros que atuam na atencao ao pre-natal. Trata-se de estudo descritivo com abordagem quantitativa, realizado em 16 unidades da rede basica de saude do municipio de Rio Branco-AC. A coleta de dados foi realizada por meio de observacao sistematica e nao participante. Dos enfermeiros que realizam a consulta pre-natal, apenas dois (11,76%) cursaram especializacao em obstetricia. Constatamos que a grande maioria das competencias essenciais esperadas na assistencia pre-natal foi desenvolvida; entretanto, algumas foram realizadas com baixa frequencia, ou seja, nao foram realizadas em todas as consultas. Os resultados revelaram que, apesar do bom desempenho dos enfermeiros, e pertinente avaliar a necessidade de esclarecimentos sobre a importância da incorporacao de protocolos assistenciais para a melhoria da qualidade dos servicos, a fim de alcancar um nivel otimo de competencia na atencao pre-natal.

Orientação nutricional no pré-natal em serviços públicos de saúde no município de Ribeirão Preto: o discurso e a prática assistencial

This study aimed to verify if pregnant women attended in prenatal care services at Basic Health Units in Ribeirão Preto-SP, Brazil, received nutritional guidance and if this guidance was pertinent to their nutritional status. Ninety-one pregnant women participated. The pregnant women were classified according to their nutritional condition, using a weight, height and pregnancy stage table established by the Brazilian Health Ministrys technical prenatal care manual. We found pregnant women with weight under (13.19%) and exceeding normal levels (37.36%). Independently of their nutritional condition, most of them (60.43%) declared they did not receive nutrition guidance. The mean number of prenatal visits did not influence the nutritional status. The results reveal deficiencies in the contents and quality of nutritional care. This suggests the need for care changes so as to turn discourse into practice.This study aimed to verify if pregnant women attended in prenatal care services at Basic Health Units in Ribeirao Preto-SP, Brazil, received nutritional guidance and if this guidance was pertinent to their nutritional status. Ninety-one pregnant women participated. The pregnant women were classified according to their nutritional condition, using a weight, height and pregnancy stage table established by the Brazilian Health Ministrys technical prenatal care manual. We found pregnant women with weight under (13.19%) and exceeding normal levels (37.36%). Independently of their nutritional condition, most of them (60.43%) declared they did not receive nutrition guidance. The mean number of prenatal visits did not influence the nutritional status. The results reveal deficiencies in the contents and quality of nutritional care. This suggests the need for care changes so as to turn discourse into practice.

Perfil das mulheres submetidas à cesareana e assistência obstétrica na maternidade pública em Ribeirão Preto

The present paper presents the social and obstetric profile of women undergoing cesarean childbirth at a public maternity hospital in the interior of Sao Paulo state. This is a quantitative, retrospective, descriptive study performed using documental research. The collected data refer to the period between July and December 2005, and between January and June 2006. A total of 670 records were reviewed. A 23% rate of cesarean births was identified at the institution studied during the aforementioned period. The studied population was characterized as having a low level of education, living in a common-law relationship, and not having a paid occupation. The main indications for cesarean sections were iterativity and acute fetal distress. The findings revealed an emphasis on obstetric nursing in the low-risk normal childbirth scenario, considering the non-interventionist character inherent to their education and training. DESCRIPTORS: Labor, obstetric. Cesarean section. Obstetrical nursing.O artigo apresenta o perfil social e obstetrico das mulheres submetidas ao parto cesarea em uma maternidade publica do interior do Estado de Sao Paulo. Trata-se de estudo quantitativo, retrospectivo, do tipo descritivo, com pesquisa documental. Os dados coletados referem-se ao periodo entre os meses de junho e dezembro de 2005, e janeiro a junho de 2006. Foram consultados 670 prontuarios. A taxa de parto cesarea na instituicao-campo foi calculada em 23% para o periodo supracitado. Foram caracteristicas da populacao estudada a baixa escolaridade formal, a uniao consensual e o trabalho nao remunerado. As principais indicacoes para as cesarianas foram a iteratividade e o sofrimento fetal agudo. Como desdobramento dos achados esta a enfase pela valorizacao da enfermagem obstetrica no cenario de atendimento ao parto normal de baixo risco, considerando seu carater nao-intervencionista inerente a sua formacao.

A dor durante o trabalho de parto: o efeito da deambulação

La finalidad de este trabajo fue la de verificar la presencia de correlacion entre la distancia deambulada y el nivel del dolor de la parturiente durante toda la fase activa del trabajo de parto. METODOLOGIA: estudio analitico de intervencion del tipo casi experimental. Participaron del estudio 80 parturientes primiparas, admitidas en trabajo de parto espontaneo, com 37-42 semanas, en el inicio de la fase activa. ANALISIS DE LOS DATOS: test de Correlacion de Spearman. RESULTADOS: las participantes transcurrieron una distancia media de 1624 metros, 63,09% de la fase activa del trabajo de parto y en un tiempo promedio de 5 horas. Se verifico que la puntuacion de los escores de dolor aumenta a medida que la dilatacion cervical avance. Sin embargo, se encontro una correlacion positiva significante solo a los 5 cm. de dilatacion, o sea, cuanto mayor los trayectos transcurridos, mayores fueron los escores de dolor alcanzados por las parturientes.1 Profesor Doctor de la Escuela de Enfermeria de Ribeirao Preto, de la Universidad de Sao Paulo, Centro Colaborador de la OMS para el Desarrollo de la Investigacion en Enfermeria, Brasil, e-mail: famamede@eerp.usp.br; 2 Profesor Doctor de la Facultad de Medicina de Ribeirao Preto, de la Universidad de Sao Paulo, Brasil; 3 Profesor Titular de la Escuela de Enfermeria de Ribeirao Preto, de la Universidad de Sao Paulo, Centro Colaborador de la OMS para el Desarrollo de la Investigacion en Enfermeria, Brasil Artigo OriginalUNLABELLED This study aimed to verify whether the distance walked is correlated with womens pain level throughout the active phase of labor. METHODOLOGY We realized an analytic, quasi-experimental intervention study. Study participants were 80 primiparous parturient women, who were admitted during spontaneous labor, with 37-42 weeks, at the start of the active phase. DATA ANALYSIS Spearmans correlation test. RESULTS the parturient women walked an average distance of 1,624 meters, 63.09% of the active phase of labor and during an average time of five hours. Pain scores increase along with the advance in cervical dilatation. However, we only found a significant positive correlation when 5cm of dilatation had been reached, that is, the more distance the participants walked, the higher the pain scores they reached.

Food choices and practices during pregnancy of immigrant women with high-risk pregnancies in Canada: a pilot study

BackgroundImmigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.MethodsThis four-phase study employed a case study design allowing for multiple means of data collection and different units of analysis. Phase one consists of a scoping review of the literature. Phases two and three incorporate pictorial representations of food choices with semi-structured photo-elicited interviews. This study was undertaken at a Prenatal and Obstetric Clinic, in an urban Canadian city. In phase four, the research team will inform the development of culturally appropriate visual tools for health promotion.ResultsFive themes were identified: (a) Perceptions of Health, (b) Social Support (c) Antenatal Foods (d) Postnatal Foods and (e) Role of Health Education. These themes provide practitioners with an understanding of the cultural differences that affect women’s dietary choices during pregnancy. The project identified building collaborations between practitioners and families of pregnant immigrant women to be of utmost importance in supporting healthy pregnancies, along with facilitating social support for pregnant and breastfeeding mothers.ConclusionIn a multicultural society that contemporary Canada is, it is challenging for health practitioners to understand various ethnocultural dietary norms and practices. Practitioners need to be aware of customary practices of the ethnocultural groups that they work with, while simultaneously recognizing the variation within—not everyone follows customary practices, individuals may pick and choose which customary guidelines they follow. What women choose to eat is also influenced by their own experiences, access to particular foods, socioeconomic status, family context, and so on.The pilot study demonstrated the efficacy of the employed research strategies and we subsequently acquired funding for a national study.

O cuidado no "resguardo": as vivências de crenças e tabus por um grupo de puérpera

Em nosso meio, o resguardo e cercado de manifestacoes culturais e tabus, fundamentadas em interpretacoes de ordem natural, sobrenatural e social. Este trabalho identificou os significados atribuidos por puerperas acerca do auto-cuidado, sob o referencial teorico da cultura. Os sujeitos foram puerperas que compareceram a Unidades de Saude com seu filho para procedimentos de rotina. Os resultados mostraram que as crencas revelam um poder simbolico na estruturacao de condutas e comportamentos das puerperas em relacao a manifestacoes e cuidados no puerperio. Consideramos importante que os profissionais de saude incorporem em sua pratica, valores e crencas das puerperas, compartilhando os saberes que envolvem o puerperio, favorecendo a compreensao critica da realidade e a promocao da saude ao binomio mae e filho.In our milieu, postpartum confinement is surrounded by cultural manifestations and taboos which are based on natural, supernatural, and social interpretations. This work has identified the meanings attributed to self-care by puerperae under the theoretical framework of culture. The subjects were women soon after childbirth who attended health units with their children for routine procedures. The results showed that the beliefs revealed a symbolic power in the infrastructure of conducts and behaviors of these women in relation to manifestations and care during the postpartum stage. It is important that health professionals incorporate the values and beliefs of women soon after childbirth into their practice, thus sharing the knowledge involving puerperium and favoring the critical understanding of reality and the promotion of health for mothers and their children.

Nutritional guidance during prenatal care in public health services in Ribeirão Preto: discourse and care practice

This study aimed to verify if pregnant women attended in prenatal care services at Basic Health Units in Ribeirão Preto-SP, Brazil, received nutritional guidance and if this guidance was pertinent to their nutritional status. Ninety-one pregnant women participated. The pregnant women were classified according to their nutritional condition, using a weight, height and pregnancy stage table established by the Brazilian Health Ministrys technical prenatal care manual. We found pregnant women with weight under (13.19%) and exceeding normal levels (37.36%). Independently of their nutritional condition, most of them (60.43%) declared they did not receive nutrition guidance. The mean number of prenatal visits did not influence the nutritional status. The results reveal deficiencies in the contents and quality of nutritional care. This suggests the need for care changes so as to turn discourse into practice.This study aimed to verify if pregnant women attended in prenatal care services at Basic Health Units in Ribeirao Preto-SP, Brazil, received nutritional guidance and if this guidance was pertinent to their nutritional status. Ninety-one pregnant women participated. The pregnant women were classified according to their nutritional condition, using a weight, height and pregnancy stage table established by the Brazilian Health Ministrys technical prenatal care manual. We found pregnant women with weight under (13.19%) and exceeding normal levels (37.36%). Independently of their nutritional condition, most of them (60.43%) declared they did not receive nutrition guidance. The mean number of prenatal visits did not influence the nutritional status. The results reveal deficiencies in the contents and quality of nutritional care. This suggests the need for care changes so as to turn discourse into practice.

Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol

BackgroundFacilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the womens ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners.Methods/DesignThis four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the citys most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated.DiscussionThe findings of this study will provide practitioners with an understanding of the cultural differences that affect womens dietary choices during maternity. We expect that the developed resources will be of immediate use within the womens units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

Desempenho das competências obstétricas na admissão e evolução do trabalho de parto: atuação do profissional de saúde

O objetivo deste estudo foi identificar os profissionais de saude e suas competencias no atendimento as parturientes no momento de admissao na maternidade e durante a evolucao do trabalho de parto e discutir as competencias da equipe de enfermagem nesse atendimento. Foi realizado nas duas maternidades de Rio Branco-AC. A coleta de dados foi realizada em julho de 2005, por meio de observacoes das competencias essenciais em obstetricia desenvolvidas pelos profissionais de saude. A estatistica descritiva e o teste exato de Fisher foram usados para analise dos dados. Os resultados evidenciaram que os profissionais de enfermagem de nivel medio e medicos atuam na admissao e no trabalho de parto. O estudo revela que as instituicoes apresentam modelos diferenciados quanto a quem cabe a responsabilidade da execucao de determinadas competencias na atencao a parturiente, nao priorizam a qualificacao profissional para a assistencia a mulher no trabalho de parto.

Conhecimento e utilização da contracepção de emergência por acadêmicos de enfermagem

Resumen El uso de métodos anticonceptivos es cada vez mayor y con ellos el uso de la anticoncepción de emergencia (AE). Este estudio tiene como objetivo describir el conocimiento y uso de la AE por estudiantes. Este es un estudio descriptivo, de carácter cuantitativo. Hacen par te del estudio los estudiantes de enfermería. La muestra consistió en 327 estudiantes, edad promedio de 21 años, en su mayoría mujeres. Sólo 17,70% eran conscientes de la acción de la píldora, 20,80% ya había sido ejercida y la razón principal fue el fracaso en el preservativo (38,23%). El uso correcto de la AE es válido, pero hay una necesidad de expansión del conocimiento. En consonancia con la orientación, las mujeres pueden usar AE, como se indica, sin olvidar el uso regular de anticoncepción y protección contra las ETS / SIDA. Palabras clave: Planeamiento Familiar. Anticoncepción. Anticonceptivos Orales. 1Aluna de Graduação em Enfermagem pela Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Bolsista de Iniciação Científica pelo programa Ensinar com Pesquisa da Universidade de São Paulo. Ribeirão Preto – SP. Brasil. E-mail: emlbatagliao@hotmail.com,2Enfermeira Obstétrica. Professora Doutora do Departamento de Enfermagem Materno-Infantil e Saúde Pública da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Ribeirão Preto – SP. Brasil. E-mail: famamede@eerp.usp.br. PESQUISA RESEARCH INVESTIGACIÓN The use of contraceptive methods is increasing and with them the use of Emergency Contraception (EC). This study aims to describe the knowledge and the use of EC students. This is a descriptive, quantitative character and took part of the research, nursing students. The sample consisted of 327 students, average age 21 years, mostly female. Only 17.70% were aware of the action of the pill, 20.80% had already been exercised and the main reason was the failure of the condom (38.23%). The correct use of EC is valid, but it is necessary to extend the knowledge. With a consistent guidance, women can use EC as indicated, without forgetting the regular use of contraception and protection against STDs/AIDS.The use of contraceptive methods is increasing and with them the use of Emergency Contraception (EC). This study aims to describe the knowledge and the use of EC students. This is a descriptive, quantitative character and took part of the research, nursing students. The sample consisted of 327 students, average age 21 years, mostly female. Only 17.70% were aware of the action of the pill, 20.80% had already been exercised and the main reason was the failure of the condom (38.23%). The correct use of EC is valid, but it is necessary to extend the knowledge. With a consistent guidance, women can use EC as indicated, without forgetting the regular use of contraception and protection against STDs/AIDS.