Isabel Cristina Araújo Brandão

Abordagem da dependencia de substancias psicoativas na adolescencia: reflexao etica para a enfermagem

El uso indiscriminado de drogas entre los jovenes aumenta progresivamente en Brasil y en el mundo. Este estudio tuvo como objetivo reflejar sobre el abordaje etico de la enfermeria en la atencion a adolescentes usuarios de drogas licitas e ilicitas. Se trata de un estudio teorico de caracter reflexivo, basado en una revision bibliografica de tipo narrativa, utilizandose de libros y articulos cientificos. Emergieron reflexiones sobre la dependencia de sustancias psicoactivas en expansion en la adolescencia, que culminaron en la discusion sobre el abordaje etico de la enfermeria junto al adolescente usuario de drogas. El enfermero puede priorizar una asistencia direccionada a la promocion de la salud del adolescente en una perspectiva emancipadora del joven en la prevencion del consumo de drogas. Se concluyo que las enfermeras deben realizar un enfoque etico a los adolescentes dependientes, considerando su contexto y su subjetividad.

ANÁLISE DA ORGANIZAÇÃO DA REDE DE SAÚDE DA PARAÍBA A PARTIR DO MODELO DE REGIONALIZAÇÃO

Objective: This article analyses the organization of the Paraiba state public health network from the regionalization model proposed by the Paraiba state government. Material and Methods: This is a documentary study that was primarily based on the Master Regionalization Plan (MRP) and on official documents of the Ministry of Health that guide the construction of these sorts of plans by the states. Results: Data analysis revealed some limitations in the process of implementation of the MRP/Paraiba, such as: (i) absence of social, economic and cultural analyses when selecting venues to represent health regions and (ii) lack of description regarding organization of health care in the state territory. Conclusion: The process of regionalization and the development of MRP in Paraiba did not follow the instruction of the Ministry of Health in some aspects, ignoring the specificities of each health region, which might lead to problems in access and coordination of network services in view of legitimating these health regions in the state. DESCRIPTORES: Health System. Decentralization. Regionalization.

Acesso potencial à atenção primária em saúde: o que mostram os dados do programa de melhoria do acesso e da qualidade do Brasil?

Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fishers exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.Objetivo: analisar a influencia de indicadores contextuais no desempenho dos municipios, no que tange ao acesso potencial a Atencao Primaria a Saude no Brasil e, ainda, discutir a contribuicao do trabalho da enfermagem nesse acesso. Metodo: estudo descritivo multicentrico, a partir de dados secundarios da Avaliacao Externa do Programa de Melhoria do Acesso e da Qualidade da Atencao Basica no Brasil, com a participacao de 17.202 Equipes de Atencao Basica. Recorreu-se ao teste qui-quadrado de proporcoes para verificar diferencas entre os estratos de municipios, no que se refere as dimensoes territorializacao, oferta, coordenacao, integracao, e, quando necessario, foram considerados os testes qui-quadrado com correcao de Yates ou exato de Fisher. Para a variavel populacao, foi aplicado o teste Kruskal-Wallis. Resultados: a maioria dos participantes era de enfermeiro (n=15.876; 92,3%). Observaram-se diferencas estatisticamente significativas entre os municipios em termos de territorializacao (p=0,0000), disponibilidade (p=0,0000), coordenacao do cuidado (p=0,0000), integracao (p=0,0000) e oferta (p=0,0000), verificando-se que o municipios que compoem o estrato 6 tendem a ter melhor performance nessas dimensoes. Conclusao: verificou-se que os estratos 4, 5 e 6 apresentam melhor desempenho em todas as dimensoes analisadas e, tambem, o papel preponderante do enfermeiro no acesso potencial a Atencao Primaria a Saude no Brasil.

Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fishers exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.Objetivo: analisar a influencia de indicadores contextuais no desempenho dos municipios, no que tange ao acesso potencial a Atencao Primaria a Saude no Brasil e, ainda, discutir a contribuicao do trabalho da enfermagem nesse acesso. Metodo: estudo descritivo multicentrico, a partir de dados secundarios da Avaliacao Externa do Programa de Melhoria do Acesso e da Qualidade da Atencao Basica no Brasil, com a participacao de 17.202 Equipes de Atencao Basica. Recorreu-se ao teste qui-quadrado de proporcoes para verificar diferencas entre os estratos de municipios, no que se refere as dimensoes territorializacao, oferta, coordenacao, integracao, e, quando necessario, foram considerados os testes qui-quadrado com correcao de Yates ou exato de Fisher. Para a variavel populacao, foi aplicado o teste Kruskal-Wallis. Resultados: a maioria dos participantes era de enfermeiro (n=15.876; 92,3%). Observaram-se diferencas estatisticamente significativas entre os municipios em termos de territorializacao (p=0,0000), disponibilidade (p=0,0000), coordenacao do cuidado (p=0,0000), integracao (p=0,0000) e oferta (p=0,0000), verificando-se que o municipios que compoem o estrato 6 tendem a ter melhor performance nessas dimensoes. Conclusao: verificou-se que os estratos 4, 5 e 6 apresentam melhor desempenho em todas as dimensoes analisadas e, tambem, o papel preponderante do enfermeiro no acesso potencial a Atencao Primaria a Saude no Brasil.

Approach to adolescents' addiction to psychoactive substances: ethical reflection for professional nursing practice

El uso indiscriminado de drogas entre los jovenes aumenta progresivamente en Brasil y en el mundo. Este estudio tuvo como objetivo reflejar sobre el abordaje etico de la enfermeria en la atencion a adolescentes usuarios de drogas licitas e ilicitas. Se trata de un estudio teorico de caracter reflexivo, basado en una revision bibliografica de tipo narrativa, utilizandose de libros y articulos cientificos. Emergieron reflexiones sobre la dependencia de sustancias psicoactivas en expansion en la adolescencia, que culminaron en la discusion sobre el abordaje etico de la enfermeria junto al adolescente usuario de drogas. El enfermero puede priorizar una asistencia direccionada a la promocion de la salud del adolescente en una perspectiva emancipadora del joven en la prevencion del consumo de drogas. Se concluyo que las enfermeras deben realizar un enfoque etico a los adolescentes dependientes, considerando su contexto y su subjetividad.

Medication and test prescription by nurses: contributions to advanced practice and transformation of care

ABSTRACT Objective: To carry out a documentary study on the rules, guidelines, policies and institutional support for the nurse to prescribe medicines and request tests with a view to the advanced practice in the scope of Primary Health Care. Methods: Documentary research using open-access institutional documents - Federal Nursing Council (COFEN), its regional representations in the respective Brazilian states (COREN) and the Brazilian Nursing Association (ABEN). Results: Most of the news/notices were issued by the Regional Nursing Councils in the different Federative Units. The argumentation regarding the prescription of medicines and request for tests by nurses is based on three categories: Autonomy and competencies for the prescription of medicines and/or request of tests; Corporate policies that undermine the full exercise of nursing; and Transformation of health and nursing care in Primary Health Care. Conclusion: The prescriptive practice by nurses integrates health care and has been defended by the institutions that represent the category. It emerges as an important element of advanced practice and in the transformation of care in the context of health teams.

Acceso potencial a la atención primaria de salud: ¿qué muestran los datos del programa de mejoría del acceso y de la calidad de Brasil?

Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fishers exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.Objetivo: analisar a influencia de indicadores contextuais no desempenho dos municipios, no que tange ao acesso potencial a Atencao Primaria a Saude no Brasil e, ainda, discutir a contribuicao do trabalho da enfermagem nesse acesso. Metodo: estudo descritivo multicentrico, a partir de dados secundarios da Avaliacao Externa do Programa de Melhoria do Acesso e da Qualidade da Atencao Basica no Brasil, com a participacao de 17.202 Equipes de Atencao Basica. Recorreu-se ao teste qui-quadrado de proporcoes para verificar diferencas entre os estratos de municipios, no que se refere as dimensoes territorializacao, oferta, coordenacao, integracao, e, quando necessario, foram considerados os testes qui-quadrado com correcao de Yates ou exato de Fisher. Para a variavel populacao, foi aplicado o teste Kruskal-Wallis. Resultados: a maioria dos participantes era de enfermeiro (n=15.876; 92,3%). Observaram-se diferencas estatisticamente significativas entre os municipios em termos de territorializacao (p=0,0000), disponibilidade (p=0,0000), coordenacao do cuidado (p=0,0000), integracao (p=0,0000) e oferta (p=0,0000), verificando-se que o municipios que compoem o estrato 6 tendem a ter melhor performance nessas dimensoes. Conclusao: verificou-se que os estratos 4, 5 e 6 apresentam melhor desempenho em todas as dimensoes analisadas e, tambem, o papel preponderante do enfermeiro no acesso potencial a Atencao Primaria a Saude no Brasil.

Enfoque de la dependencia de sustancias psicoactivas en la adolescencia: reflexion etica para enfermeria

El uso indiscriminado de drogas entre los jovenes aumenta progresivamente en Brasil y en el mundo. Este estudio tuvo como objetivo reflejar sobre el abordaje etico de la enfermeria en la atencion a adolescentes usuarios de drogas licitas e ilicitas. Se trata de un estudio teorico de caracter reflexivo, basado en una revision bibliografica de tipo narrativa, utilizandose de libros y articulos cientificos. Emergieron reflexiones sobre la dependencia de sustancias psicoactivas en expansion en la adolescencia, que culminaron en la discusion sobre el abordaje etico de la enfermeria junto al adolescente usuario de drogas. El enfermero puede priorizar una asistencia direccionada a la promocion de la salud del adolescente en una perspectiva emancipadora del joven en la prevencion del consumo de drogas. Se concluyo que las enfermeras deben realizar un enfoque etico a los adolescentes dependientes, considerando su contexto y su subjetividad.

Monitoring of growth and development of the child: a collective action of nursing

Objective: report on the experience of implementing a proposal collective action from the Nursing for monitoring the Growth and Development (GD) Method: It is a descriptive study, typified as experience report, on the implementation of a proposal of collective action from Nursing for the collective monitoring of GD of children attended in the Family Health Unit of the neighbourhood of Cidade Nova (USFCN) in the city of Natal/RN, Brazil, being done through monthly meetings with parents / caregivers and children according to the area covered by the service. This study was approved by the Ethic Research Committee of the Universidade Federal do Rio Grande do Norte (CEP-UFRN), and with the final opinion no 201/2009. Results: the work process of nurses experienced gains in pursuit of an educational practice and transforming the community. Parents and caregivers have access to learning new knowledge, exchange of experiences and assistance in home care through a new dynamic to make the health care of the child. Conclusion: the results show that parents / caregivers have become co-participants in the process of caring professional nurses, but without release the professionals of the commitment in the provision of care. Descriptors: nursing; growth and development; nursing care.