Juliana Carvalho Araújo Leite

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.

Acolhimento: perspectiva de reorganização da assistência de enfermagem

The study analyzes reception as a strategy for reorganizing nursing care, identifying its presuppotions and mechanisms which make it possible to implement and qualifying potentialities of care. It uses the qualitive approach, giving priority to primary sources: questionnaires answered by managers, degree nurses, nursing auxilliares and doctors from the Municipal Health Office of Belo Horizonte. It was found that the nursing auxiliary is the main person carrying out this activity, followed by the degree nurse. The main activities are listening, screening and forwarding, with little focus on guidance. The actors emphasize team integration and the understanding of the work process as facilitating factors. The training and qualification of professionals was considered as one of the mechanisms to overcome difficulties. It reveals the failures of the structure of service for reception. The conclusion is that this practice suggests the need for the reorganization of the nursing work process in order to improve the quality of health care.O estudo analisa o acolhimento como estrategia para reorientacao da assistencia de enfermagem, identificando seus pressupostos, os mecanismos que viabilizam sua implantacao e/ou implementacao e as potencialidades qualificadoras da assistencia. Utiliza a abordagem qualitativa, valorizando fontes primarias: questionario aplicado a gerentes, enfermeiros, auxiliares de enfermagem e medicos, dos servicos da Secretaria Municipal de Saude de Belo Horizonte. Os resultados demonstram que o auxiliar de enfermagem realiza prioritariamente esta pratica sendo em seguida o enfermeiro. Predomina a escuta, triagem e encaminhamento havendo pouco enfoque para a orientacao. Os informantes ressaltam a integracao da equipe e o entendimento do processo de trabalho como fatores facilitadores. A capacitacao dos profissionais foi destacada como um dos mecanismos necessarios a superacao das dificuldades. Revela as insuficiencias da estrutura dos servicos para acolher. Conclui-se que esta pratica sinaliza a reorientacao do processo de trabalho da enfermagem, em busca de melhoria na qualidade da assistencia.

Projeto Uni: cenário de aprender, pensar e construir a interdisciplinaridade na prática pedagógica da Enfermagem

The study examines the incorporation of the interdisciplinary approach in two nursing courses in Brazil that pursue UNI Projects. It is a descriptive, qualitative study, using historical dialectic materialism as its theoretical framework. Its purpose was to examine the changes that have taken place in the teaching of the nursing courses, with emphasis on interdisciplinarity. The primary data was gathered using interviews by focus groups, teachers and students of the courses and nurses in service. The secondary sources were obtained through an examination of curriculums and other documents available in these schools. It was found that the courses are using interdisciplinarity as a strategy to substitute the organization of the curriculum by subject. The teachers described the difficulties of working from this point of view, indicating biological training as one of the determinants of this difficulty. They concluded that the emphasis on interdisciplinarity and team work has demanded the adoption of active teaching methods and has contributed to the change to the nursing teaching model in the university investigated.

Proyecto Uni: escenario de aprender, pensar y construir la interdisciplinariedad en la práctica pedagógica de la enfermería

The study examines the incorporation of the interdisciplinary approach in two nursing courses in Brazil that pursue UNI Projects. It is a descriptive, qualitative study, using historical dialectic materialism as its theoretical framework. Its purpose was to examine the changes that have taken place in the teaching of the nursing courses, with emphasis on interdisciplinarity. The primary data was gathered using interviews by focus groups, teachers and students of the courses and nurses in service. The secondary sources were obtained through an examination of curriculums and other documents available in these schools. It was found that the courses are using interdisciplinarity as a strategy to substitute the organization of the curriculum by subject. The teachers described the difficulties of working from this point of view, indicating biological training as one of the determinants of this difficulty. They concluded that the emphasis on interdisciplinarity and team work has demanded the adoption of active teaching methods and has contributed to the change to the nursing teaching model in the university investigated.

Uni Project: a background in which to learn, think and build interdisciplinarity in teaching nursing

The study examines the incorporation of the interdisciplinary approach in two nursing courses in Brazil that pursue UNI Projects. It is a descriptive, qualitative study, using historical dialectic materialism as its theoretical framework. Its purpose was to examine the changes that have taken place in the teaching of the nursing courses, with emphasis on interdisciplinarity. The primary data was gathered using interviews by focus groups, teachers and students of the courses and nurses in service. The secondary sources were obtained through an examination of curriculums and other documents available in these schools. It was found that the courses are using interdisciplinarity as a strategy to substitute the organization of the curriculum by subject. The teachers described the difficulties of working from this point of view, indicating biological training as one of the determinants of this difficulty. They concluded that the emphasis on interdisciplinarity and team work has demanded the adoption of active teaching methods and has contributed to the change to the nursing teaching model in the university investigated.