Lucilda Selli

Técnicas educacionales en el tratamiento de la diabetes

This study focused on an educational program for type 2 diabetics and monitoring of the following variables: blood glucose, weight, body mass index (BMI), blood pressure, and self-care of feet since the initial diagnosis over a 5-year period. This was an exploratory study from 1996 to 2000. The study was carried out with 189 patients diagnosed as type 2 diabetics, divided into two groups: compliant patients (n = 101) and non-compliant (n = 88), the latter having participated for less than 2 years. The methodology consisted of an educational intervention aimed at health and self-care. The variables used were: blood glucose, weight, BMI, and systolic and diastolic arterial pressure. The differences between baseline and final values showed a decrease for all variables in the compliant group and for blood glucose and arterial pressure (AP) for the non-compliant group. Regarding diet control, medication, physical exercise, and prevention of diabetic foot, there was a general improvement, demonstrating the importance of preventive measures for health.

Mulheres com HIV/AIDS: fragmentos de sua face oculta

En el presente trabajo se busco conocer a los factores generadores del miedo que asola las mujeres seropositivas y a las consecuencias en las relaciones del cotidiano de la familia, del trabajo y del convivio social. El metodo usado fue de naturaleza cualitativa. Se focalizo en mujeres con HIV/SIDA que estan siendo acompanadas en la Unidad de Salud del Municipio de Sao Leopoldo-RS. La recogida de datos fue a traves de entrevista semiestructurada, abarcando 18 mujeres, de 23 a 55 anos. La discriminacion en el seno de la familia y en el trabajo y la perdida de amigos constituyen factor de miedo permanente y ejercen influencia en el comportamiento social de las mujeres. El miedo tambien esta relacionado con la imagen de la mujer y el aislamiento social.The study aimed at determining factors that generate the fear visiting upon HIV-positive women and consequences in routine family, work and social life relations. The method employed is of qualitative nature Women with HIV/AIDS that were followed at the Health Clinic of São Leopoldo-RS were focused. Data collection was performed by a semi-structured interview, seeking 18 women, from 23 to 55 years old. Discrimination in the family and at the workplace and loss of friends constitute a factor of constant fear and exert an influence on the womens social behavior. The fear is also related to the womens image and social isolation.

Agentes comunitários de saúde: perfil e formação

This research discusses the profile and education of the community health agents. There is no clarity about the kind of professional needed and the appropriate training to the fulfillment of the function. The research is a case study with exploratory methodology and qualitative approach. The data was collected with a focused group, formed by ten agents, intentional selected from those with more time in service in Family Health Strategy teams from the municipality of Santa Maria, Rio Grande do Sul State. The discussions were recorded and transcribed by the researcher. The data was interpreted by content analysis. The results pointed to some important questions concerning the identity of the community health agents: integration on the health team, insertion in the community, profile and education. The profile which emerges from the research, is not different from the one proposed by the Ministry of Health. However, the difference is the professionalization, an initiative assumed by the agent, guided by reality, which he faces in his activity. The gaps, perceived in his formation, cause the agent to construct his professional identity, determined more by the technical aspect of the scientific knowledge than by his social competence as a community agent.

Dysthanasia: nursing professionals' perception

Dysthanasia means slow and painful death without quality of life. This study aimed to know whether nurses identify dysthanasia as part of the final process of the lives of terminal patients hospitalized at an adult ICU. This is an exploratory-qualitative study. Data were collected through semi-structured interviews with ten nurses with at least one year of experience in an ICU, and interpreted through content analysis. Results indicate that nurses understand and identify dysthanasia, do not agree with it and recognize elements of orthonasia as the adequate procedure for terminal patients. We conclude that nurses interpret dysthanasia as extending life with pain and suffering, while terminal patients are submitted to futile treatments that do not benefit them. They also identify dysthanasia using elements of orthonasia to explain it.Dysthanasia means slow and painful death without quality of life. This study aimed to know whether nurses identify dysthanasia as part of the final process of the lives of terminal patients hospitalized at an adult ICU. This is an exploratory-qualitative study. Data were collected through semi-structured interviews with ten nurses with at least one year of experience in an ICU, and interpreted through content analysis. Results indicate that nurses understand and identify dysthanasia, do not agree with it and recognize elements of orthonasia as the adequate procedure for terminal patients. We conclude that nurses interpret dysthanasia as extending life with pain and suffering, while terminal patients are submitted to futile treatments that do not benefit them. They also identify dysthanasia using elements of orthonasia to explain it.

A contribuição dos trabalhadores na consolidação dos serviços municipais de vigilância sanitária

This study aimed to expand knowledge on the role and possible contribution of workers in the consolidation of health surveillance services in three municipalities in Greater Metropolitan Porto Alegre, Rio Grande do Sul, Brazil. The research used a qualitative methodology based on focus groups and participatory observation. The resulting data were categorized by content analysis. The results pointed to precarious management of the health surveillance services. The main problems were deficiencies in staff education and training, precarious work conditions, lack of resource allocation autonomy and self-management, in addition to prioritization of actions with a limited scope, focused on the control and oversight of products and services, to the detriment of broader activity with other determinants of the health-disease process. Despite this situation, most staff members seek further training on their own and oscillate between the pursuit of alternatives to overcome the difficulties and moments of frustration and discouragement.

Processos de trabalho no Programa Saúde da Família: atravessamentos e transversalidades

A pesquisa teve o objetivo de compreender os desafios eticos da implantacao do Programa usando a abordagem qualitativa e discussao focal em grupo. A amostra foi intencional, com integrantes das diferentes equipes PSF do municipio de Campo Bom (RS): 3 medicos, 3 enfermeiras, 2 tecnicas e 4 agentes comunitarios de saude. Foram criadas 8 situacoes de discussao sobre diferentes aspectos do PSF. O artigo e um recorte da pesquisa, tendo como objetivo especifico os estrangulamentos nos processos de trabalho do PSF. O referencial teorico sao os conceitos de atravessamento e transversalidade e a proposta da clinica ampliada. Os resultados foram classificados segundo os diferentes atores envolvidos nos processos de trabalho: usuarios, agentes comunitarios de saude, profissionais, gestores e sistema de saude. Os resultados apontam que os estrangulamentos nestes processos tem a sua origem na reproducao de procedimentos e de praticas hospitalares na atencao basica, levando a desconsiderar as dimensoes subjetivas e sociais do processo saude/doenca. A proposta da clinica ampliada poderia ser uma resposta, porque defende que os itinerarios terapeuticos precisam ser frutos de uma pactuacao entre usuario e profissional.The study was performed with the objective to understand the ethical challenges of implementing the Program, using a qualitative approach and focal group discussion. The study included members from different FHP teams in the city of Campo Bom (Rio Grande do Sul, Brazil): three physicians, three nurses, two technicians, and four community health agents. Eight situations were created to discuss different aspects of the FHP. This article is an excerpt of the study, addressing the bottleneck effects in the FHP work process. The theoretical framework included concepts of crossing and transverse and the amplified clinic proposition. The results were categorized according to the individuals involved in the work processes: users of the health system, community health agents, professionals, administrators, and health system. The bottleneck effect in these processes originates in the repetition of primary care procedures and hospital practices, disregarding the subjective and social dimensions of the health/disease process. The amplified clinic proposition could be an answer since it holds that the therapeutic plans should result from an agreement between the health system user and the professional.La investigacion tuvo el objetivo de comprender los desafios eticos de la implantacion del Programa usando el abordaje cualitativo y la discusion focal en grupo. La muestra fue intencional, con integrantes de los diferentes equipos PSF del municipio de Campo Bom (RS): 3 medicos, 3 enfermeras, 2 tecnicas y 4 agentes comunitarios de la salud. Fueron creadas 8 situaciones de discusion sobre diferentes aspectos del PSF. El articulo es una parte de la investigacion, teniendo como objetivo especifico los estrangulamientos en los procesos de trabajo del PSF. El marco teorico es el concepto de transversalidad y la propuesta de la clinica ampliada. Los resultados fueron clasificados segun los diferentes actores que participaron en los procesos de trabajo: usuarios, agentes comunitarios de salud, profesionales, gestores y sistema de salud. Los resultados apuntan que los estrangulamientos en estos procesos tienen su origen en la reproduccion de procedimientos y de practicas hospitalarias en la atencion basica, llevando a desconsiderar las dimensiones subjetivas y sociales del proceso salud/enfermedad. La propuesta de la clinica ampliada podria ser una respuesta, porque defiende que los itinerarios terapeuticos precisan ser fruto de un pacto entre usuario y profesional.

Distanásia: percepção dos profissionais da enfermagem

Dysthanasia means slow and painful death without quality of life. This study aimed to know whether nurses identify dysthanasia as part of the final process of the lives of terminal patients hospitalized at an adult ICU. This is an exploratory-qualitative study. Data were collected through semi-structured interviews with ten nurses with at least one year of experience in an ICU, and interpreted through content analysis. Results indicate that nurses understand and identify dysthanasia, do not agree with it and recognize elements of orthonasia as the adequate procedure for terminal patients. We conclude that nurses interpret dysthanasia as extending life with pain and suffering, while terminal patients are submitted to futile treatments that do not benefit them. They also identify dysthanasia using elements of orthonasia to explain it.Dysthanasia means slow and painful death without quality of life. This study aimed to know whether nurses identify dysthanasia as part of the final process of the lives of terminal patients hospitalized at an adult ICU. This is an exploratory-qualitative study. Data were collected through semi-structured interviews with ten nurses with at least one year of experience in an ICU, and interpreted through content analysis. Results indicate that nurses understand and identify dysthanasia, do not agree with it and recognize elements of orthonasia as the adequate procedure for terminal patients. We conclude that nurses interpret dysthanasia as extending life with pain and suffering, while terminal patients are submitted to futile treatments that do not benefit them. They also identify dysthanasia using elements of orthonasia to explain it.

Arranjos familiares e implicações à saúde na visão dos profissionais do Programa Saúde da Família

OBJECTIVE To describe perception of family structures and understanding of a healthy family by Programa Saúde da Família (Family Health Program) team members. METHODS Research with a qualitative approach, employing the focus group technique, and involving the Program professionals from the city of Campo Bom, Southern Brazil, between June and August 2005. Sample was comprised of 12 professionals, including doctors, nurses, nursing technicians and community health agents. The following issues were investigated: the meaning of family; the meaning of the role of family; type of family most frequently cared for by professionals; the meaning of a healthy family; and types of family causing more difficulties of care. The methodological instrument used was content analysis. RESULTS Two main categories were observed: family structures, where a great diversity of arrangements was found; and healthy family, where the predominance of speech is consistent with a multifaceted view on health, involving political, social, economic and cultural aspects. Professionals identify and respect distinct family structures and adapt medical treatment accordingly. CONCLUSIONS Findings reveal that professionals are willing to deal with the different family structures present in their routine.OBJETIVO: Descrever a percepcao dos profissionais de equipes do Programa Saude da Familia sobre as configuracoes familiares e a compreensao de familia saudavel. METODOS: Pesquisa de abordagem qualitativa, empregando tecnica de grupo focal com profissionais do Programa Saude da Familia do municipio de Campo Bom, RS, no periodo de junho a agosto de 2005. A amostra foi composta por 12 profissionais: medicos, enfermeiras, tecnicas de enfermagem e agentes comunitarias de saude. Os temas investigados no roteiro foram: significado da familia, do papel da familia; tipo de familia mais comumente atendida pelos profissionais; significado de familia saudavel; quais familias oferecem maiores dificuldades para a atencao. O instrumental metodologico utilizado foi a analise de conteudo. RESULTADOS: Observaram-se duas categorias principais: arranjos familiares, em que se constatou grande diversidade de arranjos; e familia saudavel: em que o predominio dos relatos esta de acordo com uma visao multifacetada de compreensao de saude, abrangendo aspectos politicos, sociais, economicos e culturais. Os profissionais identificam e respeitam os diferentes arranjos familiares, e adaptam o tratamento ao modelo de familia que se apresenta. CONCLUSOES: Os achados mostram que os profissionais apresentam disposicao para lidar com os multiplos arranjos familiares presentes no seu cotidiano.

Histórias de dor e de vida: oficinas de contadores de histórias

Esta pesquisa foi uma intervencao com grupos de sujeitos soropositivos, realizada na cidade de Sao Leopoldo/RS, municipio da regiao metropolitana de Porto Alegre que apresenta a terceira prevalencia de Hiv/Aids no Estado. O objetivo da pesquisa foi organizar oficinas de contadores de historias e motivar os participantes a atuar como multiplicadores. A oficina de que trata este artigo foi realizada na ONG Apoio, Solidariedade e Prevencao a Aids (ASPA), desenvolvida em cinco encontros, nos quais os sujeitos contaram as historias de vida e inventaram um ritual ancorado na religiosidade popular. O grupo era composto por oito usuarios e dois trabalhadores voluntarios, todos soropositivos; com predominio de mulheres de baixa renda e chefes de familia. Foi utilizado o referencial das praticas discursivas para analisar o material produzido na oficina. No percurso do trabalho emergiram dois temas principais: o preconceito a que estao submetidos os sujeitos soropositivos e a religiosidade como estrategia de resistencia usada pela populacao na luta contra a Aids. Enfatiza-se a importância de atividades como a de contar historias na promocao da saude da populacao.

A construção do cuidado pela equipe de saúde e o cuidador em um programa de atenção domiciliar ao acamado em Porto Alegre (RS, Brasil)

Este artigo e um estudo de caso cujo objetivo principal foi compreender a construcao do cuidado no Programa de Atendimento Domiciliar ao Acamado (PADA) de uma unidade basica de saude (UBS) em Porto Alegre, RS. Os dados foram obtidos em 13 grupos de cuidadores na UBS e em observacao participante registrada em diario de campo nos domicilios. Foi realizada analise das praticas discursivas, inspirada nos conceitos de discurso de Foucault e nos estudos sobre etica e cuidado de si. No transcurso dos grupos, os cuidadores ocuparam um espaco que chamamos metaforicamente de Oraculo de Delfos, locus de acolhimento, escuta e de suporte. Escutar os dialogos travados entre equipe e cuidadores defrontou-nos com a contradicao presente no discurso institucional que ao mesmo tempo que estimula o cuidado de si impoe normas, deveres e fazeres. O cuidado como direito de cidadania em contraposicao ao cuidado como submissao e assujeitamento tensionou o grupo em varios momentos. A nocao foucaultiana de cuidado compreende uma sintese entre o exercicio de uma pessoa sobre ela mesma, tornando-a melhor como ser humano e, ao mesmo tempo, capacitando-a a se tornar melhor como cidadao