Mara Lúcia Garanhani

Relações entre concepções e práticas de educação em saúde na visão de uma equipe de saúde da família

Este estudo objetiva analisar as concepcoes de educacao em saude de profissionais da equipe de Saude da Familia e pensar criticamente sobre a relacao estabelecida entre as praticas de educacao em saude e os discursos desses trabalhadores. Trata-se de uma pesquisa qualitativa que adota a analise de discurso como referencial teorico e tecnicas de observacao e entrevistas para a producao dos dados. Os modelos curativos e de transmissao do conhecimento encontram-se fortemente arraigados na concepcao e nas praticas de educacao em saude, prevalecendo uma relacao vertical, impositiva, superior, na qual o profissional e o detentor do saber. Os trabalhadores sentem-se educadores, e observa-se uma postura que considera o processo de trabalho educativo voltado para o aprendizado mutuo e o respeito aos conhecimentos previos da populacao, porem essa percepcao encontra-se presente somente em seu discurso, necessitando ser incorporada a sua pratica para que haja a mudanca nos servicos de saude. Verificou-se a necessidade de maior valorizacao do papel do trabalhador como sujeito propulsor de mudancas na pratica educativa e no modelo de atencao em saude vigente, bem como a importância do reconhecimento do usuario como sujeito atuante na propria saude e com capacidade de intervencao na sua realidade.

Cuidador familiar de seqüelados de acidente vascular cerebral: significado e implicações

O acidente vascular cerebral (AVC) esta entre as principais causas de morte no mundo. Diante das incapacidades impostas pelo AVC, surge o cuidador familiar. O objetivo desta pesquisa foi analisar o significado e as implicacoes de se tornar cuidador de um individuo sequelado de AVC. Trata-se de um estudo qualitativo, realizado com cinco cuidadores, em Londrina-PR, no periodo de agosto a dezembro de 2005. Os dados foram coletados por meio de entrevistas semi-estruturadas e submetidos a analise de discurso proposta por Martins e Bicudo. Da analise das entrevistas emergiram sete categorias: voltando-se para o Ser cuidado, descrevendo os cuidados, apresentando as mudancas, o apoio da espiritualidade, compreendendo o significado do cuidado, expressando as necessidades para cuidar e perspectivas para o futuro. Os resultados revelaram que ser cuidador familiar e um fenomeno complexo, que gera nos sujeitos sentimentos de alegria e felicidade concomitantes aos sentimentos de medo, ansiedade e revolta.

Social Representations of the Wheelchair for People with Spinal Cord Injury

Na busca por compreender a representacao social do uso da cadeira de rodas, atraves da analise de entrevistas com dez pessoas que sofreram lesao da medula espinhal, elaborou-se a construcao de cinco representacoes. O fenomeno vivenciado sobre a cadeira de rodas possibilitou uma trajetoria de significados e simbologias: equipamento indispensavel, apos a pessoa perceber a incapacidade para andar, simbolo de deficiencia quando vivencia a dependencia funcional; meio de locomocao e transporte apos o resgate de seus potenciais funcionais, passa a integralizar parte ou todo o seu corpo e, por fim, emerge a concepcao de autonomia sob quatro rodas, pela adaptacao a sua nova capacidade de locomocao. A cadeira de rodas, como extensao do corpo modificado pela lesao medular, ao devolver-lhe o direito de locomocao, presenteia-o nao so com a autonomia para varios atos da vida, como lhe devolve a dignidade, tao essencial a vida humana.In seeking to understand the social representation of the use of the wheelchair through the analysis of interviews with ten people who have suffered spinal cord injury, the construction of five representations was elaborated. The phenomenon experienced regarding the wheelchair provided a route of meanings and symbologies: essential equipment, after the person perceive the inability to walk; a symbol of disability when the person experienced functional dependence; means of locomotion and transport after the rescue of their potential functional; becoming an integral part or all of their body and, finally, the concept of autonomy on four wheels by adjusting to their new ability to walk emerges. The wheelchair as an extension of the modified body for spinal cord injury, returns them the right of locomotion, presents them not only with autonomy for various acts of life, but also restores their dignity, so essential to human life.

Cuidador de pessoa com acidente vascular encefálico: necessidades, sentimentos e orientações recebidas

Objectives: Understand the needs and feelings of the caregiver of individuals who have experienced a stroke, and identify the information provided to these caregivers by health professionals. Methods: This exploratory, descriptive qualitative approach used semistructured interviews to understand the experience of six caregivers, during the period from May to August, 2008. The data from these interviews were analyzed using discourse analysis. Results: Three categories were identified: the initial needs of the caregiver, the caregiver and his/her feelings, and the guidance received by the caregiver from health professionals. Needs of the caregivers were varied, but primarily concerned adaptive difficulties. Diverse feelings were identified, including ambivalence, and a range of intensity of those feelings was noted. Guidelines provided by health professionals ranged from a total absence of information, to guidance that was felt by caregivers to meet all of their needs. Conclusions: There is need for discussion regarding provision of standardized guidelines for caregivers, and a strategy to support caregivers and patients.Objectives: Understand the needs and feelings of the caregiver of individuals who have experienced a stroke, and identify the information provided to these caregivers by health professionals. Methods: This exploratory, descriptive qualitative approach used semistructured interviews to understand the experience of six caregivers, during the period from May to August, 2008. The data from these interviews were analyzed using discourse analysis. Results: Three categories were identified: the initial needs of the caregiver, the caregiver and his/her feelings, and the guidance received by the caregiver from health professionals. Needs of the caregivers were varied, but primarily concerned adaptive difficulties. Diverse feelings were identified, including ambivalence, and a range of intensity of those feelings was noted. Guidelines provided by health professionals ranged from a total absence of information, to guidance that was felt by caregivers to meet all of their needs. Conclusions: There is need for discussion regarding provision of standardized guidelines for caregivers, and a strategy to support caregivers and patients.

Ser trabalhador de enfermagem da Unidade de Centro de Material: uma abordagem fenomenológica

This study investigated the experience of nursing workers at the Sterile Processing Department (SPD) of a hospital in Londrina, State of Paraná, using the qualitative phenomenological method. Ten interviews were conducted. The analysis of the discourses made possible to build four categories: 1) How the individual came to be part of the department - describes the various ways one may come to work in the unit; 2) Speaking about the work involved in the SPD - describes the turnover, the multiple simultaneous tasks that must be performed and the preference for certain areas; the closed atmosphere; the technological evolution; and the interpersonal relationships; 3) Dealing with difficulties - describes the daily routine; the repetitive and monotonous work; the physical exhaustion; the lack of supplies and equipment; the adjustment period; and the under-appreciation, discrimination, and ignorance of other health workers about their work; 4) Overcoming the obstacles - reveals that through greater awareness of their role in the Department these professionals are able to recognize their importance.Este estudo buscou compreender a experiencia dos trabalhadores de enfermagem da Unidade de Centro de Material (UCM) de um hospital de Londrina, utilizando a pesquisa qualitativa femomenologica. Foram realizadas dez entrevistas. A analise dos discursos permitiu construir quatro categorias: 1. Falando do ingresso na UCM - situa as diferentes formas de ingresso nesta unidade; 2. Falando sobre o trabalho desenvolvido na UCM - discorre sobre a rotatividade, o trabalho concomitante e a predilecao por determinadas areas; o ambiente fechado; a evolucao tecnologica e o relacionamento interpessoal; 3. Vivenciando as dificuldades - descreve a rotina diaria; o trabalho repetitivo e monotono, o cansaco fisico, a falta de materiais e equipamentos; o periodo de adaptacao, o desconhecimento, a desvalorizacao e a discriminacao vivenciada; 4. Superando os obstaculos - revela a tomada de consciencia do seu papel na unidade reconhecendo a sua importância.

Systematization of Nursing Care in undergraduate training: the perspective of Complex Thinking

AIM: to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility METHOD: longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed. RESULTS: The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035). CONCLUSION: the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.Objetivo: analizar las percepciones de los estudiantes de un curso de graduacion en enfermeria sobre su formacion en la Sistematizacion de la Asistencia de Enfermeria. Metodo: estudio cualitativo comprensivo, realizado con 32 estudiantes de las cuatro series del curso de enfermeria de una universidad publica brasilena estatal, que tiene la Sistematizacion de la Asistencia de Enfermeria como tema transversal. La recoleccion de datos fue realizada por medio de grupo focal, con preguntas orientadoras que abordaron el aprendizaje del tema. Los grupos focales fueron grabados, filmados, transcritos en su totalidad y sometidos a un proceso de analisis de contenido, segun Bardin. El referencial teorico empleado fue el Pensamiento Complejo, propuesto por Edgar Morin. Resultados: fueron elaboradas tres categorias que agruparon las actividades de ensenanza y aprendizaje, los sentimientos experimentados y la vision del estudiante sobre su formacion en la Sistematizacion de la Asistencia de Enfermeria. Conclusion: se constato que la tematica esta presente en todas las series, sin embargo, de manera fragmentada y que, el desarrollo del proceso y de la consulta de enfermeria en la practica, fueron las actividades mas importantes en el aprendizaje de la Sistematizacion de la Asistencia de Enfermeria por los estudiantes.Descriptores: Educacion en Enfermeria; Investigacion en Educacion de Enfermeria; Estudiantes de Enfermeria; Procesos de Enfermeria; Enfermeria; Curriculum.AIM: to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility METHOD: longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed. RESULTS: The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035). CONCLUSION: the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.

Caregivers of people with stroke: needs, feelings and guidelines provided

Objectives: Understand the needs and feelings of the caregiver of individuals who have experienced a stroke, and identify the information provided to these caregivers by health professionals. Methods: This exploratory, descriptive qualitative approach used semistructured interviews to understand the experience of six caregivers, during the period from May to August, 2008. The data from these interviews were analyzed using discourse analysis. Results: Three categories were identified: the initial needs of the caregiver, the caregiver and his/her feelings, and the guidance received by the caregiver from health professionals. Needs of the caregivers were varied, but primarily concerned adaptive difficulties. Diverse feelings were identified, including ambivalence, and a range of intensity of those feelings was noted. Guidelines provided by health professionals ranged from a total absence of information, to guidance that was felt by caregivers to meet all of their needs. Conclusions: There is need for discussion regarding provision of standardized guidelines for caregivers, and a strategy to support caregivers and patients.Objectives: Understand the needs and feelings of the caregiver of individuals who have experienced a stroke, and identify the information provided to these caregivers by health professionals. Methods: This exploratory, descriptive qualitative approach used semistructured interviews to understand the experience of six caregivers, during the period from May to August, 2008. The data from these interviews were analyzed using discourse analysis. Results: Three categories were identified: the initial needs of the caregiver, the caregiver and his/her feelings, and the guidance received by the caregiver from health professionals. Needs of the caregivers were varied, but primarily concerned adaptive difficulties. Diverse feelings were identified, including ambivalence, and a range of intensity of those feelings was noted. Guidelines provided by health professionals ranged from a total absence of information, to guidance that was felt by caregivers to meet all of their needs. Conclusions: There is need for discussion regarding provision of standardized guidelines for caregivers, and a strategy to support caregivers and patients.

A violência sob o olhar de lideranças comunitárias de Londrina, Paraná, Brasil

Abstract Studies have shown that community mobilization is important to fight violence. This study identified the perceptions on violence among leaderships from two outskirt regions with different levels of com-munity mobilization in Londrina, state of Parana, Brazil. A qualitative approach was adopted, with content analysis of the data. Semi-structured inter-views were conducted with leaderships identified through the “snowball” process, until saturation of answers was reached. Results showed that the leaderships’ point of view is permeated by denial and naturalization of violence, and that violence is always something that comes from the “others” or from an external context. There was a strong con-vergence on delinquency in both communities, and illegal drug trafficking was perceived as its main grounds. Structural and cultural violences were more perceptible for the more mobilized communi-ty. Institutional violence was perceived by the two communities’ leaderships, mainly by those from the more mobilized area. These results indicate that leaderships of a more mobilized community have a more comprehensive analysis of their social context and of the complexity of the problem.Keywords: Violence; Community Participation; Qua-litative Research; Leadership; Social Problems.

Representações sociais da cadeira de rodas para a pessoa com lesão da medula espinhal

Na busca por compreender a representacao social do uso da cadeira de rodas, atraves da analise de entrevistas com dez pessoas que sofreram lesao da medula espinhal, elaborou-se a construcao de cinco representacoes. O fenomeno vivenciado sobre a cadeira de rodas possibilitou uma trajetoria de significados e simbologias: equipamento indispensavel, apos a pessoa perceber a incapacidade para andar, simbolo de deficiencia quando vivencia a dependencia funcional; meio de locomocao e transporte apos o resgate de seus potenciais funcionais, passa a integralizar parte ou todo o seu corpo e, por fim, emerge a concepcao de autonomia sob quatro rodas, pela adaptacao a sua nova capacidade de locomocao. A cadeira de rodas, como extensao do corpo modificado pela lesao medular, ao devolver-lhe o direito de locomocao, presenteia-o nao so com a autonomia para varios atos da vida, como lhe devolve a dignidade, tao essencial a vida humana.In seeking to understand the social representation of the use of the wheelchair through the analysis of interviews with ten people who have suffered spinal cord injury, the construction of five representations was elaborated. The phenomenon experienced regarding the wheelchair provided a route of meanings and symbologies: essential equipment, after the person perceive the inability to walk; a symbol of disability when the person experienced functional dependence; means of locomotion and transport after the rescue of their potential functional; becoming an integral part or all of their body and, finally, the concept of autonomy on four wheels by adjusting to their new ability to walk emerges. The wheelchair as an extension of the modified body for spinal cord injury, returns them the right of locomotion, presents them not only with autonomy for various acts of life, but also restores their dignity, so essential to human life.

Caregivers and implications for home care

Investigacion exploratoria descriptiva de abordaje cualitativo, con el objetivo de aprehender la experiencia de los cuidadores, la practica de los equipos de atencion domiciliaria y la contribucion de asistencia domiciliaria a la continuidad de la atencion. Los datos fueron colectados por medio de entrevista semiestructurada, aplicada a diez cuidadores. Los testimonios fueran sometidos a un analisis de contenido en la modalidad de analisis tematica, acerca de la cual se emergio tres tematicas: decision para el cuidado, cotidiano de los cuidados y la dimension social del cuidado en el contexto de la atencion domiciliaria. Entre los cuidadores se identifico baja renta y escolaridad, dependencia severa de los sujetos cuidados y dificultades de los equipos de Atencion Domiciliaria para suministrar los recursos materiales. Hubo sobrecarga moderada y de moderada a severa en 60% y 40% de los cuidadores, respectivamente, y privacion de actividades sociales. Por las condiciones socioeconomicas el cuidado presento fragilidades y falta de dominios.