Maria Angela Alves do Nascimento

Prática da enfermeira no Programa de Saúde da Família: a interface da vigilância da saúde versus as ações programáticas em saúde

O estudo analisa a pratica da enfermeira no Programa de Saude da Familia (PSF) em Jequie (BA); compreende as concepcoes sobre o PSF; identifica as atividades e aponta limites, avancos e perspectivas. Pesquisa qualitativa, em que as tecnicas de coleta de dados sao a entrevista semi-estruturada, a observacao e a analise de documentos. O metodo de analise de dados foi a hermeneutica dialetica. Os resultados evidenciaram que o PSF e uma estrategia de (re)orientacao do Modelo de Atencao a Saude e um caminho para consolidacao do Sistema Unico de Saude. As praticas das enfermeiras do PSF sao assistenciais, gerenciais e educativas. Durante a sua execucao utiliza uma dada organizacao tecnologica do trabalho em saude, com praticas articuladas de promocao, prevencao de doencas e agravos, recuperacao e reabilitacao da saude de grupos populacionais e intervencoes sobre a familia, o que tem resultado na reestruturacao da atencao basica e a reorganizacao do sistema local de saude. Como limites apresentam-se dificuldades em assegurar o acesso dos usuarios aos servicos de media e alta complexidade e estabelecer o sistema de referencia e contra-referencia; como avancos, destaca-se a participacao no treinamento introdutorio, e tem perspectivas o aumento da cobertura do PSF no municipio e a hierarquizacao da rede local.

Acesso aos serviços de saúde: uma possibilidade a ser construída na prática

Estudo qualitativo sobre o acesso dos usuarios as unidades basicas de Feira de Santana (BA), com o objetivo de analisar a percepcao dos usuarios quanto as caracteristicas dos servicos utilizados no sistema local de saude, articulando teoria a pratica com vistas a uma possibilidade a ser construida como direito de cidadania. O referencial teorico foi baseado em autores que analisam as dimensoes explicativas do acesso (politica, economica, tecnica e simbolica), articuladas com o modelo teorico da representacao social. Os dados empiricos foram a observacao do acesso em dois centros de saude e a entrevista com 25 usuarios atendidos nos referidos centros. A analise buscou um encontro com a realidade empirica. Os resultados mostram que o acesso aos servicos e focalizado e seletivo para responder a uma determinada queixa, tecnologicamente atrasado e discriminatorio, dirigido ao usuario de baixa renda que tem menor qualificacao no setor formal da economia e a populacao excluida socialmente.

Vínculo e autonomia na prática de saúde bucal no Programa Saúde da Família

OBJECTIVE To understand the establishment of bond in the construction of autonomy of the subjects who generate the practices of oral health in the Family Health Program. METHODOLOGICAL PROCEDURES A critical reflexive approach was undertaken in this qualitative study carried out in Alagoinhas (Northeastern Brazil). ANALYSIS OF RESULTS Interviewees taken care of by the oral health team of the Program point out their problems and the treatment they want. A line of tension is established that will define the service as welcoming, binding and will contribute towards enhancing the autonomy of those seeking oral health services. However, negotiation concerning the treatment that will be implemented, between those seeking and providing it, is fundamental. Establishing a bond made it possible for negotiation to lead to a consensus concerning necessities and responsibilities, impeding the therapeutic act from being centered on the health care worker, allowing it to ensue according to the desire of the person seeking care. CONCLUSIONS Bond maintains a close relationship with the capacity of the other to become an active subject in decision making with regard to his/her life. It allows subjects to strive towards their potentialities, favoring the reciprocity of experiences and the construction of therapeutic acts for which they are co-responsible. Oral health practice based on relational pillars needs to foster bond, making those that seek care autonomous and amplifying care.

Comprehensive health care: dilemmas and challenges in nursing

OBJECTIVE this article discusses comprehensive care as a guiding tenet of the Brazilian Unified Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge. METHODS this is a theoretical reflection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects. CONCLUSION care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.

Cuidado integral em saúde: dilemas e desafios da Enfermagem

OBJECTIVE this article discusses comprehensive care as a guiding tenet of the Brazilian Unified Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge. METHODS this is a theoretical reflection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects. CONCLUSION care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.

Assistência Farmacêutica no Programa Saúde da Família: encontros e desencontros do processo de organização

The scope of this study was to discuss the organization of the pharmaceutical assistance service in the family healthcare program. Qualitative research from a critical/analytical perspective was conducted in family healthcare units in a municipality of the state of Bahia, Brazil. Data was collected on the basis of systematic observation, semi-structured interviews and documents analysis from a dialectic standpoint. The organization of Pharmaceutical Assistance consisted of selection, planning, acquisition, storage and dispensing activities. The process was studied in the implementation phase, which was occurring in a centralized and uncoordinated fashion, without the proposed team work. An excess of activity was observed among the healthcare workers and there was an absence of a continued education policy for the workers. For the transformation of this situation and to ensure the organization of pharmaceutical assistance with quality and in an integrated manner, a reworking of the manner of thinking and action of the players concerned (managers, health workers and users), who participate directly in the organization, is necessary. Furthermore, mechanical, bureaucratic and impersonal work practices need to be abandoned.

Construção da integralidade no cuidar de pessoas com diabetes mellitus em um centro de saúde em Feira de Santana (BA)

This study analyses the care of people with diabetes mellitus (DM), under the light of integrality, through access, bond-accountability, and team formation in a healthcare unit of Feira de Santana, Bahia State. It is a qualitative study adopting a critical and reflexive approach. The subjects were healthcare workers (Group I) and users registered in the diabetes program (Group 2). Data collection techniques included a structured interview and systematic observations, while the data analysis was based on content analysis and Merhys analyzer flow chart. The results reveal that basic attention has little structure, an ineffective organization model, and a healthcare process built on the everyday of the service in a fragmented and shallow way, centered on the figure of the doctor. They also reveal that municipalization of health, as it has been done in Feira de Santana, caused the dismantling and discontinuation of healthcare attention to people with DM. Access is restricted, focused on and directed to low-complexity actions. Hosting and bond with the user are still distant from co-responsability, and there is a lack of autonomy and education in the process. In conclusion, it is necessary to widen the debate on whole care and work management, and valuate the everyday praxis of those involved with care.

Violência e mortes por causas externas

An ecological study highlighted violence and death by external causes in Salvador and in Bahia through data furnished by the Fundação Nacional de Saúde (Health National Foundation) at the Ministério da Saúde (Ministry of Health), based on mortality records and population estimates by IBGE. The risk of death by homicide in Brazil is three times greater than in the United States, and up to forty times higher than in Japan. Homicide was the primary cause of loss of potential years of life (13.4%) in Brazil (1997), followed by traffic deaths (10.6%). External causes were the second cause of death in Salvador and Bahia (1996). Violence has cultural-social and political-ideological roots and it can be prevented by intersectional, multidisciplinary actions.

Cuidado integral en salud: dilemas y retos de la Enfermeria

OBJECTIVE this article discusses comprehensive care as a guiding tenet of the Brazilian Unified Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge. METHODS this is a theoretical reflection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects. CONCLUSION care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.

Hermenêutica dialética: uma experiência enquanto método de análise na pesquisa sobre o acesso do usuário à assistência farmacêutica - doi: 10.5020/18061230.2012.p243

Objective: To describe the application of dialectical hermeneutics as a method of analysis in research on pharmaceutical services. Data Synthesis: This is the description of a qualitative approach method of analysis, used in a research having as its object of study the user access to the Pharmaceutical Services and its analysis based on understanding of the dimensions of access (geographical, economic, functional, availability and communicational) defined by various experts in the area. There is delimitation of subjects and criteria applied for their inclusion, techniques (systematic observation, semi-structured interviews and analysis of documents) and instruments for data collection, and the steps involved in organizing and analyzing data according to the methodological trajectory of dialectical hermeneutics. The form of constructing the analysis tables and the analytical categories emerged from data analysis is also demonstrated. Conclusion: Detailed description of using the method of data analysis on dialectical hermeneutics basis shows its application as a methodological alternative to studies on pharmaceutical services, revealing the possibility of overcoming the usual positivist approach that characterizes them, and the possibility of its reproduction for other objects of study in public health