Maria Marta Nolasco Chaves

Instrumentos de avaliação de necessidades em saúde aplicáveis na estratégia de Saúde da Família

Este estudo, descritivo e exploratorio, teve como objetivo geral conhecer os instrumentos utilizados para o reconhecimento das necessidades de saude da populacao no âmbito da Estrategia de Saude da Familia. Abrangeu dois Distritos do Municipio de Sao Paulo. A base teorico-metodologica consistiu da Teoria de Intervencao Praxica de Enfermagem em Saude Coletiva. Os dados foram coletados junto a unidades de saude e equipes de saude da familia. Os resultados mostraram a inexistencia de instrumentos especificos para o reconhecimento das necessidades em saude da populacao. Discutem-se tres contradicoes presentes no fenomeno estudado: a polaridade estrutural na conceituacao de necessidade contida no SUS; o principio da integralidade postulado pelo SUS e a possibilidade operacional das unidades de saude e a antinomia teoria-pratica no processo de trabalho das equipes da ESF. Conclui-se que e imperativo superar as contradicoes para redirecionar as politicas e as praticas rumo ao enfrentamento das necessidades em saude.

Análise do discurso: uma reflexão para pesquisar em saúde

En este trabajo presentamos la expresion oral y la expresion escrita como formacion discursiva, enfatizando las razones que la convierten en objeto de analisis, para ello presentamos diferentes instrumentos. Resaltamos la importancia del analisis del discurso para el desarrollo de las investigaciones en el area de la salud, pues tal metodo permite interpretar la realidad a partir del texto, o de los textos, poniendo en evidencia a los sujetos de la produccion y de su interpretacion. E asi como el contexto en el que se producen. Explicamos las contradicciones, continuidades y rupturas construidas historicamente, que hacen del discurso una practica social. Consideramos el analisis del discurso como posibilidad de captar el sentido no explicito en el lenguaje oral y escrito, por lo tanto como una forma mas de aproximacion del proceso salud-enfermedad. El objetivo es incorporar el analisis del discurso en el area e la salud, haciendo enfasis en este metodo como una rica contribucion de las Ciencias Sociales.Neste trabalho, tomamos a fala e a escrita como formacao discursiva, destacando as razoes para converte-la em objeto de analise, e apresentando diferentes instrumentos para tanto. Ressaltamos a importância da analise do discurso para o desenvolvimento das pesquisas em saude, por permitir a interpretacao da realidade a partir do texto, ou dos textos, evidenciando os sujeitos da producao e interpretacao deles, assim como o contexto de sua producao. Sao explicitadas as contradicoes, as continuidades e rupturas construidas historicamente, que fazem do discurso uma pratica social. Consideramos a analise do discurso como possibilidade de captar o sentido nao explicito na fala e escrita, portanto como mais uma forma de aproximacao do processo saudedoenca. O objetivo desta reflexao e incorporar a analise do discurso a area da saude, enfatizando este metodo como rica contribuicao das Ciencias Sociais.Neste trabalho, tomamos a fala e a escrita como formacao discursiva, destacando as razoes para converte-la em objeto de analise, e apresentando diferentes instrumentos para tanto. Ressaltamos a importância da analise do discurso para o desenvolvimento das pesquisas em saude, por permitir a interpretacao da realidade a partir do texto, ou dos textos, evidenciando os sujeitos da producao e interpretacao deles, assim como o contexto de sua producao. Sao explicitadas as contradicoes, as continuidades e rupturas construidas historicamente, que fazem do discurso uma pratica social. Consideramos a analise do discurso como possibilidade de captar o sentido nao explicito na fala e escrita, portanto como mais uma forma de aproximacao do processo saudedoenca. O objetivo desta reflexao e incorporar a analise do discurso a area da saude, enfatizando este metodo como rica contribuicao das Ciencias Sociais.

Collective Health Nursing: the construction of critical thinking about the reality of health.

Esta analise sobre os processos ensino-aprendizagem e a pesquisa de Enfermagem em Saude Coletiva frente a consolidacao do Sistema Unico de Saude (SUS) objetiva reconhecer a potencialidade da realidade de saude da populacao como estrategias de aproximacao com o campo de acao e instrumentalizacao do profissional para a reversao de situacoes indesejaveis de saude. Assim, refletiu-se sobre o trabalho da Enfermagem em Saude Coletiva por compreende-lo como mediador para promover o ensino, a aprendizagem e a construcao de conhecimento na area. Acredita-se que tais processos, fundamentados no pensamento critico, possibilitam a reflexao sobre as contradicoes entre a politica publica vigente e as acoes promovidas pelo setor, e assim, contribuem para superar o atual modelo de atencao a saude, que historicamente tem sido fundamentado em acoes curativistas para o individuo, para o modelo que reconhece as necessidades em saude e intervem na determinacao social do processo saude-doenca.This article presents an analysis of the Collective Health Nursing teaching-learning processes and research in view of the consolidation of the Brazilian National Health System (Sistema Único de Saúde - SUS), performed with the objective to acknowledge the potentiality of the health reality of the population as a strategy to approximate the field of nursing practice and training as a way to revert undesired health situations. Thus, the authors reflect about the work of Collective Health Nursing, as they understand it is a mediator to promoting teaching, learning and knowledge development in this field. The authors believe that those processes, founded on critical thinking, permit to reflect about the contradictions between the current public policy and the actions promoted by the sector, and, this way, contribute to overcome the current health care mode, which has historically been founded on curative actions towards individuals, to assuming a model that acknowledges the health needs and intervenes in the social determination of the health-disease process.

Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

Objective: to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Parana, Brazil by condition type, age group and health region. Method: a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. Results: there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. Conclusion: the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Parana, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

Use of the Software IRAMUTEQ in Qualitative Research: An Experience Report

This article describes the experience of the use of the software IRAMUTEQ to support qualitative research, and thus concepts and some characteristics of the software are addressed to aid in understanding and to illustrate its features. The observations come from two surveys carried out in the city of Curitiba, which were centered on the vulnerability of and the promotion of a healthy lifestyle to adolescent students. The tool enabled the organization of data collected from the participants’ speeches acquired through semi-structured interviews. Both studies went through the same steps in the processing of the data from the interviews because, initially, they were transcribed for the preparation of the corpus of each of the studies so as to be inserted in the software. Categorization of the data was performed using Descending Hierarchical Classification (DHC). This tool allowed us to show and confirm the thematic categories in the same way that it added quality to the presentation and supported the results.

HEALTHCARE MANAGEMENT OF TUBERCULOSIS: INTEGRATING A TEACHING HOSPITAL INTO PRIMARY HEALTH CARE

Qualitative, exploratory and interventionist case study at a teaching hospital of Parana, with the objective of proposing a Tuberculosis Healthcare Management model focused on the hospital discharge, with a view to comprehensive care for patients with tuberculosis. Interviews were conducted with key informants (17 subjects), using the Theory of Nursing Praxis Intervention in Collective Health as the theoretical and methodological framework, with its three interdependent dimensions used as analytical categories. Weakness was revealed in the protocols for hospitalized patient care, insufficient integration between levels of care and the need for direct communication between the hospital and primary care nurses. In view of this result, a Healthcare Management Model, expressed as a flow of care with matrix support, nursing consultation and phone contact between nurses. The implementation of this model will lead to greater integration between the levels of care, permitting improvements in patient monitoring with greater probability of treatment compliance.Pesquisa de cunho qualitativo, exploratorio e intervencionista em hospital universitario do Parana, com o objetivo de propor um modelo de Gestao do Cuidado da Tuberculose voltado a alta hospitalar, buscando cuidado integral ao portador dessa doenca. Foram realizadas entrevistas com informantes-chave (17 sujeitos), tendo a Teoria da Intervencao Praxica de Enfermagem em Saude Coletiva como referencial teorico-metodologico, com suas tres dimensoes interdependentes, utilizadas como categorias analiticas. Ficou evidenciado fragilidade nos protocolos voltados ao cuidado do doente internado, insuficiente integracao entre niveis de atencao e necessidade de comunicacao direta entre enfermeiros do hospital e da atencao primaria. Diante desse resultado, foi proposto modelo de Gestao do Cuidado, traduzido em fluxo de atendimento com apoio matricial, consulta de enfermagem e contato telefonico entre enfermeiros. Acredita-se que a implantacao desse modelo trara maior integracao entre os niveis de atencao, melhora no processo de acompanhamento do doente com maior probabilidade de adesao ao tratamento.

As notificações de acidentes de trabalho com material biológico em um hospital de ensino de Curitiba/PR

Estudo descritivo, de natureza qualitativa, com o objetivo de conhecer a realidade da notificacao de acidentes de trabalho com material biologico no Servico de Epidemiologia Hospitalar de Hospital de Ensino de Curitiba - PR. A coleta de dados foi realizada em bancos de dados do SINAN-Net e por meio de entrevistas semiestruturadas com dez informantes-chave. A analise dos dados, fundamentada no materialismo historico e dialetico, permitiu identificar processos relacionados as dimensoes estrutural, particular e singular na notificacao dos acidentes de trabalho.

[Municipal health conferences: the organized social movement to create health interventions].

The objective of this exploratory study was to understand the discourse leading to the health intervention proposals approved during the Health Conferences held in Curitiba-PR between 1997 and 2007. The results show that the approved health interventions were related to epidemiological indexes, the funding of the system, the change of the health care model, and the participation of the organized social movement. To broaden the participation, discussions were carried out before the final session, in which the number of participants remained nearly constant. In the final remarks it was observed that no reviews were done regarding the determinants of the health-diseases process; there was a tendency to make individuals accountable for promoting changes in their reality, and the model of broadened participation allows for reflection on the representivity of social movements in the political decisions within the sector.The objective of this exploratory study was to understand the discourse leading to the health intervention proposals approved during the Health Conferences held in Curitiba-PR between 1997 and 2007. The results show that the approved health interventions were related to epidemiological indexes, the funding of the system, the change of the health care model, and the participation of the organized social movement. To broaden the participation, discussions were carried out before the final session, in which the number of participants remained nearly constant. In the final remarks it was observed that no reviews were done regarding the determinants of the health-diseases process; there was a tendency to make individuals accountable for promoting changes in their reality, and the model of broadened participation allows for reflection on the representivity of social movements in the political decisions within the sector.

Enfermagem em saúde coletiva: a construção do conhecimento crítico sobre a realidade de saúde

Esta analise sobre os processos ensino-aprendizagem e a pesquisa de Enfermagem em Saude Coletiva frente a consolidacao do Sistema Unico de Saude (SUS) objetiva reconhecer a potencialidade da realidade de saude da populacao como estrategias de aproximacao com o campo de acao e instrumentalizacao do profissional para a reversao de situacoes indesejaveis de saude. Assim, refletiu-se sobre o trabalho da Enfermagem em Saude Coletiva por compreende-lo como mediador para promover o ensino, a aprendizagem e a construcao de conhecimento na area. Acredita-se que tais processos, fundamentados no pensamento critico, possibilitam a reflexao sobre as contradicoes entre a politica publica vigente e as acoes promovidas pelo setor, e assim, contribuem para superar o atual modelo de atencao a saude, que historicamente tem sido fundamentado em acoes curativistas para o individuo, para o modelo que reconhece as necessidades em saude e intervem na determinacao social do processo saude-doenca.This article presents an analysis of the Collective Health Nursing teaching-learning processes and research in view of the consolidation of the Brazilian National Health System (Sistema Único de Saúde - SUS), performed with the objective to acknowledge the potentiality of the health reality of the population as a strategy to approximate the field of nursing practice and training as a way to revert undesired health situations. Thus, the authors reflect about the work of Collective Health Nursing, as they understand it is a mediator to promoting teaching, learning and knowledge development in this field. The authors believe that those processes, founded on critical thinking, permit to reflect about the contradictions between the current public policy and the actions promoted by the sector, and, this way, contribute to overcome the current health care mode, which has historically been founded on curative actions towards individuals, to assuming a model that acknowledges the health needs and intervenes in the social determination of the health-disease process.

Reviewing health needs assessment approaches in the Family Health strategy

Este estudo, descritivo e exploratorio, teve como objetivo geral conhecer os instrumentos utilizados para o reconhecimento das necessidades de saude da populacao no âmbito da Estrategia de Saude da Familia. Abrangeu dois Distritos do Municipio de Sao Paulo. A base teorico-metodologica consistiu da Teoria de Intervencao Praxica de Enfermagem em Saude Coletiva. Os dados foram coletados junto a unidades de saude e equipes de saude da familia. Os resultados mostraram a inexistencia de instrumentos especificos para o reconhecimento das necessidades em saude da populacao. Discutem-se tres contradicoes presentes no fenomeno estudado: a polaridade estrutural na conceituacao de necessidade contida no SUS; o principio da integralidade postulado pelo SUS e a possibilidade operacional das unidades de saude e a antinomia teoria-pratica no processo de trabalho das equipes da ESF. Conclui-se que e imperativo superar as contradicoes para redirecionar as politicas e as praticas rumo ao enfrentamento das necessidades em saude.