Nalú Pereira da Costa Kerber

Como os trabalhadores de um Centro Obstétrico justificam a utilização de práticas prejudiciais ao parto normal

This study was performed with the objective of understanding the reasons why workers of a birthing center in southern Brazil use natural birth practices considered harmful by the World Health Organization. This exploratory study was performed in July 2009 through interviews with 23 workers. The analysis revealed three themes: Actions and behaviors dependent on health workers; Routine practices as facilitators of work; and Restricting the parturients participation in the decision-making process. Some justifications for using the practices were: perpetuation of inappropriate models, facilitation of the care provided during delivery and authoritarianism that some workers impose over parturients in the erroneous belief that workers have all the knowledge.This study was performed with the objective of understanding the reasons why workers of a birthing center in southern Brazil use natural birth practices considered harmful by the World Health Organization. This exploratory study was performed in July 2009 through interviews with 23 workers. The analysis revealed three themes: Actions and behaviors dependent on health workers; Routine practices as facilitators of work; and Restricting the parturients participation in the decision-making process. Some justifications for using the practices were: perpetuation of inappropriate models, facilitation of the care provided during delivery and authoritarianism that some workers impose over parturients in the erroneous belief that workers have all the knowledge.

Considerações sobre a atenção domiciliária e suas aproximações com o mundo do trabalho na saúde

This paper discusses home care as a service that has expanded in the public and private health system, while arguing for the possibility that such care can leverage a significant impact on the populations quality of life and health. The article presents home care as a strategic possibility for reorganizing the health system, by means of integration between health workers and health institutions, and considers its possible political, economic, and technical impacts on the health system, health workers, and users of the service.

Participação da mulher no processo decisório no ciclo gravídico-puerperal: revisão integrativa do cuidado de enfermagem

This is an integrative review that aims to identify the contribution of nursing care for womans participation in the decision process of the pregnancy and puerperal cycle, as described in Brazilian scientific publications. The scientific productions were retrieved in May, 2010, from the Virtual Library of Health (Biblioteca Virtual em Saúde) database. From the eight articles reviewed, two themes stood out: Contributions of nursing care to the womans participation in the decision process of the pregnancy and puerperal cycle; and Limitations of nursing care to the womans participation in the decision process of the pregnancy and puerperal cycle. The following review supports the production of knowledge in nursing, by identifying a gap in what nurses know and do about this issue, as shown by the lack of nursing researches that concern, specifically, the participation of the woman in the decision process during the pregnancy and puerperal cycle and the possible contributions of nursing care to ensure women of this right.Trata-se de uma revisao integrativa que objetivou identificar a contribuicao do cuidado de enfermagem, descrito nas publicacoes cientificas nacionais, para a participacao da mulher no processo decisorio no ciclo gravidicopuerperal. As producoes cientificas foram buscadas em maio de 2010, nas bases de dados da Biblioteca Virtual em Saude. Dos oito artigos que compuseram a revisao, despontaram dois nucleos tematicos: Contribuicoes do cuidado de enfermagem a participacao da mulher no processo decisorio no ciclo gravidico-puerperal; e Limitacoes do cuidado de enfermagem a participacao da mulher no processo decisorio no ciclo gravidico-puerperal. A presente revisao traz subsidios para a producao do conhecimento da Enfermagem, ao identificar uma lacuna na area do conhecimento e atuacao dos enfermeiros, evidenciada pela inexistencia de pesquisas da Enfermagem que abordem, especificamente, a participacao da mulher no processo decisorio no ciclo gravidico-puerperal, e as possiveis contribuicoes do cuidado de enfermagem para a garantia desse direito.

Sistema de significados sobre a finalidade do trabalho na Saúde da Família: uma abordagem qualitativa

This exploratory study was performed to understand the system of meanings about the purpose of the nursing and medical work performed by Family Health teams, in the cities of Rio Grande and Pelotas (Brazil). Data collection was performed by semi-directed individual interviews. The interviews of 82 participants were recorded, and analyzed. The nuclear meaning of the purpose, as an end transmuted into the product of collective work, was in agreement with the possibility of the community implementing changes and acquiring healthy individual and collective behaviors. This gives evidence of the component of ethics in the process, by means of categories such as solidarity and compassion. This led to a marker, in the text production, of the human condition in the construction of the work purpose. Through the analysis and critical discussion of the theme, this study contributes to the macro-dimension of developing competencies and adjustment to the health needs of society.Se trata de un estudio exploratorio y descriptivo, con un abordaje cualitativo, objetivando comprender el sistema de significados sobre la finalidad del trabajo de enfermeros y medicos de los equipos de la Salud de la Familia, en las ciudades de Rio Grande y Pelotas. La entrevista dirigida parcialmente, individual y grabada, fue utilizada en la recoleccion de los datos, siguiendose un analisis tematico de las declaraciones de 82 participantes. El significado nuclear de la finalidad, como fin transmutado en producto del trabajo colectivo, se mostro de acuerdo con la posibilidad de realizar cambios y adquirir comportamientos individuales y colectivos saludables por parte de la comunidad, evidenciandose el componente etico en el proceso, por medio de categorias como la solidaridad y la compasion. De esto se derivo, en la produccion textual, un marcador de la condicion humana en la construccion de la finalidad del trabajo. Por medio del analisis y discusion critica de la tematica, este estudio contribuye para la dimension macro de la formacion de competencias y adecuacion a las necesidades sociales de salud.

Atenção domiciliária e direito à saúde: uma experiência na rede pública brasileira

OBJETIVO: Reflexionar de que forma la atencion domiciliaria ha contribuido para la salud de la poblacion. METODOS: Se proceso por medio de observacion de entrevistas (con: 7 usuarios, 22 trabajadores, 2 administradores y 3 representantes del Consejo Local de Salud) y de investigacion documental, entre marzo y julio de 2006, en una unidad de atencion primaria de salud de Porto Alegre, RS. RESULTADOS: Los resultados fueron sistematizados a partir de indicadores formulados y mostraron que los trabajadores y administradores entienden la atencion domiciliaria como relevante para la salud de la comunidad, sin embargo, no aplican esa comprension en su practica de trabajo. CONCLUSION: La atencion domiciliaria se ha realizado enfocando en la enfermedad, tiene como objeto de trabajo un sujeto individual, enfatiza el cuidado curativo y no desarrolla acciones intersectoriales. Por otro lado, busca ser resolutiva en el primer contacto, presta atencion continua y longitudinal, tiene territorio definido, promueve relaciones inter-personales (trabajadores y usuarios) y actua tratando de ofrecer un cuidado humanizado.

Atenção humanizada ao parto de adolescentes: análise das práticas desenvolvidas em um centro obstétrico

Estudo quantitativo que objetivou analisar as praticas desenvolvidas na assistencia a adolescente, a partir do relato dos trabalhadores de um Centro Obstetrico de um Hospital Universitario, com base na proposta de humanizacao do parto do Ministerio da Saude. Segundo os trabalhadores, estao sendo desenvolvidas praticas uteis na assistencia ao parto, dentre as quais as orientacoes sobre formas de relaxamento no trabalho de parto, o incentivo ao vinculo entre mae e filho e a amamentacao. Porem, o direito ao acompanhante nao vem sendo considerado. A posicao de litotomia e a padronizacao da tricotomia, episiotomia e amniotomia foram constatadas. Os registros dos prontuarios, dentre eles o partograma, a anamnese, e o exame fisico e obstetrico da parturiente mostraram-se insatisfatorios. Conclui-se que, no cenario investigado, sao desenvolvidas praticas consideradas adequadas e inadequadas, mostrando a necessidade de incentivar a utilizacao de procedimentos embasados em evidencia cientifica e inseridos na proposta de humanizacao do parto.Quantitative study that aimed to analyze the practices developed in assisting the adolescent, from the account of health workers, in an Obstetric Center in a teaching hospital, based on the proposal of humanization of parturition of the Health Ministry. According to the workers, useful practices in assisting parturition, among them, orientations about relaxation techniques at parturition, improving the attachment between mother and child, are being carried out. However, the right to a companion has not been taken into account. The lithotomy position and standardization of trichotomy, episiotomy e amniotomy were registered. Medical records, among them partogram, anamnesis and physical and obstetric exam of the parturient, proved to the unsatisfactory. We conclude that, in the scenario investigated, are developed practices considered appropriate and inappropriate, showing the need to further encourage the use of procedures grounded in scientific evidence and inserted into the proposal to the humanization of birth.

Direitos das parturientes: conhecimento da adolescente e acompanhante

Abstract This study aims to analyze the knowledge of adoles -cents and their companions regarding their rights concerning giving birth. It is a qualitative and exploratory investigation concerning an outline of research entitled: “Humanized Attention to Ado-lescents´ birth”. The study took place in a Teaching Hospital in Southern Brazil, and the subjects were adolescents who gave birth in the Unified Health System in that hospital and their family members. Knowing at least one right of the parturient in the Obstetric Center was the inclusion criterion of study. Data were extracted from interviews with 10 adolescents and 36 members of their families, from July 2008 to April 2009. Data analysis was performed according to the rights described by the Humanization Program of Prenatal Care and Birth guidelines. The right to a companion at the moment of giving birth was the most frequently mentioned. It is clear that there is lack of consideration, on the part of health workers, of indications and choice of procedures applied. Furthermore, lack of awareness of obstetric services users’ rights, as well as the lack of information and conditions to meet the standards established by the Ministry of Health on the part of the institutions, prove to be the reality. This finding calls for reflection on the quality and situation of public health services in terms of assistance to the users concerning their rights, particularly pregnant adolescents in perinatal care. Keywords: Women’s Health; Women’s Rights; Par-turition; Adolescent; Nursing.

How the workers of a birthing center justify using harmful practices in natural childbirth

This study was performed with the objective of understanding the reasons why workers of a birthing center in southern Brazil use natural birth practices considered harmful by the World Health Organization. This exploratory study was performed in July 2009 through interviews with 23 workers. The analysis revealed three themes: Actions and behaviors dependent on health workers; Routine practices as facilitators of work; and Restricting the parturients participation in the decision-making process. Some justifications for using the practices were: perpetuation of inappropriate models, facilitation of the care provided during delivery and authoritarianism that some workers impose over parturients in the erroneous belief that workers have all the knowledge.This study was performed with the objective of understanding the reasons why workers of a birthing center in southern Brazil use natural birth practices considered harmful by the World Health Organization. This exploratory study was performed in July 2009 through interviews with 23 workers. The analysis revealed three themes: Actions and behaviors dependent on health workers; Routine practices as facilitators of work; and Restricting the parturients participation in the decision-making process. Some justifications for using the practices were: perpetuation of inappropriate models, facilitation of the care provided during delivery and authoritarianism that some workers impose over parturients in the erroneous belief that workers have all the knowledge.

The effects, beliefs and practices of puerperal women's self-care

The objective of this exploratory-descriptive study was to identify the beliefs, effects and practices that permeate womens self-care during puerperium. The participants were fifteen puerperal women from Rio Grande/RS. Data collection was performed in September and October of 2010 using semi-structured interviews, performed between fifteen and thirty days postpartum. Thematic analysis was used. Two categories emerged regarding self-care during puerperium, which was performed based on the family guidance received at home. One referred to restrictions, or activities that should be avoided to prevent harm; the other involved encouragement, i.e., practices that promoted benefits to the puerperal woman or newborn. This study shows the importance of professionals being aware of the quarantine period, as it is a cultural heritage that remains in effect today. In conclusion, common knowledge is highly valued by these women, and despite the need for scientific evidence supporting such knowledge it was not a trigger for problems in either the mothers or infants in this study.Objetivou-se neste estudo exploratorio-descritivo conhecer as crencas, influencias e praticas que permeiam o autocuidado das mulheres no puerperio. Foram informantes quinze puerperas de Rio Grande-RS. Colheram-se os dados em setembro e outubro de 2010, com entrevistas semiestruturadas, realizadas entre quinze e trinta dias pos-parto. Adotou-se a analise tematica para o tratamento dos dados. Fundamentadas no cuidado/autocuidado durante o puerperio, o qual provinha da orientacao familiar realizada em âmbito domestico, delinearam-se duas categorias: uma referente a restricoes, aquilo que devia ser evitado por gerar maleficios; outra envolvendo incentivos, ou seja, praticas que traziam beneficios a puerpera ou ao recem-nascido. Este estudo mostra a importância dos profissionais terem consciencia a respeito da quarentena, pois e uma heranca cultural que ainda perdura nos dias atuais. Concluiu-se que o saber popular e muito valorizado por essas mulheres e, embora careca de embasamento cientifico, nao se mostrou como desencadeador de problemas ao binomio mae-bebe.

O discurso e a prática do parto humanizado de adolescentes

ABTRACT: This descriptive study aimed to identify the childbirth care practices developed by health professionals towards adolescent parturients. Data were collected from the database of the study “Humanizing Childbirth Care in Adolescents”, developed in the city of Pelotas-RS, by means of semi-structured interviews, between 2008 and 2009. The study population consisted of health workers from the obstetric center of a public teaching hospital. The analysis was systematized as per the guide Care in Normal Birth, published by the World Health Organization. Results evidenced that useful practices, such as intimacy and privacy, choice of the type of childbirth and breastfeeding encouragement are not respected. The harmful practices that stood out were the use of the lithotomy position and oxytocin. Examples of practices that are frequently developed inappropriately are food restriction and the use of amniotomy. In conclusion, childbirth care practices partially complied with the Humanizing Labor and Childbirth Policy. DESCRIPTORS: Adolescent. Women’s health. Humanizing childbirth. Nursing.ABTRACT: This descriptive study aimed to identify the childbirth care practices developed by health professionals towards adolescent parturients. Data were collected from the database of the study “Humanizing childbirth care in adolescents”, developed in the city of Pelotas-RS, by means of semi-structured interviews, between 2008 and 2009. The study population consisted of health workers from the obstetric center of a public teaching hospital. The analysis was systematized as per the guide Care in Normal Birth, published by the World Health Organization. Results evidenced that useful practices, such as intimacy and privacy, choice of the type of childbirth and breastfeeding encouragement are not respected. The harmful practices that stood out were the use of the lithotomy position and oxytocin. Examples of practices that are frequently developed inappropriately are food restriction and the use of amniotomy. In conclusion, childbirth care practices partially complied with the Humanizing Labor and Childbirth Policy. DESCRIPTORS: Adolescent. Women’s health. Humanizing delivery. Nursing.