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OBJECTIVE: to understand humanization practices in the parturitive course from the point of view of purperae and nurse-midwives. METHODS: an exploratory, descriptive, qualitative research carried out in a maternity hospital in Bahia State. Semi-structured interviews were carried out, with a structured script applied to 11 mothers and 5 nurse-midwives from March to June 2019. Analysis followed Bardin's content structure. RESULTS: this study unveiled the importance of using soft care technologies, respect for female role, active participation and women's autonomy as a positive impact on the parturition process. FINAL CONSIDERATIONS: nurse-midwives are qualified professionals to assist women in labor and birth. They can favor the implantation and implementation of care with humanization practices, respect for women's choices and incentive to the normal way of delivery with an expanded view of individual and multidisciplinary needs.

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OBJECTIVES: to analyze nursing actions involving health advocacy in the context of primary health care and the consolidation of this right to health. METHODS: this is an integrative literature review with content analysis of the results on health advocacy and its relationship with nursing in the context of primary health care. RESULTS: the content analysis of the seven selected studies resulted in two thematic categories: "Right to health - a complex and progressive consolidation movement in Brazil" and "Advocacy in health and nursing". CONCLUSIONS: despite the difficulties in defining the concept of health advocacy, nurses, in their practice, act with innovative alternatives to daily conflicts, exercising the users' right to health in their relationships with health team members and the community.

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ABSTRACT Objectives: to analyze nursing actions involving health advocacy in the context of primary health care and the consolidation of this right to health. Methods: this is an integrative literature review with content analysis of the results on health advocacy and its relationship with nursing in the context of primary health care. Results: the content analysis of the seven selected studies resulted in two thematic categories: "Right to health - a complex and progressive consolidation movement in Brazil" and "Advocacy in health and nursing". Conclusions: despite the difficulties in defining the concept of health advocacy, nurses, in their practice, act with innovative alternatives to daily conflicts, exercising the users' right to health in their relationships with health team members and the community.

RESUMEN Objetivos: analizar las acciones de enfermería que involucran la defensa de la salud en el contexto de la atención primaria de salud y la consolidación de este derecho de salud. Métodos: esta es una revisión integrativa de la literatura con análisis de contenido de los resultados sobre la defensa de la salud y su relación con la enfermería en el contexto de la atención primaria de salud. Resultados: del análisis de contenido de los siete estudios seleccionados se originaron dos categorías del tema: "Derecho de salud: un movimiento complejo y progresivo de consolidación en Brasil" y "Defensa en salud y enfermería". Conclusiones: a pesar de las dificultades para definir el concepto de defensa de la salud, las enfermeras, en su práctica, actúan con alternativas innovadoras a los conflictos diarios, practicando el derecho de los usuarios a la salud en sus relaciones con miembros del equipo de salud y la comunidad.

RESUMO Objetivos: analisar as ações de enfermagem que envolvem advocacia em saúde no âmbito da atenção primária à saúde e a consolidação deste direito à saúde. Métodos: trata-se de um estudo de revisão integrativa da literatura com análise de conteúdo dos resultados sobre a advocacia em saúde e sua relação com a enfermagem no contexto de atenção primária à saúde. Resultados: da análise de conteúdo dos sete estudos selecionados, originaram-se duas categorias do tema: "Direito à saúde - um movimento complexo e progressivo de consolidação no Brasil" e "Advocacia em saúde e Enfermagem". Conclus ões: apesar das dificuldades de definição do conceito de advocacia em saúde, os enfermeiros, em sua prática, atuam com alternativas inovadoras aos conflitos diários, exercendo o direito à saúde dos usuários em suas relações com membros da equipe de saúde e a comunidade.

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ABSTRACT Objective: to understand how nurses deal with the elderly's autonomy at the end of life. Method: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. Results: nurses deal with the elderly's autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. Final considerations: the elderly's autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on "Living Wills" Health Care Directives and principles of palliative care must be encouraged.

RESUMEN Objetivo: comprender la forma en que los enfermeros se ocupan de la autonomía del anciano en relación con el fin de la vida. Método: estudio cualitativo, exploratorio, guiado por la Teoría Fundamentada en los Datos. Diez enfermeros, ocho médicos y 15 técnicos de enfermería fueron entrevistados entre noviembre de 2016 y mayo de 2017, en un hospital universitario, en Río de Janeiro/Brasil. Resultados: los enfermeros lidian con la autonomía del anciano en atención al código de ética y ejercen el liderazgo en las acciones e interacciones para defender este derecho, evaluando, orientando y escuchando las preferencias de los ancianos; interactuando con la familia; y compartiendo información con el equipo de salud. Consideraciones finales: la autonomía de los ancianos debe ser asegurada en la planificación asistencial, teniendo como base la comunicación centrada en el paciente y desarrollada en el proceso interacional entre los agentes involucrados en el cuidado. Es necesario fomentar la discusión sobre las Diretivas Antecipadas de Vontades (Directivas Anticipadas de Voluntades) y sobre los principios de los cuidados paliativos.

RESUMO Objetivo: compreender a forma como os enfermeiros lidam com a autonomia do idoso na terminalidade da vida. Método: estudo qualitativo, exploratório, guiado pela Teoria Fundamentada nos Dados. Dez enfermeiros, oito médicos e 15 técnicos de enfermagem foram entrevistados entre novembro de 2016 e maio de 2017, em um hospital universitário, no Rio de Janeiro/Brasil. Resultados: os enfermeiros lidam com a autonomia do idoso em atendimento ao código de ética e exercem a liderança nas ações e interações para defender este direito, avaliando, orientando e ouvindo as preferências dos idosos; interatuando com a família; e compartilhando informações com a equipe de saúde. Considerações finais: a autonomia dos idosos deve ser assegurada no planejamento assistencial, tendo como base a comunicação centrada no paciente e desenvolvida no processo interacional entre os agentes envolvidos no cuidado. É preciso fomentar a discussão sobre as Diretivas Antecipadas de Vontades e sobre os princípios dos cuidados paliativos.

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OBJECTIVE: to understand how nurses deal with the elderly's autonomy at the end of life. METHOD: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. RESULTS: nurses deal with the elderly's autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. FINAL CONSIDERATIONS: the elderly's autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on "Living Wills" Health Care Directives and principles of palliative care must be encouraged.

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OBJECTIVE: To explore the actions and factors associated to patient advocacy by intensivist nurses using the Protective Nursing Advocacy Scale. METHOD: A quantitative, descriptive-exploratory, cross-sectional study. The questionnaire was answered by nurses who worked in Intensive Care Units in the South and Southeast regions of Brazil. A factorial exploratory analysis of the data, T-tests and the chi-square test were used for association between factors. RESULTS: 451 nurses participated in the study. A greater number of nurses disagreed with the negative consequences that patient advocacy may have or bring to them. Greater dialogue among nursing staff would enhance teamwork results. Nurses with two or more job relationships need more physical and mental effort, which compromises their quality of life and work, leading to them being those who least practice patient advocacy. CONCLUSION: Nurses understand patient advocacy as an important part of their work, as well as factors which may influence their decision to defend their patients, but are still unaware of the benefits of advocacy.

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Children with HIV are dependent on taking continuous medication and care, and family preparation is required when disclosing HIV. This study aimed to unveil families' experiences with HIV disclosure to children under 13 years old. Eight family members who have disclosed HIV to seropositive children were interviewed in-depth and individually. The fieldwork took place at a public paediatric outpatient hospital in Rio de Janeiro. The results showed that the family members' discourse highlighted two ways of knowing their own condition and disclosing the condition of the children with HIV. First, they needed to address the communication of bad news and discover their own HIV status through their children's disease. Second, the disclosure was a process constituted by four stages: preparing for disclosure, identifying the time, deciding how and where to tell, and instilling silence after disclosure. They also recognized that nurses had a role in the process as part of an interprofessional team. Nurses can develop advocacy care and empower family members in the preparation of safe HIV disclosure. By systematizing and institutionalizing the care advocacy process, nurses may enable caretakers and children to participate in their therapeutic management, improving adherence to the treatment and self-care with autonomy.

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The Community Advocacy Project is an evidence-based practice that has been shown to lead to numerous positive changes in the lives of intimate partner violence (IPV) survivors. Prior research conducted in the Midwest United States, and with primarily African American and Anglo American survivors, has shown that this short-term, community-based advocacy intervention results in increased safety and quality of life even 2 years after the intervention ends. The current study describes the process of culturally adapting and disseminating this program in Monterrey, Mexico, with a sample of low-income Mexican IPV survivors exposed to a variety of considerable contextual stressors. Interviews were conducted with advocates, advocate supervisors, and survivors to examine the acceptability and utility of the intervention. Twenty-seven IPV survivors, seven advocates, and four advocate supervisors participated in the intervention research. Advocates and their supervisors were highly laudatory, believing the intervention to be culturally relevant and effective. Encouraging changes were found for survivors as well, with positive changes over time being found on safety, quality of life, social support, and depression.

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OBJECTIVE: The objective of the study was to analyze criticisms, compliments and suggestions of users, family and workers, placed in an Ombudsman of a Centro de Atenção Psicossocial para Álcool e outras Drogas (Psychosocial Care Centers for Alcohol and Other Drugs- CAPS ad). METHOD: A study carried out in the CAPS ad of Macapá-AP from August to December 2016, through the thematic content analysis of the files deposited in the ombudsman, recently introduced in the service, containing criticisms, compliments and suggestions from users, family members, and CAPS ad. RESULTS: It was observed the dissatisfaction with the infrastructure of the CAPS ad, and with the relationships built between users and professionals, in addition, suggestions were given of workshops, and improvement in the development of the Projeto Terapêutico Singular (freely translated as Unique Therapeutic Project). FINAL CONSIDERATIONS: It is concluded that the multidisciplinary team needs to put in practice the real psychosocial care in the service, and that the management helps in the improvement of the service's place, and in the proposal of qualifications to this team.

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ABSTRACT Objective: Identify the barriers and facilitators of health advocacy to users delivered by nurses from the Family Health Strategy. Method: Qualitative study carried out with nurses from the Family Health Strategy of a city in the south of Brazil. Study participants were 15 nurses, who were interviewed. The content of the interviews was recorded, transcribed and analyzed in the light of the discursive text analysis. Results: Two categories emerged, one about the lack of organization at the workplace, bureaucracy and limitations to professional work in health environments, and another about the facilitating aspects to exercise advocacy both individually and collectively. Conclusion: When nurses, provided with technical, scientific and relational knowledge, are empowered to make decisions, they are not only supported by other professionals at work but also develop actions of health advocacy to users, thus qualifying the care delivered.

RESUMEN Objetivo: Identificar las barreras y facilitadores de la acción política en salud de los usuarios por parte de enfermeros de Estrategia Salud de la Familia. Método: Estudio cualitativo realizado con enfermeros de Estrategia Salud de la Familia en ciudad del Sur de Brasil. Participaron 15 enfermeros mediante entrevistas grabadas, transcriptas y analizadas por análisis textual discursivo. Resultados: Surgieron dos categorías, una discurriendo sobre falta de organización del trabajo, la burocracia y las limitaciones de actuación profesional en ámbitos sanitarios, y otra sobre aspectos facilitadores para el ejercicio de la acción política de modo colectivo e individual. Conclusión: Cuando el enfermero, poseedor de conocimientos técnicos, científicos y de relación, desarrolla su autonomía para toma de decisiones, contando con el apoyo de otros colegas profesionales. Consigue desarrollar acciones políticas en salud para los usuarios, calificando así la atención brindada.

RESUMO Objetivo: Identificar as barreiras e facilitadores da advocacia em saúde dos usuários por enfermeiros da Estratégia Saúde da Família. Método: Estudo qualitativo realizado com enfermeiros da Estratégia Saúde da Família em uma cidade no sul do Brasil. Participaram 15 enfermeiros mediante uso de entrevistas gravadas, transcritas e analisadas à luz da análise textual discursiva. Resultados: Emergiram duas categorias, uma discorrendo sobre a falta de organização do trabalho, da burocracia e das limitações para atuação profissional nos ambientes de saúde e outra sobre os aspectos facilitadores para o exercício da advocacia de forma individual e coletivamente. Conclusão: Quando o enfermeiro, imbuído dos saberes técnicos, científicos e de relacionamento, desenvolve sua autonomia na tomada de decisões, além de contar com o apoio de outros profissionais no trabalho, consegue desenvolver ações de advocacia em saúde aos usuários e, assim, qualifica o cuidado prestado.

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OBJECTIVE: Identify the barriers and facilitators of health advocacy to users delivered by nurses from the Family Health Strategy. METHOD: Qualitative study carried out with nurses from the Family Health Strategy of a city in the south of Brazil. Study participants were 15 nurses, who were interviewed. The content of the interviews was recorded, transcribed and analyzed in the light of the discursive text analysis. RESULTS: Two categories emerged, one about the lack of organization at the workplace, bureaucracy and limitations to professional work in health environments, and another about the facilitating aspects to exercise advocacy both individually and collectively. CONCLUSION: When nurses, provided with technical, scientific and relational knowledge, are empowered to make decisions, they are not only supported by other professionals at work but also develop actions of health advocacy to users, thus qualifying the care delivered.

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ABSTRACT Objective: The objective of the study was to analyze criticisms, compliments and suggestions of users, family and workers, placed in an Ombudsman of a Centro de Atenção Psicossocial para Álcool e outras Drogas (Psychosocial Care Centers for Alcohol and Other Drugs- CAPS ad). Method: A study carried out in the CAPS ad of Macapá-AP from August to December 2016, through the thematic content analysis of the files deposited in the ombudsman, recently introduced in the service, containing criticisms, compliments and suggestions from users, family members, and CAPS ad. Results: It was observed the dissatisfaction with the infrastructure of the CAPS ad, and with the relationships built between users and professionals, in addition, suggestions were given of workshops, and improvement in the development of the Projeto Terapêutico Singular (freely translated as Unique Therapeutic Project). Final considerations: It is concluded that the multidisciplinary team needs to put in practice the real psychosocial care in the service, and that the management helps in the improvement of the service's place, and in the proposal of qualifications to this team.

RESUMEN Objetivo: El objetivo del estudio fue analizar las críticas, elogios y sugerencias de los usuarios, familiares y trabajadores colocados en la Audiencia de un Centro de Atención Psicosocial para Alcohol y otras drogas (CAPS ad). Método: Estudio realizado en el CAPS ad de la ciudad Macapá, estado de Amapá desde el agosto hasta el diciembre 2016, a través del análisis temático de contenido de los archivos depositados en la audiencia, recién implantada en el servicio, conteniendo críticas, elogios y sugerencias de usuarios, familiares, y trabajadores del CAPS ad. Resultados: Se observó la insatisfacción con la infraestructura del CAPS ad, y con las relaciones construidas entre usuarios y profesionales. Además, se presentaron sugerencias de talleres, y de mejora en la construcción del proyecto terapéutico singular. Consideraciones finales: Se concluye sobre la necesidad de que el equipo multidisciplinario ponga en práctica la real atención psicosocial en el servicio, y que la gestión auxilie en la mejora del local del servicio, y en la proposición de capacitaciones a ese equipo.

RESUMO Objetivo: O objetivo do estudo foi analisar as críticas, elogios e sugestões dos usuários, familiares e trabalhadores, colocadas na Ouvidoria de um Centro de Atenção Psicossocial para Álcool e outras drogas (CAPS ad). Método: Estudo realizado no CAPS ad de Macapá-AP no período de agosto a dezembro de 2016, por meio da análise temática de conteúdo das fichas depositadas na ouvidoria, recém implantada no serviço, contendo críticas, elogios e sugestões de usuários, familiares, e trabalhadores do CAPS ad. Resultados: Observou-se a insatisfação com a infraestrutura do CAPS ad, e com as relações construídas entre usuários e profissionais, além disso, foram apresentadas sugestões de oficinas, e de melhora na construção do Projeto Terapêutico Singular. Considerações finais: Conclui-se sobre a necessidade de a equipe multidisciplinar colocar em prática a real atenção psicossocial no serviço, e que a gestão auxilie na melhora do local do serviço, e na proposição de capacitações à essa equipe.

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Em autopoise e reforma psiquiátrica Roberto Tykanori conseguiu integrar sua experiência política e clínica com erudição filosófica. O livro analisa a reforma psiquiátrica e a constituição da política em saúde mental, no Brasil, de um modo inovador e instigante. O conceito orientador de sua investigação é o de autopoiese, a capacidade dos seres humanos de produzirem instituições e também a sua própria existência.

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A falta de adesão ao tratamento e a consequente falta de controle da hipertensão arterial (HA) representam um grande desafio à Atenção Primária no Brasil. Compreender a relação subjetiva dos portadores de HA com a enfermidade pode ampliar as possibilidades de medidas de controle da HA mais efetivas. O objetivo deste trabalho foi conhecer e analisar as representações sociais de mulheres portadoras de HA sobre a doença e seu convívio familiar. Fizeram parte do estudo 26 mulheres diagnosticadas com HA e cadastradas em uma Unidade de Atenção Primária à Saúde do município de Porto Firme, MG. O estudo fundamentou-se na pesquisa qualitativa e elegeu as representações sociais como princípio teórico-metodológico. Os dados, obtidos por meio de grupos focais, entrevistas individuais e anotações em diário de campo, foram examinados através da análise de conteúdo. Nas análises emergiram os atrativos semânticos que retratavam as representações das mulheres sobre HA - efeitos psicológicos/sentimentos ligados ao diagnóstico da HA; o cotidiano do portador de HA e as mudanças em seu dia a dia;e o convívio familiar com HA - por meio das quais se identificaram diferentes dimensões e espaços ligados à adesão, no âmbito individual e coletivo, destacando-se o acesso à informação associado ao suporte social como fator favorável à adesão ao tratamento.

The lack of compliance with treatment and the consequent lack of control of hypertension represent a major challenge to primary care in Brazil. Understanding the subjective relationship of patients with hypertension can expand the possibilities of more effective control measures. The aim was to understand and analyze the social representations of women with hypertension about the disease and their family environment. Study participants were 26 women diagnosed with hypertension and registered in a Unit of Primary Health Care in the city of Porto Firme, Brazil. The study was based on qualitative research and elected social representations as theoretical and methodological principle. The data, collected through focus groups, interviews and notes in a diary, were examined through content analysis. In the analysis emerged semantic attractions depicting the representations of women on hypertension - psychological effects and feelings related to the diagnosis of hypertension; daily life of patients with hypertension and changes in their daily lives; and family life with hypertension - through which have identified different dimensions and spaces connected to membership, both individually and collectively, emphasizing access to information associated with social support as a factor in favor of compliance with the treatment.

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En primer término, se exponen unas ideas generales en el ámbito de las reflexiones bioéticas sobre cómo debe plantearse en su conjunto el problema de la dignidad humana. Después, algunas anotaciones muy concretas sobre las manifestaciones fenomenológicas y sobre las exigencias bioético-médicas de esa nobleza (AU)

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Bioética é um tema em pauta na atualidade e considerar o fato de revelar ou não ao paciente sua real situação clínica é ponto essencial e controverso no meio médico. Considerar que o não-revelar é proteger o paciente e que contar seria ato somente provocador de sofrimento é entendimento ultrapassado. Na atualidade o importante não é decidir se a verdade será dita ao paciente, mas se perguntar: "como compartilhar o que eu sei com o meu paciente". O porquê e como fazê-lo é o que os autores pretendem analisar

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