Revisão sistemática de literatura e metassíntese qualitativa: considerações sobre sua aplicação na pesquisa em enfermagem

Institutional Violence Perpetrated against Transgender Individuals in Health Services: A Systematic Review of Qualitative Studies

This review aims to analyze the evidence related to violence perpetrated against transgender individuals in health services based on their narratives. This is a systematic literature review of qualitative studies. A search was carried out in the Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and MEDLINE databases using the descriptors "transgender people", "violence", and "health services". The eligibility criteria included original qualitative articles addressing the research question, with fully available text, reporting violence specifically by health workers, involving trans individuals aged 18 and above, and published in Portuguese, English, or Spanish. In addition, studies were included that reported experiences of violence suffered by the trans population, through their narratives, in health services. A total of 3477 studies were found, of which 25 were included for analysis. The results highlighted situations such as refusal of service; resistance to the use of social names and pronouns; barriers to accessing health services; discrimination and stigma; insensitivity of health workers; lack of specialized care and professional preparedness; and a system focused on binarism. The analysis of the studies listed in this review highlights the multiple facets of institutional violence faced by the transgender population in health services. It is evident that the forms of violence often interlink and reinforce each other, creating a hostile environment for the transgender population in health services. Thus, there is an urgent need to create strategies that ensure access to dignified and respectful care for all individuals, regardless of their gender identity.

Support for Mothers, Fathers, or Guardians of Transgender Children and Adolescents: A Systematic Review on the Dynamics of Secondary Social Networks

Mothers', fathers', or guardians' support for disclosures of diverse gender identity has significant relationships with decreased suicidality for transgender children and adolescents. They play an essential role in facing transphobia, protecting trans children, and strengthening the expression of their identity. These guardians need structural, emotional, and informative support; they need to be prepared to recognize and manage of their own feelings, as well as deal with the challenges that come with new social contexts of transphobia in schools, health institutions, and other community spaces. This study aimed to analyze the scientific evidence on the dynamics of secondary social networks to support mothers, fathers, or guardians of transgender children and adolescents. This is a systematic review of qualitative studies, guided by PRISMA guidelines. Controlled and free vocabularies were used to survey the primary studies in the following databases: EMBASE; Scopus; MEDLINE; Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycInfo; Latin American and Caribbean Literature in Health Sciences (LILACS); and Web of Science. A total of 28 articles made up the final sample of this review. Secondary social networks were described as fragile, characterized by conflicting and broken ties with healthcare services and professionals, isolation and unpreparedness from schools, and emotional and informational support from peer groups and some qualified healthcare professionals. The literature shows the potential of the dynamics of secondary social support networks; however, it presented the unpreparedness of professionals and institutional policies for welcoming transgender children and adolescents and their families, with the peer group being the main emotional and informative support network.

Dynamics of Primary Social Networks to Support Mothers, Fathers, or Guardians of Transgender Children and Adolescents: A Systematic Review

Mothers, fathers, or guardians of children and adolescents who do not identify with the gender they were assigned at birth face barriers in their social network to recognize their children’s gender identity. This study aimed to analyze the scientific evidence on the dynamics of primary social networks to support mothers, fathers, or guardians of transgender children and adolescents. This is a systematic review of qualitative studies guided by the PRISMA guidelines. Controlled and free vocabulary were used to survey the studies in the EMBASE, Scopus, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science databases. A total of 21 studies composed the final sample. Primary social networks were described as fragile and conflicting family/blood relationship ties with disapproval, isolation, rejection, a lack of understanding, and feelings of exclusion were expressed. Some have lost friends, reported tension in marriage and with relatives, and were commonly treated with hostility and harassment. Social transition does take place in the mutual context of struggle and resistance which demands a support network for parents or guardians.

Reforma Sanitária Brasileira: uma revisão sobre os sujeitos políticos e as estratégias de ação

RESUMO O objetivo deste trabalho foi analisar a produção científica sobre o Movimento da Reforma Sanitária Brasileira, buscando caracterizar os sujeitos envolvidos e as estratégias adotadas. Para isso, foi efetuada uma revisão sistemática de artigos indexados no Portal de periódicos da Capes, na SciELO e na Biblioteca Virtual em Saúde. Os resultados evidenciam a diversidade de olhares acerca dos sujeitos individuais e coletivos que são considerados como integrantes do ‘movimento sanitário’. O Centro Brasileiro de Estudos de Saúde (Cebes) é o ator mais analisado, mas algumas produções direcionam atenção específica a outras organizações. O protagonismo de cada um desses sujeitos varia em cada artigo e depende também do momento histórico analisado. No que se refere às estratégias, destacam-se tanto a ocupação de espaços no aparelho estatal quanto a produção e divulgação de propostas relacionadas com a defesa do direito universal à saúde e com os diversos aspectos da construção do Sistema Único de Saúde. Além disso, foi identificada uma lacuna na produção científica analisada, porquanto os autores dedicam pouca atenção à caracterização dos sujeitos que compõem o ‘movimento’, aspecto essencial para compreender os conflitos e interesses envolvidos na luta política em torno do processo da reforma sanitária.

Estudos sobre o Movimento da Reforma Sanitária Brasileira: olhares diversos sobre um mesmo fenômeno

RESUMO A Reforma Sanitária Brasileira tem sido estudada com apoio de diferentes referenciais teórico--metodológicos, e essa variedade de abordagens motivou esta pesquisa. Portanto, o objetivo deste artigo foi analisar estudos sobre o movimento sanitário, publicados entre 1987 e 2019, a partir de uma revisão sistemática de 28 artigos selecionados, entre 426 capturados, no ‘Portal de periódicos da Capes’, na ‘SciELO’ e na ‘Biblioteca Virtual em Saúde’. Os resultados apontam que a maioria dos autores são sujeitos engajados ética e politicamente no movimento e utilizam, em grande medida, a abordagem marxista. Em relação às fontes de informação, foram priorizadas a pesquisa bibliográfica e a consulta a documentos institucionais ou publicizados pelas entidades da Reforma Sanitária Brasileira. Poucos estudos, entretanto, explicitaram claramente as estratégias metodológicas e o embasamento teórico utilizado para realizar a análise textual. Conclui-se que a escolha dos referenciais teórico-metodológicos está relacionada com a trajetória profissional e política dos autores, impactando diretamente na delimitação dos objetos de estudo e, consequentemente, no alcance e nos resultados das análises sobre o movimento sanitário.

Percepção de familiares de pessoas com transtornos alimentares acerca do tratamento: uma metassíntese da literatura

Resumo Relações familiares parecem ter uma contribuição relevante na etiopatogenia dos transtornos alimentares (TAs), o que faz com que as diretrizes internacionais de tratamento recomendem a participação da família. Esta metassíntese teve como objetivo sintetizar e reinterpretar os resultados de estudos qualitativos primários sobre a percepção de familiares de pessoas com TAs acerca do tratamento. A estratégia de busca foi organizada utilizando-se a ferramenta SPIDER e as análises foram realizadas por dois revisores independentes. A partir de 1.115 estudos originariamente recuperados de 6 bases de dados (CINAHL, LILACS, PsycINFO, PubMed, Scopus e Web of Science), foram selecionados 19 artigos. Os resultados convergem para o reconhecimento de que a família é parte do processo saúde-doença e precisa ser considerada como destinatária de cuidados, não apenas como coadjuvante/acompanhante no cuidado à pessoa acometida. Como a dinâmica familiar tem contribuição relevante no desenvolvimento e na manutenção dos TAs, é necessário investir na transformação das relações familiares para que se possam obter ganhos mais efetivos e duradouros no tratamento.

Perception of family members of people with eating disorders about treatment: a metasynthesis of the literature,

Abstract Family relationships seem to have a relevant contribution to the etiopathogenesis of eating disorders (EDs), which makes the international treatment guidelines recommend family participation. This study aimed to synthesize and reinterpret the findings of primary qualitative studies about the perception of family of people with EDs about treatment. The search strategy was organized using the SPIDER tool, and the analyzes were carried out by two independent reviewers. From 1115 studies originally retrieved from six databases (CINAHL, LILACS, PsycINFO, PubMed, Scopus and Web of Science), 19 articles were selected. The results converge to the recognition that the family is part of the process and also needs to be considered as a care recipient, not just as a coadjuvant/companion for the patient. Since family dynamics have a relevant contribution in the development and maintenance of EDs, it is necessary to invest in the transformation of family relationships so that more effective and lasting gains in treatment can be obtained.

Corpos em Evidência: Contribuição do Mapa Corporal Narrado em Pesquisas com Populações Vulnerabilizadas

Resumo O mapa corporal narrado é uma metodologia cada vez mais empregada em pesquisa. O objetivo deste estudo foi realizar uma metassíntese para sintetizar, interpretar e analisar resultados de evidências qualitativas de pesquisas sobre mapa corporal narrado com populações vulnerabilizadas e compreender que lacuna na produção de conhecimento o seu uso visa a suprir. As bases de dados/bibliotecas foram Web of Science, Proquest, BVS, Scopus, Ebsco, SciELO e PubMed, resultando em 4.050 registros. Após a aplicação dos critérios de inclusão/exclusão, foram recuperados oito artigos. A síntese das evidências qualitativas foi organizada em três categorias de análise: (1) inovação criativa; (2) potencial terapêutico; (3) metodologia emancipatória. Conclui-se que a ferramenta alinha-se com o paradigma emancipatório e crítico e dialoga com a psicologia clínica e comunitária.

Conferências de saúde: metassíntese de boas práticas, obstáculos e recomendações a partir de experiências no Brasil, 1986-2016

Resumo O estudo teve como objetivo identificar evidências produzidas sobre as conferências de saúde brasileiras e sistematizar boas práticas, obstáculos e recomendações para qualificar a participação social no Sistema Único de Saúde. A metodologia utilizada foi revisão de literatura com análise do tipo metassíntese, a partir da busca nos portais Bireme e Pubmed de estudos publicados entre 1986 e 2016. A busca resultou em 507 artigos, dos quais 15 atendiam ao critério de ser estudo qualitativo primário sobre conferências de saúde brasileiras. A maior parte dos estudos eram relatos de experiência, de âmbito municipal, publicados nos últimos 10 anos. A metassíntese possibilitou sistematizar os resultados em avanços, obstáculos e recomendações para as conferências, de acordo com distintos eixos: papel, divulgação, participação, organização e encaminhamentos. Verificou-se que, apesar da importância das conferências para democratizar o sistema de saúde e das inovações no formato e na organização delas, o acesso e a participação precisam ser qualificados, com maior divulgação, mobilização da população, empoderamento, formação política e articulação com outros espaços de debate. As recomendações tiveram destaque pelas propostas para enfrentar os obstáculos apresentados, sobretudo com a necessidade de monitoramento, aprimoramento da articulação com os conselhos de saúde e maior influência das resoluções das conferências sobre a gestão.

A Meta-summarization of Qualitative Findings About Health Systems Performance Evaluation Models: Conceptual Problems and Comparability Limitations

Due to the replacement of the issue of performance measurement in health policies worldwide this study identifies and analyzes the models for evaluating health systems performance. For this purpose, a systematic review of the literature on the topic "health systems performance evaluation" is done, making it compatible with a qualitative meta-synthesis of the type "meta-summarization." It works with all databases related to the theme (PubMed, Scopus, EMBASE, PubAdm and Lilacs/Scielo). Portuguese, English, and Spanish are elected as language limit. Of the total number of articles (n = 32), 23 articles (71.8%) do not have a definition on "performance." In those who have a definition, "performance" could be summed up in 6 central ideas. Among the most frequent subsidiary concepts that makes up the performance idea are the concepts of "efficiency" (11.9%), "quality" (9.5%) and "effectiveness" (7.1%). Six models were found in this review: "dashboard," "balanced scorecard," "open system model," "PCATool," "analyze dimension and performance indicators" and "standardized checklist and interview." The "dashboard" was the most frequent performance evaluation model, found in 35.7% of studies. Only 25% of the reviewed studies presented the performance evaluation model applied specifically to health systems. Far from being configured as management tools useful to comprehension of health systems, these performance evaluation models have shortcomings that compromise their systemic evaluative power. This reinforces the inversion of reality in the relationship between quality and performance. Also, the performance evaluation models used try to adapt to the object, however in most them with relevant analytical problems compromising the specificities in depth of the health system under analysis. This generates inaccuracies and replaces the question about its use and their limitations to compare health systems.

[Systematic review on bullying and family: an analysis based on bioecological systems]

OBJECTIVE

Analyze the relationships between family context and involvement in school bullying.

METHODS

The following databases were searched: Web of Science, PsycoInfo, Pub-Med, Lilacs and SciELO virtual library, using the terms bullying, family and parents. A total of 61 papers met the eligibility criteria. The corpus was analyzed through the Bioecological Development Framework.

RESULTS

The experiences of students experiencing situations of bullying are multifaceted and are related to the family context. Elements from the microsystem, such as violence in the family, parental practices, environment and type of family arrangements, were the elements more frequently explored and related to bullying, though the relationships of parents with the children's friends, the parents' education and socioeconomic conditions, along with the exo, meso and macro systems were also related to bullying.

CONCLUSION

The review contributes to the literature by broadening the approach to this phenomenon that affects the health and development of children and adolescents.

Repercussions on the family from the birth and care of children with multiple disabilities: a qualitative meta-synthesis

Multiple disabilities in children, present in various syndromes, involve physical, economic, and social problems and affect the parents of these children and their families. The attempt to learn more about this problem from a qualitative perspective gave rise to the current study's objective, namely to identify and summarize the scientific literature on the repercussions on the family from the birth and care of a child with multiple disabilities. This is a qualitative meta-synthesis of data from Scopus, PsycInfo, and SciELO, using the following descriptors: qualitative; children with disabilities; parent-child relations; family relations; and caregivers. The data were analyzed in three stages according to the method proposed by Noblit & Hare: extraction of first-order concepts; production of second-order concepts; and interpretative synthesis. After the search and eligibility process, eight studies were included, from which emerged six second-order concepts: social restriction; strain on family relations; feelings of affliction; financial instability; changes in the family dynamics; and stress to health and wellbeing. Three syntheses were developed, based on these concepts: disability and ideal parenthood; burden of care; and family redefinitions and adaptations. The studies showed that parents and families experience difficulties resulting from social representations of multiple disabilities and the burden of care (health problems, limitations to other activities, increased financial costs, and changes in the family's routine). They also indicate that these elements invade and can interfere in family and social relations.

BREAST RECONSTRUCTION FROM THE PERSPECTIVE OF WOMEN SUBMITTED TO MASTECTOMY: A META-ETNOGRAPHY

ABSTRACT Objective: to analyze qualitative studies published in the national and international scientific literature on breast reconstruction after mastectomy for breast cancer, from the perspective of women. Method: systematic literature review using meta-ethnography, where the synthesis of knowledge is based on the induction and interpretation of the data found. Searches in the electronic databases identified 65 studies. 27 studides meet the inclusion and exclusion criteria. 13 studies compressed the analytical corpus of the review, according to the Critical Appraisal Skills Programme checklist. The data were synthesized by means of the meta-ethnographic approach. Results: the analyzed studies showed similarities regarding the women´s decision to perform breast reconstruction, the difficulty of choosing the type of surgery and to deal with the experience of the reconstruction, and that the women had difficulties in establishing relationships with certain health professionals, especially with doctors. They refer to the ambivalence of feelings regarding the expectations and results of breast reconstruction and complex process of "carrying on". Conclusion: this review synthesizes the scientific knowledge regarding women's perspective regarding the breast reconstruction process and highlights that health professionals must understand the perceptions of women undergoing mastectomy and breast reconstruction in order to improve the care provided.

VIOLÊNCIA DOMÉSTICA OU VIOLÊNCIA INTRAFAMILIAR: ANÁLISE DOS TERMOS

Resumo Os termos Violência Doméstica (VD) e Violência Intrafamiliar (VI) são identificados na literatura com significados ora semelhantes, ora distintos. O objetivo deste trabalho foi identificar, analisar e compreender o uso dos termos VD e VI em artigos acadêmicos na área da psicologia. O método utilizado foi a revisão sistemática. Os termos VD e VI foram pesquisados nos artigos on-line da Revista Psicologia & Sociedade. Identificaram-se 46 artigos, sendo o uso do termo VD unânime quando se refere à violência de gênero e contra a mulher; já quando a violência se refere às crianças e adolescentes, observou-se uma maior diversidade no uso dos termos, e com relação à violência contra idosos, a prevalência foi do termo VI. Conclui-se sobre a importância de não reduzir o significado dos termos culminando em uma compreensão limitada ao âmbito microssocial, mas ampliando as reflexões acerca dos conceitos de forma a englobar também dimensões macrossociais.

Revisão da produção científica sobre análise de conjuntura: contribuição à análise política em saúde

RESUMO Diversas abordagens desenvolvidas no âmbito das ciências humanas e sociais têm sido utilizadas nas análises políticas em saúde, uma delas é a análise de conjuntura. Com objetivo de sistematizar os principais conceitos, referenciais e estratégias metodológicas desse tipo de estudo e problematizar sua aplicação na área da saúde, foi realizada uma revisão sistemática sobre o tema. Não foi identificada uma única vertente teórica de referência nem um percurso metodológico padrão, mas merece destaque o fato de a maioria dos artigos não se preocupar em explicitar, de maneira clara, teorias e métodos. Os artigos que deram enfoque à dimensão política incluíram, entre seus objetivos, analisar fatos e atores envolvidos. Sobre os artigos que tratam de questões de saúde, foi possível notar maior preocupação com aspectos teóricos e metodológicos, sendo que todos comentaram sobre a relação entre o setorial e outras dimensões de caráter político e/ou estrutural. Ao considerar que a análise de conjuntura tem o propósito de subsidiar a ação, constata-se que, quando limitada a um setor, restringe a visão acerca das determinações que incidem sobre os fatos e atores, inclusive em saúde, condição que pode prejudicar a tomada de decisão.

[The influence of quality of life in treatment adherence of diabetic patients: a systematic review]

OBJECTIVE

To verify the influence of quality of life in treatment adherence of patients with diabetes mellitus.

METHOD

Systematic review of the literature using the databases MEDLINE, CINAHL, Scopus, LILACS, SciELO and Web of Science with studies published between 2003 and 2014 in English, Portuguese or Spanish.

RESULTS

Six studies were included in the review, three were identified as having better quality of life scores, being related to better adherence to diabetes treatment measured by glycated hemoglobin or characteristics related to diet, exercise, use of medication and foot care. No association was found between quality of life and adherence in two investigations and a study found a negative association between these variables.

CONCLUSION

There is causal relationship between quality of life and adherence with diabetes treatment. It is suggested that psychosocial aspects of patients should be considered by health professionals in the search for better clinical outcomes in diabetes care.

Reconstruyendo el significado de calidad de vida de los cuidadores en el cuidado: una metasíntesis

<p>Las enfermedades crónicas no transmisibles afectan la calidad de vida de las personas que las padecen y de sus cuidadores familiares. Se ha demostrado que se cambian los estilos de vida, aparece el dolor y las limitaciones, se altera la socialización y surgen sentimientos de pérdida y muerte. Se requiere por esto hacer una revisión sistemática del conocimiento generado para construir teóricamente<br />el concepto de calidad de vida de los cuidadores familiares.</p><p><strong>Objetivo:</strong> Realizar una integración interpretativa a partir de la evidencia científica del fenómeno de calidad de vida de cuidadores de personas con enfermedad crónica.</p><p><strong>Método:</strong> Metasíntesis de 24 artículos publicados de investigaciones científicas del fenómeno de calidad de vida de cuidadores de personas con enfermedad crónica, de bases de datos electrónicas reconocidas en enfermería y salud a partir del método de Sandelowski y Barroso (2006).</p><p><strong>Resultados:</strong> Emergió un planteamiento hipotético denominado Reconstruyendo el significado de calidad de vida de los cuidadores en el cuidado que se sustenta en tres momentos  para el significado de calidad de vida: vivir en desasosiego,<br />vivir para la calidad de vida del otro y construir la propia calidad de vida.</p><p><strong>Conclusiones</strong>: La reconceptualización de la calidad de vida de los cuidadores genera en el cuidador una forma diferente de percibir su experiencia, la cual está condicionada por los asuntos morales que están asociados a la labor de ser cuidador y las opciones de desarrollo humano con el significado espiritual emergente. La construcción del significado de calidad de vida para el cuidador se da a través de la experiencia de cuidado, edificándose en el ejercicio de su rol de cuidador, el cual responde a factores estrechamente relacionados con lo moral y evoluciona tomando un significado espiritual.</p>

[Construction of a scale to assess the methodological quality of systematic reviews]

The aim of this study was to describe the process of creation and validation of methodology to assess the methodological quality of systematic reviews. From the expansion of the scope and addition of new items to the Assessment of Multiple Systematic Reviews (AMSTAR) instrument evidence of validity and reliability of the new methodology was sought. Firstly, the original scale was translated, adapted, expanded and evaluated by a panel of five experts. Then it was tested by evaluating a random sample of five systematic reviews by three judges with no formal training in the scale. Finally, the consolidated scale was assessed in a new panel by two judges. The panel of experts reached a consensus regarding the validity of the proposed changes. With respect to the scale total and per item score, the average agreement between judges was considered satisfactory in the consolidated scale. From the processes of adaptation and validation performed, the methodology in its final version consisted of 14 items that taken together indicate the methodological quality of systematic reviews from different areas of knowledge.

Primary health care assessment tools: a literature review and metasynthesis

This study comprises a systematic review and metasynthesis of qualitative literature on national and international databases to identify the main tools used to assess Primary Health Care (PHC). A total of 3,048 results were returned for literature written in Portuguese, Spanish and English published between 1979 and 2013. Thirty-three articles/studies were selected after thorough reading and analysis. Eight of these studies addressed the use of one or more of the following validated PHC assessment tools: the WHO Primary Care Assessment Tool (PCET); the ADHD Questionnaire for Primary Care Providers (AQ-PCP); the General Practice Assessment Questionnaire (GPAQ), PACOTAPS (primary health care software); and the PCAT (Primary Care Assessment Tool). The study showed that the majority of these tools were used internationally. The PCAT and EUROPEP were used in Brazil and the most commonly used tool in this country was the PCAT. The results show that the use of research tools to assess PHC may assist in the creation of new proposals to improve family healthcare and that PCAT is the most adequate tool for this purpose.

Role of complementary therapies in the understanding of primary healthcare professionals: a systematic review

Objective To identify the understanding of the healthcare professionals in relation to the role of complementary therapies in primary health care. Method Systematic review by way of the following information sources: PubMed, CINAHL, PeriEnf, AMED, EMBASE, Web of Science, Psicoinfo and Psicodoc, using the keyword Primary Health Care alone, and associated with the following keywords: Medicinal Plants, Herbal Medicine, Homeopathy, Traditional Chinese Medicine, Acupuncture, Anthroposophical Medicine. Results Twenty-two studies from 1986 to 2011 were included. We identified three styles of practice: conventional medicine, complementary therapies and integrative medicine. Positioning professional practices within these three styles may facilitate discussion of concepts of health care, enhancing the health care provided as a result. Conclusion The work process in primary care presents difficulties for conducting integrative and holistic health care, but this practice has been introduced over time by professionals who integrate conventional medicine and complementary therapies, concerned with the care and well-being of patients.

[Humanization policy in primary health care: a systematic review]

OBJECTIVE

To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy.

METHODS

A systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis.

RESULTS

Among the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users.

CONCLUSIONS

Although many practices were cited as humanizing they do not produce changes in the health services because of the lack of more profound analysis of the work processes and ongoing education in the health care services.

Auditoria em enfermagem: revisão sistemática da literatura

Este estudo teve como objetivo analisar a produção científica acerca da auditoria em enfermagem publicada em artigos nacionais entre 1998 e 2008. Realizou-se uma revisão sistemática da literatura, com os artigos sendo pesquisados nas bases de dados LILACS e SciELO, a partir dos descritores auditoria, auditoria de enfermagem, qualidade da assistência à saúde e supervisão de enfermagem. A amostra constituiu-se de dez trabalhos. As publicações analisadas descrevem as principais distorções e não conformidades presentes nas anotações de enfermagem, relacionando-as, principalmente, com a qualidade da assistência de enfermagem e com os prejuízos financeiros às instituições. As publicações também destacam a função administrativa do enfermeiro, sobretudo a função de liderança junto à equipe de enfermagem; e a auditoria de enfermagem, como um processo educativo.