Practical Approach to Care Kit: inovação para a clínica do enfermeiro no manejo do HIV

Resumo Objetivo: analisar a utilização do Practical Approach to Care Kit como uma tecnologia adotada na prática clínica dos enfermeiros no manejo do HIV na Atenção Primária à Saúde. Método: pesquisa exploratória e descritiva, ancorada no referencial metodológico da Teoria Fundamentada nos Dados Construtivista. A definição dos participantes foi realizada por amostragem inicial, com 12 enfermeiros, e amostragem teórica, com cinco gestores, totalizando 17 participantes. Os dados foram coletados por entrevistas intensivas e análise documental, e foram analisados em duas etapas: 1) codificação inicial; e 2) codificação focalizada. Resultados: os profissionais identificaram o Practical Approach to Care Kit como uma inovação tecnológica que contribuiu para a ampliação da prática clínica e empoderamento do enfermeiro no manejo clínico da infecção por HIV. Também destacaram sua importância como ferramenta para orientação das diferentes responsabilidades e atribuições no compartilhamento do cuidado, contribuindo para a prestação de práticas baseadas em evidências. Conclusão: o Practical Approach to Care Kit é uma inovação tecnológica que transformou a prática clínica do enfermeiro no manejo do HIV, ampliando seu escopo de atividades na realização do diagnóstico, avaliação da condição de saúde e aconselhamento, avaliação da adesão ao tratamento, efeitos adversos e prescrição de exames, medicamentos e imunobiológicos.

Practical Approach to Care Kit: innovación para la clínica de enfermería en el manejo del VIH

Resumen Objetivo: analizar el uso del Practical Approach to Care Kit como tecnología adoptada en la práctica clínica de los enfermeros en el manejo del VIH en la Atención Primaria de la Salud. Método: investigación exploratoria y descriptiva, basada en el marco metodológico de la Teoría Fundamentada en los Datos Constructivistas. La definición de los participantes fue realizada por muestreo inicial, con 12 enfermeros, y muestreo teórico, con cinco gestores, fueron 17 participantes en total. Los datos fueron recolectados a través de entrevistas intensivas y análisis de documentos, y fueron analizados en dos etapas: 1) codificación inicial; y 2) codificación enfocada. Resultados: los profesionales identificaron el Practical Approach to Care Kit como una innovación tecnológica que contribuyó a la expansión de la práctica clínica y al empoderamiento de los enfermeros en el manejo clínico de la infección por VIH. También destacaron su importancia como herramienta para orientar las diferentes responsabilidades y obligaciones en la distribución de la atención de los pacientes, contribuyendo a la prestación de prácticas basadas en evidencia. Conclusión: el Practical Approach to Care Kit es una innovación tecnológica que ha transformado la práctica clínica de los enfermeros en el manejo del VIH, ampliando su radio de acción para la realización del diagnóstico, evaluación del estado de salud y asesoramiento, evaluación de la adherencia al tratamiento, efectos adversos y prescripción de exámenes, medicamentos e inmunobiológicos.

Ethical problems in nursing teleconsultations for people living with HIV during the Covid-19 pandemic

OBJECTIVES

to understand the ethical problems experienced by primary health care nurses in using nursing teleconsultations for people living with the human immunodeficiency virus during the coronavirus pandemic.

METHODS

qualitative research, anchored in Constructivist Grounded Theory. Data was collected between July and September 2020, with 17 participants.

RESULTS

the first category highlights the ethical problems in conducting teleconsultations, managing high demand, communication barriers, and risks related to data security. The second emphasizes the potential of teleconsultations in communication and access, by generating changes in the work process and the use of protocols to guide clinical practice.

CONCLUSIONS

nurses' work in digital mode requires professional qualification, with a view to stimulating reflection on teleconsultation practice, ethical-moral deliberation and combating stigma, and also adopting data security-centered conduct.

Practical Approach to Care Kit: Innovation for nurses' clinical practice in HIV management

OBJECTIVE

to analyze the use of the Practical Approach to Care Kit as a technology adopted in nurses' clinical practice for HIV management in Primary Health Care.

METHOD

an exploratory and descriptive research study anchored in the methodological framework of the Constructivist Grounded Theory. The participants were defined through initial sampling, with 12 nurses, and theoretical sampling, with five managers, totaling 17 participants. The data were collected by means of intensive interviews and documentary analysis, and they were analyzed in two stages: 1) Initial coding; and 2) Focused coding.

RESULTS

the professionals identified the Practical Approach to Care Kit as a technological innovation that contributed to expanding the clinical practice and to empowering nurses in the clinical management of HIV infection. They also highlighted its importance as a tool for guiding the different responsibilities and duties while sharing care, contributing to the provision of evidence-based practices.

CONCLUSION

The Practical Approach to Care Kit is a technological innovation that has transformed nurses' clinical practice in HIV management, expanding their scope of activities in carrying out the diagnosis, assessing the health condition and counseling, evaluating adherence to the treatment, adverse effects and prescription of exams, medications, and immunobiological.

Management in the care of people with HIV in primary health care in times of the new coronavirus

OBJECTIVE

To understand management practices in the care of people living with the human immunodeficiency virus (HIV) in primary health care in a Brazilian capital, in times of the new coronavirus (covid-19) pandemic.

METHOD

Qualitative research, anchored in the methodological-analytical framework of the grounded theory, constructivist aspect. Data were collected by using intensive online interviews with nurses from health centers and managers of the municipal health department. Data collection and analysis occurred concomitantly in two phases of analysis: initial and focused coding.

RESULTS

They point to the development of best care practices, with emphasis on initiatives for coordination of care, decentralization of clinical management for primary health care services, establishment of protocols and flows, agreement of intersectoral partnerships, use of groups and social networks, use of tools such as teleconsultation and health surveillance spreadsheet and formation of support networks.

CONCLUSION

The Brazilian capital restructured its network of health services with the implementation of clinical and management protocols, seeking to maintain care for people living with HIV. We highlighted the incorporation of non-face-to-face care technologies and the facilitation of routines, as strategies for expanding access.

Melhores práticas de gestão no cuidado ao HIV: scoping review

RESUMO Este estudo objetivou mapear e examinar as melhores práticas de gestão do HIV disponíveis nas publicações científicas da área da saúde. Realizou-se revisão sistemática da literatura por meio de scoping review, nas bases PubMed, Scopus, Web of Science, Cinahl, Lilacs e Catálogo de Teses e Dissertações da Capes, no período de 2009 a julho de 2020. Dos 427 estudos identificados, 19 foram incluídos, e apesar de não explicitar um conceito de melhor prática, apresentam práticas de gestão do HIV expressas como uma melhor prática por meio da avaliação de estratégias, ferramentas, serviços de saúde, programas de saúde, intervenções e ações que contribuíram para uma melhoria de uma determinada condição de saúde na prevenção e cuidado em HIV. As práticas identificadas nos estudos com uma ‘melhor prática’ justificam-se pela análise dos aspectos de avaliação, os quais expressaram modificações positivas, contribuindo para melhorias das práticas de gestão do HIV. Acredita-se que esses achados podem subsidiar a construção de políticas públicas em diferentes cenários e a instituição de práticas de saúde que visem à melhoria da qualidade das ações direcionadas à gestão do HIV.

Best management practices in HIV care: scoping review

ABSTRACT This study aimed to map and examine the best HIV management practices available in scientific publications in the health field. A systematic literature review was carried out through scoping review, on the basis of PubMed, Scopus, Web of Science, CINAHL, LILACS, and CAPES Thesis and Dissertations Catalog, from 2009 to July 2020. From the 427 identified studies, 19 were included, and although it does not explain a concept of best practice, they present HIV management practices expressed as a best practice through the evaluation of strategies, tools, health services, health programs, interventions, and actions that contributed to an improvement of a given health condition in HIV prevention and care. The practices identified in the studies with a ‘best practice’ are justified by the analysis of the evaluation aspects, which expressed positive changes, contributing to improvements in HIV management practices. It is believed that these findings can support the construction of public policies in different scenarios and the establishment of health practices that seek to improve the quality of actions aimed at managing HIV.

GESTÃO NO CUIDADO ÀS PESSOAS COM HIV NA ATENÇÃO PRIMÁRIA À SAÚDE

RESUMO Objetivo compreender as melhores práticas de gestão no cuidado à saúde das pessoas que vivem com HIV em serviços de Atenção Primária à Saúde em Florianópolis, Santa Catarina. Método pesquisa qualitativa, ancorada na teoria fundamentada nos dados construtivista. Os participantes do estudo foram enfermeiros e gestores envolvidos com as práticas de gestão no cuidado às pessoas que vivem com HIV no município. Os dados foram coletados entre julho e setembro de 2020, a partir de entrevistas intensivas com 12 enfermeiros, em quatro Unidades Básicas de Saúde e cinco gestores da Secretaria Municipal de Saúde, de Florianópolis, Santa Catarina, Brasil, totalizando 17 participantes. A coleta e análise dos dados ocorreram de forma concomitante, seguindo as fases de codificação inicial e focalizada. Resultados chegou-se ao fenômeno intitulado “Desvelando as melhores práticas de gestão no cuidado às pessoas que vivem com HIV relacionadas com o cuidado descentralizado, compartilhado e baseado em evidências,” sustentado por três categorias que apontam para a descentralização do manejo clínico da infecção por HIV para a Atenção Primária à Saúde em Florianópolis, a instrumentalização e treinamento dos profissionais para o manejo da infecção mediante o uso de evidências científicas e as práticas de cuidado desenvolvidas frente à pandemia de Covid-19. Conclusão a descentralização do cuidado às pessoas que vivem com HIV para a Atenção Primária à Saúde foi apresentada como alicerce das melhores práticas, amparadas no trabalho em equipe e manejo clínico baseado em evidências.

Practices of nurses in monitoring Chronic Non-communicable Diseases in Primary Health Care

Abstract Objective to analyze the Primary Health Care nurses' practices for monitoring the four main Chronic Non-communicable Diseases (circulatory system diseases, cancer, diabetes, and chronic respiratory diseases) in a city in the interior of Santa Catarina State. Method single case study, qualitative approach. Data was collected through triangulation of techniques: focused interviews, document analysis, and online database, from January to July 2019. The analysis techniques were given by means of theoretical propositions and the construction of explanation regarding the nurses' practices. Results the nurse's practices for monitoring chronic diseases identified were: HiperDia Group; health education; tele-monitoring; welcoming; home visits; nursing consultation; care plan; self-monitoring and protocols. Conclusion and implications for the practice the nurses in the studied context perform several practices for the monitoring of chronic diseases, contributing to the effectiveness of policies for this condition and, possibly, with the drop in the mortality indicator for these causes.

MANAGEMENT IN THE CARE OF PEOPLE LIVING WITH HIV IN PRIMARY HEALTH CARE

ABSTRACT Objective to understand the best management practices in the health care provided to people living with HIV in Primary Health Care services from Florianópolis, Santa Catarina. Method a qualitative research study anchored in the Constructivist Grounded Theory. The study participants were nurses and managers involved with management practices in the care provided to people living with HIV in the municipality. The data were collected between July and September 2020 from intensive interviews with 12 nurses in four Basic Health Units and with five managers of the Municipal Health Department, Florianópolis, Santa Catarina, Brazil, totaling 17 participants. Data collection and analysis took place concomitantly, following the initial and focused coding phases. Results this resulted in the phenomenon entitled “Unveiling the best management practices in the care provided to people living with HIV related to decentralized, shared and evidence-based care”, supported by three categories that point to decentralization of the clinical management of the HIV infection to Primary Health Care in Florianópolis, to instrumentalization and training of professionals to manage the infection through the use of scientific evidence, and to the care practices developed in the face of the COVID-19 pandemic. Conclusion decentralization of care for people living with HIV to Primary Health Care was presented as the foundation of the best practices, supported by teamwork and evidence-based clinical management.

Práticas do enfermeiro no monitoramento das Doenças Crônicas Não Transmissíveis na Atenção Primária à Saúde

Resumo Objetivo analisar as práticas do enfermeiro da Atenção Primária à Saúde para o monitoramento das quatro principais Doenças Crônicas Não Transmissíveis (doenças do aparelho circulatório, câncer, diabetes e doenças respiratórias crônicas) em um município do interior do Estado de Santa Catarina. Método estudo de caso único, de abordagem qualitativa. Os dados foram coletados por meio de triangulação de técnicas: entrevistas focadas, análise documental e banco de dados on-line, de janeiro a julho de 2019. As técnicas de análise deram-se por meio de proposições teóricas e da construção da explicação relativas às práticas dos enfermeiros. Resultados as práticas do enfermeiro para o monitoramento das doenças crônicas identificadas foram: Grupo HiperDia; educação em saúde; telemonitoramento; acolhimento; visita domiciliar; consulta de Enfermagem; plano de cuidados; automonitoramento e protocolos. Conclusão e implicações para a prática os enfermeiros do contexto estudado realizam práticas diversas para o monitoramento das doenças crônicas, contribuindo para a efetividade das políticas para esta condição e, possivelmente, com a queda no indicador de mortalidade por essas causas.

Economic assessment of teledermatology in the state of Santa Catarina - Brazil

OBJECTIVES

In locations with poor public dermatology services, teledermatology emerges as a viable way to fill this need. Thus, the aim was to estimate how much could be saved with the use of teledermatology in the state of Santa Catarina, Brazil, from 2015 to 2018.

STUDY DESIGN

Observational study of the analytical type with a cross-sectional design and collection of secondary data in electronic media.

METHODS

A total of 95,828 teledermatology test protocols from the period were evaluated. The amount that would be necessary to refer all the patients of the several regions of the state for evaluation by General Dermatology (secondary network) was estimated, as it occurred before the deployment of teledermatology, considering the cost of displacement, consultation with a specialist, cost aid and opportunity cost of patients and companions. This amount was compared with the amount effectively spent on the screening deployment via teledermatology.

RESULTS

There was a minimum savings of $1,170,550.82 during the period, with an average cost savings of $21.94 per protocol not forwarded to the secondary network. The greater the distance and time spent to evaluate the patient by a specialist, the greater the savings.

CONCLUSIONS

Teledermatology provides savings in public resources, reduces the number of patient referrals, and improves the dermatological assistance provided to the population of Santa Catarina. This is a relevant and efficient health technology.

Self-care among people with Diabetes Mellitus and quality of care in Primary Health Care

OBJECTIVES

to verify the adherence to self-care activities among people with diabetes mellitus and its association with quality of care received in Primary Care.

METHODS

a cross-sectional study with 329 people with diabetes assisted in Primary Care. Sociodemographic and self-care data were collected. To assess quality of care in Primary Care, secondary data from the Access and Quality Improvement Program were used. For comparisons between adherence to self-care activities and quality of care received in Primary Care, the Kruskal-Wallis Test was used.

RESULTS

better adherence to the diet, blood glucose monitoring and medication use were observed among people with diabetes treated in Primary Care with better coordination of care, agenda organization, and equipment. Foot examination, despite the inverse relationship with quality of care, proved to be desirable.

CONCLUSIONS

adherence to self-care among people with diabetes was associated with quality of care received in Primary Care.

Best leadership practices of nurses in hospital risk management: case study

OBJECTIVE

To highlight the best leadership practices of nurses who contribute to hospital risk management.

METHOD

Single case study with two integrated units of analysis, with a qualitative approach. Data collected from April to November 2018, through focused interviews with nurse managers, non-participant observation and documentary research. Analysis using the analytical technique to the explanation construction.

RESULTS

Three thematic categories were evidenced, demonstrating that the best leadership practices involve technical and non-technical competencies anchored in behavioral development, scientific knowledge, guidelines for quality and patient safety and participatory management of the health team.

CONCLUSION

The best leadership practices of nurses who contribute to hospital risk management pervade technical skills and/or formal positions, valuing each team professional in a unique way and emphasizing the importance of scientific knowledge and the professional reference model that the nurse exercises in hospitals.

Adesão ao autocuidado de pessoas com Diabetes Mellitus na Atenção Primária: estudo de método misto

Resumo Objetivo elaborar um modelo interpretativo sobre a adesão ao autocuidado de pessoas com Diabetes Mellitus na Atenção Primária à Saúde. Método estudo de método misto realizado em quatro Unidades Básicas de Saúde. O estudo quantitativo transversal foi composto por 329 participantes, elegeram-se variáveis sociodemográficas e clínicas e o questionário de atividades de autocuidado. No estudo qualitativo, com 31 participantes, utilizou-se a vertente construtivista da Teoria Fundamentada nos Dados. Os dados foram analisados utilizando-se a estatística descritiva e a codificação inicial e focalizada. Resultados a maioria dos participantes é do sexo feminino, casada, com um a cinco anos de estudo, aposentada e com renda de um a três salários-mínimos. Obteve-se baixa adesão à alimentação saudável, à atividade física e ao monitoramento glicêmico. A adesão desejável foi relacionada ao uso de medicamentos e cuidados com os pés. Na etapa qualitativa, obteve-se como fenômeno: Enfrentando a complexidade do tratamento do Diabetes Mellitus e buscando o autocuidado. Este foi sustentado por duas categorias: Encontrando as dificuldades para seguir o tratamento e Valorizando os aspectos facilitadores do tratamento que deram subsídios para a elaboração do modelo. Conclusões e implicações para a prática foi elaborado um modelo interpretativo cujos elementos demonstram a complexidade do fenômeno e contribuem para a adesão ao autocuidado nessa população.

Disability in people with chronic low back pain treated in primary care

Abstract Introduction: Low back pain is a common musculoskeletal problem and can become chronic, with varying degrees of disability. Objective: Analyze the factors associated with disability in individuals with chronic low back pain (CLBP), treated in primary care. Methods: Cross-sectional study with 82 basic health unit (BHU) users in the municipality of Florianópolis (Brazil) with CLBP. Sociodemographic and clinical variables, health status, lifestyle and treatment were investigated. Self-rated disability was investigated using the Roland Morris questionnaire (≥ 14 points). The χ2 or Fisher’s exact tests were used in inferential analysis for univariate association and the presence of disability. Multivariate association was analyzed by logistical regression, estimating the crude and adjusted odds ratios (OR) and their respective confidence intervals (95%CI). Results: Adults aged 40-59 years had a greater chance of developing disability (OR: 8.17; 95%: 1.21 - 55.0), while professionally active individuals (OR: 0.08; 95%CI: 0.02 - 0.33) who reported engaging in physical activity ≥ 3 times a week (OR: 0.19; IC95%: 0.04 - 0.83) had less chance of the same outcome when compared to the other participants. Conclusion: Factors related to disability were age, employment status and frequency of physical activity. Incentive strategies to return to work and engage in regular physical activity and exercise should be encouraged.

University educational management and clinical practice applied to nursing by the faculty of a public university

OBJECTIVE

to emphasize university educational management actions and their articulation to develop clinical practice in nursing training, designed by its faculty.

METHODS

a single-case study with qualitative approach. The sources were composed of documentary research, focused interview with key informant and direct non-participant observation. Data were organized with the help of NVivo®10. Analysis followed the explanation construction technique from the perspective of complex thinking.

RESULTS

three categories emerged: Characterization of university educational management actions; Articulation of university educational management with clinical practice and its repercussion; and Spaces to develop university educational management and clinical practice. Final considerations: university educational management actions are associated with the work of professors, supporting teaching, research, and extension in order to improve clinical knowledge in the general nursing training.

Demands for psychosocial support from communities vulnerable to natural disasters

OBJECTIVE

To identify the demands for the psychosocial care of vulnerable communities in the Vale do Itajaí, Santa Catarina Methods: Qualitative research, multiple case study, through narrative interviews with health professionals in three municipalities, from January to May 2018. The analysis of the narratives followed a formal analysis of the text, structural description of the content, analytical abstraction, analysis of knowledge, and contrastive comparison.

RESULTS

The described categories were: Meanings of the demands for support before the flood; Meanings of the demands during the occurrence of the disaster; Meanings of demands after the flood: psychosocial care; Meanings of the demands for monitoring the territory after the disaster.

CONCLUSION

The identification of demands for mental health care after the disaster occurs through the search for health services, specific symptoms, and consequences of adapting to the recovery phase, such as migratory processes and temporary housing. The research contributes to the culture of care with a multiprofessional perspective in health care for the population affected by disasters.

Integration in health: cooperation at triple international border Amazon

OBJECTIVE

To describe the scope and limitations of the main strategies of cooperation in health, adopted between 2005 and 2017, in the context of the triple border Brazil, Colombia and Peru.

METHOD

Single, explanatory, qualitative, integrated case study carried out in 2017, in the context of the triple Amazon border, Brazil, Colombia and Peru, in the city of Tabatinga, state of Amazonas, Brazil. Our sources of evidence were: documentary data; interviews with health managers of the State Health Secretariats of Amazonas and Municipal Health of Tabatinga, Municipal Health Council of Tabatinga and Consulate of Peru in Colombia; and direct observations in four health services of Tabatinga. Data were organized with MaxQDA12® software.

RESULTS

Data analyzed showed that, during the study period, the Brazilian federal government made several health cooperation agreements with both Peru and Colombia and that the state government of Amazonas undertook strategies to improve the health conditions of the dwellers of Tabatinga and the region of Alto Solimões, which indirectly reached the populations of neighboring countries, supporting the interrelationships between the countries of the region. Regarding the municipal government, we verified the existence of health integration agreements, established informally, to minimize the adversities of the local health.

CONCLUSION

The cooperation strategies in health adopted in the triple Amazon border have different purposes, benefits and limitations. It is noteworthy that the existence of cooperation agreements between the federal governments of Brazil, Colombia and Peru and the presence of informal cooperation agreements between the municipal governments of Tabatinga (Brazil), Leticia (Colombia) and Santa Rosa (Peru). The limitations of this study are the lack of knowledge of local managers about the cooperation agreements established between federal governments and the lack of legitimacy of the informal agreements established by the Tabatinga government.

RESILIENCE AND SELF-CARE IN PEOPLE WITH DIABETES MELLITUS

ABSTRACT Objective: to investigate the association between resilience and self-care in people with diabetes mellitus treated in Primary Health Care. Method: Cross-sectional study, sample consisting of 362 people, aged 18 years or older, diagnosed with diabetes for at least one year. Descriptive analyzes and comparison of means were performed, assuming statistical significance with a value of p <0.05. The Resilience Scale and Questionnaire on Diabetes Self-Care Activities were applied, containing six dimensions: general food, specific food, physical activity, blood glucose monitoring, foot care, medication use, plus three items on smoking. Data collection took place between December and May 2016, in ten Health Centers in a city in the south of the country. Results: among the 15 self-care activities, four showed a statistically significant association when compared to the average resilience, highlighting: healthy eating and professional guidance, desirable sweet consumption, blood sugar assessment as recommended. Conclusion: the results obtained highlight the relationship between high averages of resilience and adequate performance in the care of diabetes mellitus.

HEALTH PROMOTION BEFORE THE HIV/AIDS EPIDEMIC IN PRIMARY CARE IN PUNTA ARENAS

ABSTRACT Objective: to identify the attitudes and actions of health professionals in health promotion before the HIV/AIDS epidemic in Primary Health Care (PHC), Punta Arenas, Magallanes and Chilean Antartica Chilena region, Chile. Method: a qualitative, descriptive, and exploratory study carried out at PHC facilities in the city of Punta Arenas, Chile. Sixteen professionals who work in the five Family Health Centers participated. Data collection was carried out between March and May 2019. Data was obtained through a semi-structured interview. To organize data, ATLAS ti® was used, which were analyzed according to thematic content analysis. Results: two categories have emerged. The first category, Health promotion and prevention actions before HIV/AIDS, described the actions carried out by nurses in their daily work, such as counseling on STI/AIDS prevention, sexual/reproductive health and education for professionals and the community. The second category, Nurse-midwives’ attitudes towards caring for people living with HIV/AIDS, includes caring without prejudice, active behavior and empathy due to high workload. Conclusion: health promotion and prevention actions carried out by PHC professionals are mainly related to counseling and education for professionals and the community. The need to integrate prevention measures with other professionals and vulnerable groups in the community stands out.

CHALLENGES IN TUBERCULOSIS COINFECTION TREATMENT IN PEOPLE WITH HIV/AIDS IN ANGOLA

ABSTRACT Objective: to know the challenges faced during tuberculosis coinfection treatment in people with HIV/AIDS (HIV/TB) in Huambo, Angola. Method: this is a qualitative convergent-care investigation carried out in the antituberculosis dispensary of the sanatorium hospital of Huambo, Angola. It included 18 people co-infected with HIV/TB and 11 health professionals. Data were collected from January to July 2016 through conversation interviews, participatory observation and a convergence group. In data analysis, conventional content analysis of Hsieh and Shannon was used. Results: the data originated two categories: challenges of HIV/TB coinfected people when facing the diseases and treatment adherence, and challenges due to intervening factors upon HIV/TB treatment adherence. Conclusions: people’s conception about living with HIV/TB, associated with the intervening factors upon HIV/TB treatment adherence, results in late search for health services, non-adherence to treatment and worsening of diseases, thus posing as challenges to be overcome for better control of this double epidemic.

Care sharing for people with HIV/AIDS: a look targeted at young adults

OBJECTIVE

To understand the care sharing for people living with HIV/AIDS, especially young adults, as well as the structuring of the line of care in the capital of Santa Catarina.

METHOD

Qualitative research, anchored by theory based on data collected in the Health Care Network of Florianópolis, totaling 19 participants distributed between two sample groups. The data collection and analysis were concomitant, with comparative analysis method.

RESULTS

The municipality has been transitioning in the health care model for people with HIV/AIDS, especially young adults, whose care is shared within the Health Care Network.

FINAL CONSIDERATIONS

In the municipality, there is the inclusion of management of HIV in primary health care services along with the establishment of a more resolutive care model. Thus, the care of this population is shared in different points of the health care network.

Knowledge of nursing student on the prevention of sexually transmitted infections

OBJECTIVE

To identify the knowledge and self-care actions taken by nursing undergraduate students of a Federal University of the South of Brazil, against Sexually Transmitted Infections.

METHOD

Exploratory qualitative study, conducted 40 interviews with undergraduate students at the beginning and end of the course. The analysis was thematic, resulting in three categories.

RESULTS

Knowledge about the subject is a decisive factor for self-care, and the more knowledge, the greater the prevention. The dissemination of knowledge of students at the end of the course not only influences self-care but also health promotion in the social sphere.

FINAL CONSIDERATIONS

Knowledge is important in self-care and caring for others. The dissemination of knowledge becomes evident according to the complexity of the course. Stable relationships may interfere with the use or disuse of condoms in sexual relationships, a misnomer present in today's society.

ADHERENCE TO TREATMENT OF YOUNG ADULTS LIVING WITH HIV/AIDS FROM THE PERSPECTIVE OF COMPLEX THINKING

ABSTRACT Objetive: to understand the adherence to treatment of young adults with HIV/AIDS treated in a specialized care service from the perspective of complex thinking. Method: a qualitative study, with the data grounded theory approach. Twelve young adults aged from 15 to 24 years old living with HIV/AIDS, nine health professionals and four mothers participated in the study. Data was obtained from interviews conducted between April and September 2016 and analyzed using the constant comparative method. Results: the adherence to treatment of young adults with HIV/AIDS has been understood as a dynamic, multifactorial and constantly changing phenomenon. This process involves multiple aspects, including fear of becoming ill, physical and social death, discrimination and stigma. It was found that even in the face of these difficulties, young adults decide to continue their treatment in search of normalization of health, a long and common life like other young people who do not live with HIV/AIDS. Conclusion: it was considered that in view of the complex and changing phenomenon, adherence to treatment of young adults with HIV/AIDS should be understood and managed by health professionals.

CARE FOR THE PERSON WHO LIVES WITH HIV/AIDS IN PRIMARY HEALTH CARE

ABSTRACT Objective: to understand the process of caring for the person with HIV/AIDS in the Primary Health Care of a capital in southern Brazil. Method: qualitative, exploratory and descriptive research, carried out in the Health Centers of this city, from March to August 2015. Sixteen nurses participated through semi-structured interviews, which were organized and codified with the help of the software QSR Nvivo®, version 10. Afterwards, the data were analyzed through comparative analysis. Results: results were described in two categories: “The inter-subjective encounter given the vulnerability to HIV/AIDS”, and, “Accepting needs and formulating actions given the reality”. Potentialities and weaknesses were evidenced through these categories, such as: reception, long-term care, active search, home visits, and, in return, lacking a formal flow of care for people living with HIV/ AIDS, lack of HIV/AIDS line of care and medical/centered care. Conclusion: the need to implement HIV/AIDS management in primary care was verified, as well as to overcome the fragilities in this care with the aid of implementing a formal care flow, establishing managerial processes and permanent education for the professionals. Then, expanding and qualifying care in HIV/AIDS, with important contributions of the nurse in the perspective of integral care in the process of living with HIV/AIDS.

REVASCULARIZAÇÃO MIOCÁRDICA: REFERÊNCIA E CONTRARREFERÊNCIA DO PACIENTE EM UMA INSTITUIÇÃO HOSPITALAR

RESUMO Objetivo: compreender o processo de referência e contrarreferência vivenciado pelo paciente com coronariopatia submetido à cirurgia de revascularização do miocárdio. Métodos: pesquisa qualitativa, ancorada na Teoria Fundamentada nos Dados. O cenário da pesquisa foi uma instituição hospitalar pública, referência em atendimento cardiovascular no Estado de Santa Catarina (Brasil). A coleta de dados ocorreu entre março de 2013 a junho de 2014, por meio de entrevista semiestruturada envolvendo 21 participantes, distribuídos em três grupos amostrais (pacientes, profissionais de saúde e profissionais gestores). Resultados: o processo de referência e contrarreferência aponta o fenômeno “Emergindo a alta complexidade como referência para a pessoa submetida à revascularização miocárdica diante da fragilidade da Atenção Primária à Saúde no acompanhamento e articulação com os demais níveis de atenção no Sistema Único de Saúde”, sustentado por cinco categorias. Conclusão: para que a referência aconteça há necessidade de consolidar o vínculo do paciente com coronariopatia com a atenção primária à saúde, uma vez que este encontra dificuldades no acompanhamento da sua condição na rede pública. Na contrarreferência evidenciou-se a desarticulação entre os serviços de atenção à saúde, a qual afeta o cuidado à pessoa submetida à revascularização miocárdica na manutenção da sua qualidade de vida.

Satisfação dos usuários com um serviço de referência no cuidado do HIV

Objetivos: caracterizar a los usuarios con VIH que utilizan un servicio de referencia en el Estado de Santa Catarina, Brasil, y comparar la satisfacción entre los usuarios del ambulatorioe internación. Metodología: estudio cuantitativo transversal, realizado con 106 personas con VIH asistidas en un servicio de infectología en la ciudad de Florianópolis (Santa Catarina). La recolección de datos ocurrió de julio a diciembre de 2013 por medio de un formulario compuesto por cuestiones sociodemográficas y satisfacción. Para análisis de datos se utilizó el test chi-cuadrado y el software SPSS®.Resultados: la mayoría de los usuarios demostró satisfacción con el servicio en todos los aspectos: disponibilidad de los cuidados (80,2 %),oportunidad/libertad para dar sugerencias (94,3 %), satisfacción con las relaciones personales (94,3 %), acceso al servicio (87,7 %) y cuidado recibido (90 %). No hubo diferencia entre los grupos (ambulatorio e internación) en la comparación entre los aspectos relacionados con la satisfacción.Conclusión: la satisfacción de las personas viviendo con VIH se mostró positiva para los usuarios del servicio en ambulatorio y para los de la internación.

Myocardial revascularization: factors intervening in the reference and counter-reference in the hospital setting

OBJECTIVE

To understand the intervening factors in the process of reference and counter-reference of the individual with heart disease in the scenario of high complexity in the health care network.

METHOD

Research anchored in the Grounded Theory (Teoria Fundamentada nos Dados). It totaled 21 participants. The data collection scenario was a cardiovascular reference hospital in the south of Brazil and occurred between March and June 2014.

RESULTS

The intervening factors in the reference process were the difficulty to access the points of the network and telemedicine and the central to manage the flow of patients in the network. In the counter-reference, there was a link with the hospital and the lack of communication among network professionals.

CONCLUSION

It reveals the need to reorganize the service flow in HCN, enhancing PHC, expanding the performance of medium complexity and increasing the capacity of high complexity in order to carry out the process of reference and counter-reference.

Prevention of chronic complications of diabetes mellitus according to complexity

Objective:

To assess the prevention by primary health care providers of chronic complications of diabetes mellitus according to the complex thinking theoretical approach.

Method:

Evaluative research based on the complex thinking theoretical approach. The following techniques for data collection were used: interviews with 38 participants; observation in collective and individual appointments; and analysis of medical records of people with diabetes. The triangulation applied for data analysis was the ATLAS.ti software.

Results:

The prevention and management of chronic complications of diabetes did not meet the requirements set forth by ministerial public policies aimed at this population. Systematic monitoring to prevention of chronic complications showed significant gaps.

Final considerations:

Primary health care did not consider preventive actions for diabetes mellitus complications. This context was marked by disjunctive, fragmented, and dissociated practices types of care targeted to the totality of the assisted people.

Objetivo:

Avaliar a prevenção de complicações crônicas do diabetes mellitus a luz do referencial teórico do Pensamento Complexo por integrantes da atenção primária à saúde.

Método:

Pesquisa avaliativa, que teve como referencial teórico o Pensamento Complexo. Como técnicas de coleta de dados foram utilizadas: entrevista com 38 participantes; observação nos atendimentos coletivos e individuais;e análise em 25 prontuários de pessoas com diabetes. A triangulação subsidiou a análise de dados que teve auxílio do software ATLAS.ti.

Resultados:

A prevenção e o manejo das complicações crônicas do diabetes não atendiam ao estabelecido nas políticas públicas ministeriais destinadas a esse público. O acompanhamento sistematizado para controle da prevenção das complicações crônicas apresentou importantes lacunas.

Considerações finais:

A assistência na atenção primária não contemplava ações de prevenção de complicação do diabetes mellitus. Esse contexto era por marcado por práticas disjuntivas, fragmentadas e dissociadas de uma assistência que visa a totalidade das pessoas assistidas.

Actions and interactions in clinical nursing practice in Primary Health Care

OBJECTIVE

Understanding the actions and interactions required for developing clinical nursing practice in Primary Health Care.

METHOD

A qualitative study anchored in the Grounded Theory. Data was collected between April and October 2016 with nurses divided into two sample groups.

RESULTS

Eighteen (18) nurses participated in the study. The category "Recognizing the Systematization of Nursing Care as an essential element for clinical nursing practice" supports the "actions-interactions" component and it is composed of two subcategories: "Accomplishing clinical practice in nursing consultations", which presents the challenges encountered in performing clinical practice; and "Highlighting management tools for evidence-based clinical practice", which operates through strategies in response to the studied phenomenon.

CONCLUSION

Care actions developed in clinical nursing practice are highlighted by the systematization of care in nursing consultations, a moment of direct interaction with the individual, thus contributing to improvement in the quality of care provided.

UM OLHAR PARA A PREVENÇÃO DAS COMPLICAÇÕES CRÔNICAS DO DIABETES SOB AS LENTES DA COMPLEXIDADE

RESUMO Objetivo: avaliar como os profissionais da Atenção Primária à Saúde desenvolvem atividades preventivas para evitar as complicações crônicas nas pessoas com Diabetes Mellitus atendidas nesse nível da atenção. Método: foi utilizado como referencial teórico o Pensamento Complexo e como referencial metodológico a pesquisa avaliativa. O estudo foi realizado em um município de médio porte localizado no Sul do Brasil. Participaram da pesquisa 35 profissionais de saúde e três gestores. Como técnicas de coleta de dados adotou-se: entrevista, observação e análise de prontuários. Para a análise dos dados obteve-se auxílio do software ATLAS.ti e empregou-se a triangulação de dados. Resultados: a prevenção foi compreendida como uma atividade dissociada da prática assistencial; o conceito atribuído não era claro e nem diferenciado de outros conceitos da área da saúde; a assistência priorizava ações curativas em detrimento das preventivas; e a prevenção mencionada era mais voltada para o cumprimento de metas e de campanhas estabelecidas pelas instâncias reguladoras. Conclusão: a prevenção na atenção às pessoas com Diabetes Mellitus na Atenção Primária à Saúde encontrava-se fragmentada e disjuntiva de uma assistência que contemplasse a integralidade e a totalidade necessária nesse processo e que fosse capaz de trabalhar nos níveis de prevenção em saúde.

Health education to prevent chronic diabetes mellitus complications in primary care

ABSTRACT Objective: Understand how Family Health Strategy members organize themselves for health education, on the management and prevention of chronic complications of diabetes mellitus in primary health care. Method: Qualitative study that used complex thought as the theoretical framework and evaluative research as the methodological framework. Thirty-eight healthcare professionals took part in the study. Data was gathered using the following techniques: interview, observation, and analysis of medical records. The data analysis, which was supported by triangulation, used ATLAS.ti software. Results: Shortcomings in health education were identified, such as insufficient infrastructure, poor interpersonal relationships among health professionals, and lack of planning for carrying out this activity. However, there is room for potential improvement in this situation. Conclusion: Health education for people with diabetes mellitus in primary health care is set within a multifaceted context, with multiple barriers to its implementation.

Cirurgia de revascularização do miocárdio: características da internação e alterações relacionadas ao tempo de internação

O estudo teve como objetivo identificar as características da internação e alterações apresentadas por indivíduos submetidos à Cirurgia de Revascularização do Miocárdio e sua associação com tempo de internação para cirurgia. Estudo epidemiológico observacional e transversal, realizado entre março de 2013 a março de 2014, com 99 indivíduos submetidos à Cirurgia de Revascularização do Miocárdio.  Verificou-se que dor no peito e angina/dor torácica identificados no pré-operatório e insuficiência respiratória, hipertermia, Hipertensão Arterial Sistêmica e arritmias apresentadas no pós-operatório foram preditores para maior tempo de internação. A associação entre as características da internação e as alterações clínicas com o tempo de Internação de indivíduos submetidos à Cirurgia de Revascularização do Miocárdio fornecem subsídios para atuação do enfermeiro e demais profissionais de saúde e gestores, a fim de criar estratégias para detecção precoce de intercorrências relacionadas à Cirurgia de Revascularização do Miocárdio.

PERFIL EPIDEMIOLÓGICO DA POPULAÇÃO SUBMETIDA À REVASCULARIZAÇÃO CARDÍACA E ACESSO AO SISTEMA ÚNICO DE SAÚDE

O objetivo deste estudo foi descrever o perfil epidemiológico de uma população submetida à revascularização cardíaca e compreender como esta população acessa os serviços de saúde para promoção, prevenção, tratamento e reabilitação. Estudo descritivo, transversal, amostra de 99 participantes, entre março de 2013 e fevereiro de 2014. Em relação ao perfil, 70 (70,7%) homens, 61 (61,6%) casados, 53 (53,5%) aposentados, 86 (86,9%) procedentes da região metropolitana, com idade média de 61,3 (±8,5) e média de anos de estudos de seis (±3,4), as comorbidades prevalentes foram Hipertensão Arterial Sistêmica 84 (84,8%) e Diabetes Mellitus 42 (42,4%). Referente ao Acesso aos serviços de saúde, 49 (49,4%) acessaram o hospital e 31 (31,3%) a Unidade Básica de Saúde. Observa-se a necessidade de ações estratégicas que facilitem o acesso e acompanhamento desta população aos serviços de saúde, em especial na Atenção primária à saúde, antes e após a revascularização cardíaca.

Potentialities and weaknesses in the care network of people with HIV/AIDS

OBJECTIVE

to understand the strengths and weaknesses in the care network of people with HIV/AIDS in a referral center in the state of Santa Catarina-SC.

METHOD

participants were eight subjects and their care network, totaling 18 participants. Data were collected through interviews and examined by content analysis, theoretically supported by symbolic interaction.

RESULTS

the analysis resulted in the following categories: The network offering care to people with acquired immunodeficiency syndrome, and Facing Barriers in care, which reflect the strengths and weaknesses in the care network. The fi rst depicts the provision of emotional and humanized care, and the second a restricted network formed by health professionals and a family member.

CONCLUSION

the professional care network is important, despite the increased number of assistances in a physical structure and amount of professionals who no longer meet the growing demand.

Primary care for diabetes mellitus patients from the perspective of the care model for chronic conditions

Objective

to assess the health care Primary Health Care professionals provide to diabetes mellitus patients from the perspective of the Modelo de Atenção às Condições Crônicas.

Method

qualitative study, using the theoretical framework of Complex Thinking and the Modelo de Atenção às Condições Crônicas and the methodological framework of assessment research. To collect the data, 38 interviews were held with health professionals and managers; observation of the activities by the health teams; and analysis of 25 files of people who received this care. The data analysis was supported by the software ATLAS.ti, using the directed content analysis technique.

Results

at the micro level, care was distant from the integrality of the actions needed to assist people with chronic conditions and was centered on the biomedical model. At the meso level, there was disarticulation among the professionals of the Family Health Strategy, between them and the users, family and community. At the macro level, there was a lack of guiding strategies to implement public policies for diabetes in care practice.

Conclusion

the implementation of the Modelo de Atenção às Condições Crônicas represents a great challenge, mainly needing professionals and managers who are prepared to work with chronic conditions are who are open to break with the traditional model.

Myocardial revascularization: factors intervening in the reference and counter-reference in Primary Health Care

OBJECTIVE

Understanding the factors that influence the reference and counter-reference process of people indicated/submitted to Myocardial Revascularization surgery in the Primary Health Care scenario.

METHOD

A qualitative research anchored in the Grounded Theory, totaling 41 participants subdivided into three groups (patients, health professionals and managers) in the Metropolitan and West Region of Santa Catarina.

RESULTS

Two categories elucidate the intervening factors found, contrasting the potentialities and obstacles in (creating) the bond between people affected by cardiovascular diseases and primary health care for the reference process, highlighting weaknesses in the primary health care services provided, with failures in the counter-reference for people submitted to myocardial revascularization surgery.

CONCLUSION

Strengthening the potentialities presented in this study is essential for the reference process of people affected by Cardiovascular Disease, as well as strategic actions focused on solving the evidenced obstacles which contribute to deficiencies in the referral and counter-referral process, thus impeding integral care in the health care network.

OBJETIVO

Compreender os fatores que influenciam o processo de referência e contrarreferência da pessoa com indicação/submetida à Cirurgia de Revascularização Miocárdica no cenário da Atenção Primária à Saúde.

MÉTODO

Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados, totalizando 41 participantes subdivididos em três grupos (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina.

RESULTADOS

Duas categorias elucidam os fatores interventores encontrados, Contrastando as potencialidades e entraves no vínculo da pessoa acometida por doenças cardiovasculares com a atenção primária à saúde para o processo de referência e Destacando fragilidades nos serviços disponibilizados na atenção primária à saúde, com insucessos da contrarreferência da pessoa submetida à cirurgia de revascularização miocárdica.

CONCLUSÃO

Torna-se essencial o fortalecimento das potencialidades apresentadas neste estudo para o processo de referência da pessoa acometida por Doença Cardiovascular, assim como ações estratégicas com foco na resolução dos entraves apontados e que contribuem para a deficiência do processo de referência e contrarreferência, dificultando a integralidade do cuidado na rede de atenção à saúde.

INTEGRAÇÃO ENTRE DADOS QUANTITATIVOS E QUALITATIVOS EM UMA PESQUISA DE MÉTODOS MISTOS

RESUMO Objetivo: descrever a experiência da integração entre dados quantitativos e qualitativos, por meio de uma pesquisa de métodos mistos. Método: trata-se de um relato de experiência da utilização dessa abordagem metodológica em um estudo de tese de doutorado em enfermagem sobre a governança da prática profissional de enfermagem no ambiente hospitalar. Resultados: o texto apresenta três tópicos principais: fundamentação teórica sobre as características e tipologias dos estudos de métodos mistos; procedimentos de coleta, análise e combinação dos dados; e benefícios e desafios da realização desse tipo de estudo. Conclusão: sustenta-se que a realização de uma pesquisa de métodos mistos permitiu a identificação de convergências e divergências entre os dados qualitativos e quantitativos, contribuindo para a produção de resultados que se complementam entre si.

RELATIONSHIP BETWEEN THE SOCIAL REPRESENTATIONS OF HEALTH PROFESSIONALS AND PEOPLE WITH TUBERCULOSIS AND TREATMENT ABANDONMENT

ABSTRACT Objective: to relate the social representations of health professionals and people with tuberculosis with treatment abandonment. Method: a descriptive and exploratory study with qualitative approach. Twelve health professionals and eight patients participated from Health Centers in Lima, Peru. Data were collected, between June and July 2012, through semi-structured interviews, analyzed according to content analysis technique. Results: similar content emerged from the analysis of the categories representations of both actors. They present similar aspects such as the treatment of tuberculosis generates suffering, tuberculosis is contagious and causes distancing and isolation, and the lack of knowledge generates treatment abandonment. These representations interfere with the conduct of care and adherence of tuberculosis treatment. Conclusion: there is need for education strategies in a psychosocial approach, considering the multidimensionality of treatment adherence, contributing to the reduction of treatment abandonment rates and the tuberculosis transmission chain.

MELHORES PRÁTICAS NO CUIDADO À PESSOA COM DOENÇA CARDIOVASCULAR: INTERFACE ENTRE LIDERANÇA E SEGURANÇA DO PACIENTE

Estudo descritivo, com abordagem qualitativa, que objetivou conhecer as melhores práticas do enfermeiro, bem como propor aprimoramentos no cuidado seguro à pessoa com doença cardiovascular atendida em instituição hospitalar privada especializada em cardiologia no Sul do Brasil. Desenvolvido entre agosto e outubro de 2015, nas três Unidades de Clínica Cirúrgica, com participação de 14 enfermeiros. Coleta de dados realizada através de entrevista semiestruturada e utilizou-se como referencial a Análise de Conteúdo. Foram identificadas melhores práticas nas ações de cuidado ao paciente, melhores práticas de liderança do enfermeiro, e por fim, proposições para o aprimoramento das melhores práticas para o cuidado seguro à pessoa com doença cardiovascular. Há necessidade de investir na cultura de segurança, no aperfeiçoamento da equipe de enfermagem, na utilização de melhores práticas e melhoria dos ambientes de trabalho para o alcance da segurança do paciente.

Coping strategies for oncology nurses in high complexity

OBJECTIVE

to identify the coping strategies of oncology services of nurses in highly complex hospital care before the person with cancer.

METHOD

it is a qualitative research, with 18 nurses in inpatient oncology units and/or outpatient chemotherapy in two cities in southern Brazil, sampled by a snowball and carrying out semi-structured interviews. Data were submitted to thematic analysis.

RESULTS

three categories emerged that show strategies such as denial and resignation in care, for support in the health team and the plurality and multiplicity of perspectives on the care, including the patient and his family and the search for personal and professional improvement.

CONCLUSION

coping strategies are expressed in the cultural understanding of what it means to have cancer or not and management of health institutions for nurses to work with satisfaction. The service in education is a major factor in the development of ethical competence.

NURSE LEADERSHIP PRACTICES IN PRIMARY HEALTH CARE: A GROUNDED THEORY

ABSTRACT This is a qualitative study and its aim was to understand the meaning of nurse leadership exercised in the services of Primary Health Care in a municipality located in Southern Region of Brazil. Grounded Theory was used as methodological framework. Data collection was carried out with semi-structured interviews applied to 30 nurses who worked in Primary Health Care and nursing professors, divided into four groups, between 2011 and 2012. After the analysis process, nine categories emerged and sustained the phenomenon 'Revealing the nursing leadership practices in the complex context of Primary Health Care'. Leadership was understood as a resource in the process of caring/managing people and developing a team of leaders, intending the organization and qualification of health work. It is important to rescue the clinical work of nurses, in order to keep their investment in the health team and to strengthen the binomial leader/caregiver.

ACTIONS/INTERACTIONS MOTIVATING NURSING LEADERSHIP IN THE CONTEXT OF PRIMARY HEALTH CARE

The aim of this qualitative study is to understand the actions/interactions identified as motivating leadership for nurses working at Primary Health Care services in a city in the South of Brazil. The Grounded Theory was used as the methodological framework. Data collection occurred through semi-structured interviews with twenty-three nurses working in the municipal health network and seven Nursing professors with expertise on the theme, distributed in four sample groups. The analysis revealed the category Composing the profile of nurses for leadership and its importance in health organizations, supported by three subcategories. The nurse exercises leadership driven by personality, vocational training stimulus, characteristics of the profession and influence of the environment. Nurses are influenced and influence the health service, acting in compliance with health policies, helping to foster the participation and integration of other workers in the health services.

Representações sociais das pessoas com tuberculose sobre o abandono do tratamento

RESUMO Objetivo Compreender as representações sociais das pessoas com tuberculose sobre o abandono do tratamento em um Programa de Controle da Tuberculose. Método Estudo descritivo, de abordagem qualitativa, realizado num município de Lima, Peru. Os dados foram coletados de outubro a novembro de 2012, através de entrevistas semiestruturadas, com oito pessoas, e analisados conforme a técnica de análise temática de conteúdo. Resultados As categorias levaram à construção da representação social de que a doença e o tratamento trazem sofrimento. Esta representação influencia na não adesão ao tratamento, podendo gerar um incremento de casos de abandono. Conclusão São necessárias estratégias educativas ligadas a processos de interação social, à subjetividade e ao contexto do paciente, direcionadas a diminuir o abandono do tratamento da tuberculose, as recidivas, a multirresistência. Novos desafios são apontados diante das avaliações frente ao alcance dos Objetivos de Desenvolvimento do Milênio.

Satisfaction of the elderly population attended in the family health strategy in Santa Cruz, Rio Grande do Norte, Brazil

This study aimed to identify the satisfaction of the elderly population in relation to the health care received in the Family Health Strategy, in Santa Cruz, in the State of Rio Grande do Norte, Brazil. It is a descriptive quantitative study, with a sample of 101 older adults registered in the municipality's family health system. The data were collected between May and September 2011, using a structured questionnaire, and were analyzed using descriptive statistics. It was observed that 67.3% of the interviewees were satisfied with the assistance received, and 72.3% were satisfied with the advice received. In relation to scheduling, waiting times and time spent in the consultations, many were dissatisfied (62.4%, 54.5% and 70.3% dissatisfaction, respectively). We conclude that, in spite of the majority of older adults being satisfied with this care, it is necessary to improve the attendance, particularly in the flow of requests for consultations in the units studied.

Best practice of nurse managers in risk management

OBJECTIVE

To identify the actions, undertaken by nurse managers in a risk management program, considered as best practice.

METHOD

A case study undertaken in a private hospital in the south of Brazil. A risk manager and nurse managers working in a risk management program participated in this study. The data was collected between May and September 2011 through analysis of documents, semi-structured interviews and non-participant observation. Based on the triangulation, the data was analyzed through practical measures.

RESULTS

Educational actions, the critical analysis of the context, and the multiple dimensions of the management were evidenced as best practice.

CONCLUSIONS

The broadening of understanding regarding risk management best practice offers further support for nurse managers to achieve excellence in their actions and thus provide safe and quality care.