Unveiling family relationships based on the context of domestic violence: a Grounded Theory

OBJECTIVE

To understand the meanings attributed to family relationships by women who have experienced domestic violence.

METHOD

Explanatory study using Symbolic Interactionism and Grounded Theory as references. Data were collected from March to November 2021, through online interviews with 23 women found on the social media application Facebook®.

RESULTS

Data analysis allowed the construction of a theoretical model consisting of three processes: "We learned that it was normal to be mistreated": experiencing a context of violence in the family of origin; "I just wanted a family": experiencing partner violence and redefining family relationships in the context of violence.

CONCLUSION

The meanings attributed to family relationships are elaborated and modified according to the interpretation, trajectory of confrontation, and interactions of women with other individuals and objects in the social web, over time. When experiencing domestic violence, women give new meaning to their feelings and begin to attribute new values, emotions, and empathy to family relationships, expanding their understanding of their weaknesses and potential.

Vulnerabilities of Venezuelan refugee women: violence and intersectional social relations

OBJECTIVE

To analyze the vulnerabilities of Venezuelan women considering their experiences of violence in refugee situations.

METHOD

Qualitative study, developed with ten (10) Venezuelan refugee women in the southern region of Brazil, through individual in-depth interviews. The theoretical framework of analysis was Vulnerability, Human Rights, and Intersectionality.

RESULTS

The greater the intensity of the intersection of social markers present, such as sex, racial, nationality, generation, cultural, bodily, territorial and other relations, the greater the range of vulnerable experiences in the social relations of these women, producing exclusions and violation of rights.

CONCLUSION

The situations of vulnerabilities of refugee women are enhanced as more or less social markers intersect in their life experiences and established social relationships, causing impacts that allow the transition from 'vulnerable to violated subjects'. Thus, intersectional relationships were formed, either promoting oppression or producing resilience and resistance.

Reproductive planning and pregnancy of HIV serodiscordant couples: a phenomenological study

OBJECTIVE

To understand the experience of reproductive planning and pregnancy for HIV serodiscordant couples.

METHOD

Qualitative study, with phenomenological approach, theoretical-philosophical-methodological framework of Martin Heidegger. The field stage took place in a reference service in the care for people living with HIV, in southern Brazil. From an intentional sample, a phenomenological interview was conducted with 11 couples between August 2013 and April 2014. The analysis was hermeneutic.

RESULTS

It was possible to understand, from the meaning units that: couples accept and overcome the serological discordance together; experiencing pregnancy is difficult; there is an effort to have a normal life; the diagnosis is silenced by prejudice and stigma; comes the couple's relief after the child's negative diagnosis.

CONCLUSION

It is necessary to recognize the couple as a unit of care with a view to a non-fragmented care in the field of sexual and reproductive health.

Inter-sectorial network for assisting women in situations of violence: handicraft work built by the people

OBJECTIVES

to discuss the meanings attributed by professionals to the construction of the service network for women in situations of violence.

METHODS

Convergent Care Research developed with the application of a convergence group with 32 participants from the health, social assistance, or public security sectors, in Santa Maria, Rio Grande do Sul. The data was produced during ten meetings, based on the problematization methodology, and submitted to analysis of thematic content and interpreted with the referential of networks.

RESULTS

the construction of the network is an artisanal work carried out by people continuously, permeated by bonds, communication and partnerships between services and knowledge of work processes. Lashings require permanent movement.

FINAL CONSIDERATIONS

building a network implies defining intertwining lines; form nodes that create cross-sector connections. There is a need to institutionalize processes through care continuity protocols, associated with an efficient communication system between sectors.

Driving Factors and Actions Taken by Women to Confront Violence: Qualitative Research Based on Art

This qualitative study based on art aimed to analyze the critical path of women in coping with situations of violence in the city of Santa Maria/Rio Grande do Sul, Brazil, in these women's perspective. It has as settings the Women's Police Station (DEAM) and the institutional care service for women in situations of violence, named Casa Abrigo (Shelter House). The "talking map" creativity and sensitivity technique was used in conjunction with the in-depth interview to analyze the critical path of 12 women in situations of violence. The driving factors of the critical path of women in coping with situations of violence were related to their knowledge about the DEAM's assistance, their perceptions about the experience of different types of violence, the fact that they can no longer stand the violence and that they worry about their children, as well as the support of their family, of the ex-husband's or ex-partner's relatives, and of their female friends. The decisions executed and actions taken by the women included reporting the aggressor, requesting a restraining order, seeking help from the guardianship council and family members, getting back together with the aggressor, and leaving home. There is a need to strengthen the decision-making process of women in situations of violence to break the silence and the situation of violence. For this purpose, it is urgent to broaden the information for and knowledge of women about where and how to seek help, through access to clear and precise information in all places that compose the assistance network for these women.

Content validation to support the monitoring of disclosure of HIV diagnosis in childhood

OBJECTIVES

to create and validate the content of a guide for monitoring the communication of the HIV diagnosis in childhood.

METHODS

methodological study, with a design guided by the Knowledge-to-Action (KTA) Framework, supported by a participatory approach. The guide's content was structured according to the communication elements proposed by Lasswel from review studies.

RESULTS

the content was validated by 26 experts from nursing, medicine, psychology and pedagogy, using a Likert-type scale for relevance, clarity and precision. Data collection took place online and achieved a Content Validity Index of 0.94.

CONCLUSIONS

the guide can contribute to the practice of professionals who care for children living with HIV, to support the family in communication and to the child's right to know their diagnosis. For further research, it is recommended to create and validate the face of the technology in order to implement it.

Communication of HIV diagnosis in proper time: scoping review

OBJECTIVE

To map how the communication of the HIV infection diagnosis occurs in pediatrics.

METHODS

Scoping review of the 64 original articles. We selected research papers in Portuguese, English, or Spanish, with the participants: child, adolescent, relative/family, and/or health professional from 2011-2020. We accessed the following sources: PubMed, CINAHL, Scopus, WoS, ASSIA, PsycINFO, ERIC, Sociological Abstracts, Edubase, LILACS, BDENF, and IndexPsi.

RESULTS

Regarding the population, it was evident to us that the relative must be the sender of the diagnosis with the professionals' support; regarding the reasons for the communication, the child maturity, expressed by questions, the necessity of therapy adherence, abilities to communicate and the right of knowing the diagnosis must be considered. The communication channel is centered on materials that promote comprehension, quantity, and quality of information. That indicated an interactive process. Regarding the effects, they are beneficial when the communication occurs at a proper time.

CONCLUSION

Communication must occur through a process that includes professional support to the relatives/family, development of abilities to evaluate the appropriate moment, and the monitoring effect.

Intentionality of women's actions in labor: a study in social phenomenology

OBJECTIVE

to understand the intentionality of women's autonomous actions in labor.

METHODS

a study in Alfred Schütz's social phenomenology, developed with 15 puerperal women admitted to a university hospital in southern Brazil. Data were collected through phenomenological interviews and analyzed according to the adopted framework and the comparison with scientific productions.

RESULTS

the actions intended to receive physical and emotional support from their companions, from pregnancy, for a peaceful delivery with less pain, fast and without interventions. The intention was to do the right things for the child's well-being and, after delivery, to be painless and active to take care of their children.

FINAL CONSIDERATIONS

women's actions have intentionality arising from their knowledge, which is guided by the social relationships established in the world of life.

Desenvolvimento motor de lactentes expostos ao HIV: oportunidades no ambiente domiciliar

Objetivou-se avaliar se as variáveis do ambiente e as sociodemográficas e clínicas do familiar e do lactente verticalmente exposto ao Vírus da Imunodeficiência Humana (HIV) interferem nas oportunidades no domicílio para o desenvolvimento motor infantil. Estudo transversal, no Sul do Brasil, entre dezembro de 2015 a setembro de 2017, com 83 familiares e seus respectivos lactentes verticalmente expostos ao HIV, utilizando dois instrumentos: questionário do lactente e familiar e o Affordances in the Home Environment for Motor Development - Infant Scale.  Análise com correlação de Pearson e Spearman e regressão linear simples. As oportunidades foram moderadamente adequadas, com associações positivas significativas entre as variáveis idade do familiar e do lactente, escolaridade e possuir irmão exposto ao HIV e as dimensões espaço físico, variedade de estimulação, brinquedos de motricidade grossa e fina. Conclui-se que as variáveis sociodemográficas do familiar e do lactente interferiram nas oportunidades para desenvolvimento motor infantil no domicílio.

Social support perceived by pregnant and puerperal women with HIV: A cross-sectional study

Objective: To assess whether the social support perceived by pregnant women with HIV is different from that observed by puerperal women also with HIV. Method: The study had a quantitative approach and a cross-sectional design. It was developed from April to November 2014 in southern Brazil with 78 participants. The Social Support Scale for people living with HIV/AIDS was applied. In addition, descriptive analysis, T-test, Fisher’s exact test, and linear logistic regression were performed. Results: There was a significant difference in total and instrumental social support scores, which show that the group of pregnant women report higher social support rates. Puerperal women are 8.8 times more likely to have low total social support (OR: 8.80; IC: 1.01-16.76) and 6.0 times more likely to have low instrumental social support (OR: 6.00; IC: 1.53-10.48). The level of satisfaction with the support from friends in the emotional (p =0.009) and instrumental (p =0.004) dimensions was low. It was evidenced that beingpregnant is a protective factor in comparison with being a puerperal woman. Conclusions: Puerperal women living with HIV are dissatisfied with the social support they perceive, which involves the clinical practice of health professionals. Therefore, health professionals must qualify health care in a way that includes the social dimension of this type of patients.

Construção de uma linha de cuidado para atenção à saúde de mulheres vivendo com HIV

Resumo Objetivo Construir uma linha de cuidado para a atenção à saúde de mulheres vivendo com HIV. Método Pesquisa participante desenvolvida por meio da técnica de grupo focal com 11 profissionais e gestores de serviços de saúde em município do Sul do Brasil. Os dados foram analisados a partir da análise de conteúdo. Resultados Os profissionais e gestores elencaram dificuldades e facilidades para promoção do acesso das mulheres que vivem com HIV aos serviços de saúde. Identificaram a descentralização do cuidado, os serviços articulados em Redes de Atenção à Saúde e a constituição da linha de cuidado para mulheres vivendo com HIV como estratégia para potencializar a qualidade da atenção à saúde para essa população. Conclusão e implicações para a prática Considera-se que a linha de cuidado deve ser flexível, horizontal e levar em consideração escolhas e autonomia das mulheres no acesso aos serviços de saúde. A construção desse produto, mediado pela participação efetiva de profissionais e gestores em pesquisa participante, indica o potencial para a reorganização dos serviços em rede.

Linha de cuidado para crianças e adolescentes vivendo com HIV: pesquisa participante com profissionais e gestores

RESUMO Objetivo Construir uma linha de cuidado para a atenção à saúde às crianças e adolescentes com HIV. Método Pesquisa participante desenvolvida por meio da técnica de grupo focal com 23 profissionais e gestores da atenção primária e especializada, em município do Sul do Brasil. O material empírico foi submetido à análise de conteúdo temática. Resultados O fato de a atenção à saúde para esta população ser realizada, majoritariamente, nos serviços especializados fomentou a discussão de aspectos conceituais, estruturais e sociais acerca da temática. Pactuou-se como deve ser realizada a atenção centrada no usuário e compartilhada entre os serviços, considerando os atributos qualificadores da atenção. As atribuições de cada serviço, as articulações e a operacionalização foram definidas para a integração entre os pontos da rede. A validação das ideias centrais culminou com a construção da linha de cuidado para crianças e adolescentes vivendo com HIV. Conclusão e implicações para a prática A implantação desse produto adaptado ao cotidiano assistencial dos municípios requer ações estratégicas para a integração dos pontos de atenção e para qualificação da atenção à saúde dessa população.

Effectiveness of interventions for adherence to antiretroviral therapy in adults with HIV: a systematic review

OBJECTIVE

To identify the best available evidence of intervention effectiveness for adherence to antiretroviral therapy for HIV in adults.

METHOD

The methodology proposed by the Cochrane Collaboration was used, with search in the databases: PubMed, Embase, LILACS, CINAHL, Web of Science and SCOPUS. Randomized clinical trials of interventions to promote adherence to antiretroviral therapy for HIV, in the ≥ 18-year-old population, published from 2010 onward, were considered. The eligibility, inclusion and extraction of results were developed by two independent researchers.

RESULTS

The five studies included in the quantitative analysis were effective interventions that developed educational actions with the patient, especially mediated by software, the use of medication schedule reminders and the inclusion of treatment supporters that also received educational actions to develop such role.

CONCLUSION

The combination of interventions strengthens the promotion of adherence. There is a need for investment in the implementation of educational actions with patients, such as the inclusion of supporters, in addition to counseling and electronic devices for reminders, which must be offered in the services in an articulated and continuous manner.

Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus

OBJECTIVE

to evaluate the cost-effectiveness ratio and the budget impact of sending text messages associated with medical consultations in order to reduce the viral load of patients infected with the Human Immunodeficiency Virus.

METHOD

a randomized clinical trial, basis for the development of a dynamic cohort model with Markov states in order to compare medical appointments for adults infected with the Human Immunodeficiency Virus versus the alternative strategy that associated medical consultations to sending text messages through telephone.

RESULTS

156 adults participated in the study. As for the viral load, it was verified that in the control group there was an increase, in the intervention group A (weekly messages) there was a reduction (p = 0.002) and in group B (biweekly messages) there was no statistically significant difference. Sending text messages would prevent 286,538 new infections by the Human Immunodeficiency Virus and 282 deaths in the 20-year period, compared to the standard treatment. The alternative strategy would result in saving R$ 14 billion in treatment costs.

CONCLUSION

weekly sending messages in association with the standard treatment can reduce the circulating viral load due to its effect in decreasing new infections, in addition to reducing health costs.

Creation and validation of a visual educational technology content for lactation physiology learning

OBJECTIVE

to create and validate a visual educational technology content for lactation physiology learning.

METHOD

a methodological study that contemplated the stages of content creation and validation guided by the conceptual model of Knowledge Translation into action. The creation took place in partnership with the educational technology center of the project's home institution. The validation was attended by 27 judges with experience in the obstetric, neonatal, pediatric or maternal and child areas and in the theme of breastfeeding.

RESULTS

an educational technology covered animation and video techniques to locate, respectively, elements of lactation physiology and the population involved. An Overall Content Validity Index of 0.84 was obtained.

CONCLUSION

the visual educational technology for lactation physiology learning has been validated in content as a tool to introduce the theme and mediate health education actions that can have a positive impact on breastfeeding.

Communication of bad news in pediatrics: integrative review

OBJECTIVES

to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics.

METHODS

integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included.

RESULTS

the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information).

CONCLUSIONS

there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child's right to know their condition.

Men's sexual and reproductive health in the situation of HIV-serodiscordance

OBJECTIVE

to know men's perspective in face of reproduction in the situation of HIV-serodiscordance.

METHOD

qualitative study developed in a university hospital in Southern Brazil. Unstructured in-depth interviews were conducted with 11 men living with HIV and a thematic content analysis was performed.

RESULTS

men expressed not wanting to have children and that this pregnancy was different. They showed concerns related to the vertical transmission of HIV, sexual and reproductive rights and responsibility in the exercise of parenthood. Final considerations: men's perspective is influenced by their role in the family, which is historically and culturally determined, and by the concerns about infection, which are socially determined and entail their understanding of reproductive rights and their participation in care. In services, men's perspective must be considered in the planning and implementation of health care actions by supporting their participation in the exercise of fatherhood.

Association between social support and adherence to anti-retroviral treatment in people living with HIV

OBJECTIVE

To investigate the association between social support, adherence to HIV anti-retroviral therapy, and clinical and sociodemographic factors.

METHOD

A cross-sectional study conducted from July 2016 to August 2018 in a specialized outpatient clinic in southern Brazil. Individual interviews were conducted for the application of the following instruments: Questionnaire for the Evaluation of Adherence to Anti-retroviral Treatment (CEAT-HIV) and Social Support Scale for People Living with HIV/AIDS. The Spearman bivariate correlation test was used for analysis purposes.

RESULTS

Among the 168 participants, the mean social support score was 3.53 points (SD = 0.66), and 64.9% (n = 109) of the respondents had insufficient adherence. There was a significant association (p < 0.05) between emotional social support and the following adherence domains: antecedents of non-adherence behaviors and doctor-patient communication.

CONCLUSIONS

Social support is associated with antecedents of non-adherence behaviors and doctor-patient communication.

REASONS FOR WOMEN’S AUTONOMOUS ACTIONS IN THE CHILDBIRTH PROCESS: AN UNDERSTANDING BASED ON SOCIAL PHENOMENOLOGY

ABSTRACT Objective: to describe women’s autonomous actions during childbirth and to understand their reasons. Method: qualitative research designed through social phenomenology premises. Phenomenological interviews were conducted with 15 postpartum women hospitalized at a hospital’s rooming-in setting in the south of Brazil, from September to December 2017. For the analysis, the principles of the adopted framework were followed, associated with productions related to the object of study. Results: autonomous actions were developed from the time of pregnancy and during childbirth, and their reasons derived from their previous experiences. Such experiences were signified by the fear of what they had heard or because in previous births they had experienced pain, complications and unwanted interventions; due to the bond with companions and their experience with labor and delivery. Conclusion: the reasons for women’s autonomous actions in the childbirth process are sustained on their biographical situation, set of knowledge and social relations.

Musical educational technology for lactation physiology learning: knowledge translation

OBJECTIVE

create and validate a musical educational technology for lactation physiology learning for professional training in health.

METHOD

methodological study with application of a conceptual framework of Knowledge Translation. In the creation cycle, the knowledge of the physiology of lactation was synthetized in key points to create the lyrics and the melody. In the action cycle, the content of the musical educational technology was validated by judges experts in breast feeding, in the period from September to December 2017.

RESULTS

18 judges from all Brazilian regions participated in the validation. The content of the technology obtained a global Content Validity Index of 0.94 with one round of validation.

CONCLUSION

the musical educational technology is validated to introduce the content of the physiology of lactation in the learning process of students, mediated by the teacher.

Critical path of women in situation of violence: an integrative literature review

OBJECTIVE

To identify Brazilian and international scientific evidence on the critical path of women in situations of violence.

METHOD

Integrative literature review developed in four databases and two electronic portals, in January 2017. Twenty-one full articles in English, Portuguese or Spanish from original researches were included in the time cut from 1994 to 2016, and which presented critical path elements, even without using this concept.

RESULTS

The critical path of women in situations of violence is constituted of elements related to their perceptions, actions and previous experiences regarding availability and quality of services, social representations of public servers and community and the results obtained in the search for help.

CONCLUSION

Critical path elements are decisive for the women, and can promote, inhibit or delay the beginning of the route and consequently the end of situations of violence experienced by these women.

Violence against women in Primary Health Care: Potentialities and limitations to identification

Objective

To determine the potential and limitations of Primary Health Care professionals to identify situations of violence against women.

Location

A municipality of Rio Grande do Sul, Brazil.

Design

Descriptive and exploratory study with a qualitative approach.

Participants

Twenty-one health professionals of three Family Health Strategy units, as well as one Basic Health Unit. The inclusion criterion consisted of being a health worker in these services. The exclusion criterion was to be absent from work by any kind type license during the period of data production.

Method

The technique used to produce data was individual, semi-structured, interviews in order to collect sociodemographic data and the monitoring by professionals related to the potentials and limitations to identify violence situations. The data collection was suspended based on the saturation criterion. The data were systematized and analyzed by the content analysis technique, according to the analytical categories of health care network and gender.

Results

The potential to identify themes were: professional experience, receptive atmosphere, bonding, and listening to the reports of women, children and/or neighbors and observing their behavior; to identify the lesions; prenatal consultations; and home visits. As to the limitations: silence, denial/non-recognition of violence, lack of complaints by women; fear and guilt; flaws and unpreparedness of the health team; and fear due to the presence of aggressor.

Conclusions

It is urgent to recognize the potential of Primary Care and to promote the qualification of professionals in order to identify the situation among visible and invisible complaints, leading to the confrontation of violence.

Operationality of concepts in Heideggerian phenomenological investigation: epistemological reflection on Nursing

OBJECTIVE

To describe the investigative path of analysis and the operationality of concepts based on Martin Heidegger's theoretical and philosophical framework.

METHOD

Theoretical reflection on the phenomenon of pregnancy in a woman with heart disease.

RESULTS

Stages of the investigative movement were evidenced based on the pre-reflection related to the object of study and to the search for the phenomenal meaning, using the existential and analytical Hermeneutics as the approach and resulting in the reach of the phenomenal totality.

CONCLUSION

The worldview of the researcher, who considered the subjectivities of the person in a health or disease situation, favored the announcement of the referential by the object of study. Knowledge production in the light of Martin Heidegger's phenomenology unveiled phenomena lived and experienced in the Health and Nursing field, provided of epistemological rigor that demanded appropriation of concepts inherent to the existential analytics.

Evaluation of the health attention to pregnant women with HIV: comparison between primary and specialized service

ABSTRACT The public network for health care of pregnant women with HIV, in Santa Maria, Rio Grande do Sul/Brazil, includes primary and specialized care services. Objective: Evaluating whether the type of service interferes in the quality score of the health care in the experience of the pregnant women with HIV. Methods: Cross-sectional study, with data collection from April-November/2014, with 78 participants. The Primary Care Assessment Tool-Brazil instrument was applied and the Pearson's Chi-square test and Fisher's exact test were used. Results: The quality of care received was evaluated as unsatisfactory both in primary care (6.50) and in specialized care (6.35). Conclusion: The type of service interferes with the quality of care, which can affect women's choice of service. It is necessary to improve the quality of both types of services and to search for the management of shared care to attend both the usual care of gestation and the specificity of infection.

Profile of infected pregnant women and children exposed to HIV at a specialized service in the South of Brazil

Abstract Objectives: to characterize the social and clinical profile of pregnant women infected with HIV, the factors associated to the prevention of vertical transmission, and to analyze the quality of the information available in the SINAN notification forms and clinical records of infected pregnant women and children exposed to HIV in a specialized service in the countryside of Rio Grande do Sul. Methods: retrospective documentary study conducted from medical records of 110 HIV mothers and their children born between June/2014 and March/2017. For the analysis, the absolute frequency and the data percentage were taken under consideration. Results: the characterization of infected women represents a Brazilian scenario among young adults, low schooling level and the occurrence of unpaid employment situation. Most mothers underwent treatment during pregnancy and had prenatal care with the intention of applying the prophylactic measures recommended by the national protocols. A greater occurrence of incompleteness of data in the factors of prevention of vertical transmission was identified. Conclusions: the compromise is identified regarding the quality of assistance addressed to the population, which is largely exposed to unfavorable social conditions. The occurrence of data incompleteness shows that there is still not a culture among health professionals that ensures that the information is adequately filled out and favors the exchange of the information among the services.

Motivos do abuso de substâncias psicoativas por mulheres assistidas em Centro de Atenção Psicossocial

Resumo OBJETIVO Compreender os motivos atribuídos por mulheres ao abuso de substâncias psicoativas. MÉTODO Abordagem qualitativa de natureza fenomenológica. Foram entrevistadas 12 mulheres usuárias de substâncias psicoativas em tratamento no Centro de Atenção Psicossocial álcool e drogas, no Sul do Brasil. As entrevistas foram realizadas entre maio e junho de 2013. Os dados foram interpretados à luz da Fenomenologia Social de Alfred Schütz. RESULTADOS O abuso de substâncias psicoativas é motivado pela influência das pessoas com as quais as mulheres mantêm um relacionamento ou com as quais conviveram. Ainda, as perdas e os conflitos familiares vivenciados também foram como um estopim para o abuso de substâncias psicoativas. CONCLUSÃO A assistência à saúde das mulheres necessita atender além das demandas, na medida em que deve levar em consideração a história de vida dessas mulheres.

Possibilities of care for serodiscordant couples for HIV who got pregnant

OBJECTIVE

Understanding the meaning of pregnancy for heterosexual couples facing serodiscordant situation for HIV, aiming at construction of care possibilities based on subjectivity.

METHOD

Phenomenological research, theoretical-philosophical-methodological framework by Martin Heidegger. Research was conducted in a University Hospital in the countryside of Southern Brazil, from September 2013 to May 2014 through a phenomenological interview, with participation of eleven couples.

RESULTS

For the couples, pregnancy is part of life when they wish to have a child, even when one or both of them already have children from previous relationships. In addition, it is part of life when they consider the risks and do not want to have children in such circumstances anymore, but it happened unexpectedly.

CONCLUSION

Understanding reproductive needs and demands of these couples is an aid for qualification and improvement of care as a contribution to nursing care planning towards reproductive health of these couples.

AVALIAÇÃO DA ADESÃO AO TRATAMENTO ANTIRRETROVIRAL DE PESSOAS VIVENDO COM HIV

Avaliar a adesão ao tratamento antirretroviral de pessoas que vivem com HIV através do “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH), de forma a descrever seus itens a partir da correlação entres as questões deste instrumento. Estudo transversal, realizado em um Hospital Universitário do Rio Grande do Sul no primeiro semestre de 2012 com 179 pessoas em tratamento para o HIV. Foram realizadas análises estatísticas descritivas e de correlação entre os itens do questionário. Avaliação da adesão: 46,4% baixa/insuficiente, 36,9% boa/adequada e 16,8% estrita. Correlações: deixar de tomar a medicação relaciona-se aos fatos de se sentir melhor/pior, ou sentir-se triste/deprimido. Seguir a prescrição médica está relacionado com a autoavaliação em relação à ingesta dos medicamentos. A baixa/inadequada adesão legitima o uso do CEAT-VIH enquanto ferramenta a ser utilizada pela enfermagem junto à equipe multiprofissional no planejamento do cuidado e intervenção nas situações que interferem na adesão.

Primary health care attributes assessment: children and adolescents living with HIV

Abstract Objectives: To evaluate the attributes derived from Primary Health Care (PHC) focusing on children and adolescents living with HIV, in the experience of health professionals, comparing traditional units (BHU) and Family Health Strategy (FHS). Method: Cross-sectional research in which 524 professionals from 25 cities of Rio Grande do Sul, Brazil were interviewed. The Primary Care Assessment Tool Brazil was used from March through August 2014. Results: The PHC score attributed to FHS (7.8) was higher than that attributed to BHU (6.8). The higher scores contributed to the home visit, the professional qualification and the employment bond, the latter acting independently of the others. Conclusion: The satisfactory evaluation of the derived attributes approves the interaction with users and community and the potential of PHC to attend these children and adolescents, and the home visit qualifies the practice.

Problematization Methodology and Convergent Healthcare Research: praxis proposal in research

ABSTRACT Objective: Presenting theoretical subsidies for the nursing care practice based on the possibility of convergence between research practice and educational practice. Method: The Convergent Healthcare Research was developed from February to August 2015, with an intersectoral working group formed by 32 participants, including health, social services and public safety professionals. Ten group meetings were organized, based on the Problematization Methodology with Maguerez's Arch. Results: The reflection-action movement resulted in the shared (re)building of the flowchart of care to women subjected to a situation of violence, as a device for communication between the services. Final considerations: The research practice based on the Problematization Methodology with Maguerez's Arch proved to be useful and viable in qualitative research, which has as purpose the transformation of the reality studied.

PROMOÇÃO DA AUTOEFICÁCIA EM AMAMENTAR POR MEIO DE SESSÃO EDUCATIVA GRUPAL: ENSAIO CLÍNICO RANDOMIZADO

RESUMO Objetivo: avaliar o efeito da estratégia educativa em sessão grupal a partir da utilização do álbum seriado "Eu posso amamentar o meu filho" na promoção da autoeficácia em amamentar. Método: foi desenvolvido um ensaio clínico com 208 puérperas randomizadas aleatoriamente para o grupo intervenção ou controle. A intervenção consistiu na aplicação do álbum seriado "Eu posso amamentar o meu filho" em sessão grupal no alojamento conjunto. Utilizou-se a Breastfeeding Self-Efficacy Scale - Short Form para mensurar os escores de autoeficácia no período de acompanhamento (alojamento conjunto, 15 dias após o parto e mensalmente até os 120 dias). Resultados: encontrou-se maior percentual de mulheres com autoeficácia em amamentar alta ao longo do período de acompanhamento no grupo intervenção (p=0,002) e um aumento da média dos escores de autoeficácia nesse grupo no período de acompanhamento (p<0,05). Conclusão: houve modificação ou reforço da autoeficácia materna em amamentar com a utilização do álbum seriado em sessão grupal - Número de Registro: RBR-6srs33.

Intervening factors in the feeding of infants vertically-exposed to HIV: an integrative review

Objective

To evaluate the available scientific literature on factors that may intervene in the adequate feeding of infants vertically-exposed to HIV.

Methods

This was an integrative review of the literature, performed on the LILACS, PubMed and Scopus databases in February 2017. The search was guided by the question "What are the factors involved in feeding infants vertically-exposed to HIV." Selected studies met the inclusion criteria of being research articles published in English, Portuguese, or Spanish. Articles excluded were those on exclusive breastfeeding. There was no need to perform a temporal cut off of the studies.

Results

In all, the 32 primary studies selected showed that intervening factors were of three types: individual, such as maternal feelings and desires, beliefs, and practical difficulties; social, such as socioeconomic conditions, social support, and stigma; and political, such as health services structure and organization, supplies, health care guidance, and the knowledge and attitudes of health care professionals.

Conclusions

The factors that interfere with feeding infants vertically-exposed to HIV may be independent or associated with each other. To reduce the risk of inadequate nutrition and its associated diseases, actions must be taken to identify and minimize these factors, guaranteeing a better quality of life and reduction of infant morbidity and mortality.

Fatores associados à adesão ao tratamento antirretroviral em adultos infectados pelo HIV: estudo transversal

Objetivo: analisar os fatores associados à adesão ao tratamento antirretroviral em adultos que vivem com HIV. Método: estudo transversal, com 179 adultos atendidos em serviço especializado, no Sul do Brasil. Foi utilizado o “Cuestionário para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH) e análise estatística descritiva e inferencial (Regressão de Poisson). Resultados: dos participantes, 83,2% foram classificados em não adesão ao tratamento. Estiveram associados à não adesão o menor nível de escolaridade, a dificuldade de manutenção do acompanhamento ambulatorial, a propensão para alcoolismo, a mudança no estilo de vida e a utilização de medicações psiquiátricas. Conclusões: o diagnóstico precoce de adesão possibilita o planejamento de ações educativas focadas nas características associadas à não adesão.

Prevention of vertical mother-to-child transmission of HIV: care and adhesion provided by couples

RESUMO Objetivo: desvelar o movimento existencial do casal ao realizar a profilaxia da transmissão vertical do HIV. Método: investigação qualitativa, com abordagem fenomenológica de Martin Heidegger. Foi realizada entrevista fenomenológica com 14 participantes entre dezembro/2011 e fevereiro/2012 no ambulatório de um hospital universitário, Brasil. Foi desenvolvida análise compreensiva e interpretativa heideggeriana. Resultados: o casal compreende que seguiu a orientação dos profissionais de saúde conforme o que foi indicado. Ao não poder amamentar, a mulher não deixou de ser mãe, mas não foi uma vivência completa. Desvelaram-se os sentidos da ocupação do ser-casal em realizar o tratamento profilático e o da facticidade diante do fato de não amamentar. Conclusão: indica-se repensar o cuidado, propondo uma relação profissional que transcenda o impessoal que dita com o que o casal deve se ocupar, viabilizando sua participação de maneira ativa nas decisões e ações de cuidado.

Revealing an HIV diagnosis for children and adolescents: subsidy for the practice of care

Objective

To collectively build a guide for following-up on HIV diagnosis disclosure to children and adolescents in a specialized service.

Method

Convergent-care research approach with observation triangulation, interview and groups, conducted from May to June 2015 with seven health professionals in a pediatric outpatient clinic for infectious diseases. Thematic content analysis was developed.

Results

The discussion of understanding the disclosure, its triggers, actors involved, used strategies, and limits and possibilities listed by the professionals subsidized the construction of a guide to be applied in the stages: analyzing children's questions and curiosities; evaluating their cognitive ability; discussing the reasons to reveal; listing the professionals involved on follow-up process; including family; developing strategies for disclosure.

Conclusion

This guide may mediate changes in care practice to ensure the child's rights and to make the professionals co-accountable.

Instruments for articulating the network of attention to women in situation of violence: collective construction

Objective

This paper aims at identifying all the necessary information to build instruments which are designed to facilitate the professional integration of services to women in situation of violence with a view to the establishment of a network of attention.

Method

Qualitative study, convergent, whose information has been produced from February to August 2015 by 10 group meetings, with 32 participants from the Integrated Working Group to Confront Violence in Santa Maria-RS, located at the Universidade Federal de Santa Maria. Using thematic content analysis.

Results

It defined the flow direction; the points to compose the network; what it would take to communicate among services: identification of wife and family, report on the situation and the continuity of care.

Conclusions

There is a need for an institutional formalization of constructed devices. The articulation between the services requires communication, involvement and commitment of the professionals to ensure the continuity of care.

Women's autonomy in the process of labour and childbirth: integrative literature review

Objective

To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process.

Method

The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body.

Results

The main practices that favoured the exercise of women's autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice.

Conclusion

There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

Health care for women in situations of violence: discoordination of network professionals

OBJECTIVE

To learn the conceptions and actions of health professionals on the care network for women in situations of violence.

METHOD

A qualitative, descriptive, exploratory study was conducted between April and July 2015 with the participation of 21 health professionals from four primary health care teams in a city of the central region of the state of Rio Grande do Sul. Data were collected by means of individual semi-structured interviews. Content analysis was used for data systematization.

RESULTS

Health professionals recognized the importance of the health care network for coping with the problem of violence against women. However, their conceptions and actions were limited by the discoordination or absence of integration among professionals and services of the care network.

CONCLUSION

The conceptions and actions of health professionals contribute to the discoordination among the services. It is necessary to reflect on the daily practices of care for women in situations of violence.

OBJETIVO

Conhecer as concepções e ações de profissionais de saúde sobre a rede de atenção às mulheres em situação de violência.

MÉTODO

Estudo qualitativo, descritivo e exploratório, realizado no período de abril a julho de 2015. Participaram 21 profissionais de saúde de quatro equipes da Atenção Primária à Saúde em um município da região central do estado do Rio Grande do Sul. A coleta de dados ocorreu mediante entrevistas semiestruturadas e individuais. Para sistematização dos dados, empregou-se a análise de conteúdo.

RESULTADOS

Os profissionais de saúde reconheciam a importância da rede de atenção à saúde no enfrentamento da problemática da violência contra as mulheres. Contudo, suas concepções e ações eram limitadas pela desarticulação ou ausência de integração entre os profissionais e serviços da rede de atenção.

CONCLUSÃO

As concepções e ações dos profissionais de saúde contribuem para a desarticulação entre os serviços. Faz-se necessário refletir acerca das práticas cotidianas de cuidados direcionados às mulheres em situação de violência.

Focus group on qualitative research: experience report

ABSTRACT Objective: to report the experience of applying the focus group technique for production of data in qualitative research. Method: four group sessions were held from May to June 2015, with the participation of professionals from the public sector of PHC and from specialized service. Results: the way focus group was developed is described in steps: planning, recruitment, ambience, group sessions, and evaluation. Conclusion: we highlight that the focus group, as a technique to produce data in collective space, can contribute not only to the construction of knowledge in Nursing, but also to the research approach with the assistance practice.

Atenção à saúde de crianças e adolescentes com HIV: avaliação da longitudinalidade

Resumo Objetivo Avaliar a presença do atributo longitudinalidade da Atenção Primária à Saúde, na experiência de profissionais dos municípios de procedência de crianças e adolescentes com HIV, acompanhados em serviço especializado. Métodos Estudo transversal realizado em 25 municípios do Rio Grande do Sul com 527 profissionais da saúde. Utilizou-se questionário de caracterização e o instrumento Primary Care Assessment Tool-Brasil, versão Profissionais. Foram utilizados Teste Qui-Quadrado de Pearson e Regressão de Poisson. Resultados A longitudinalidade apresentou-se satisfatória (p=6,96). Associaram-se ao alto escore: profissional com idade menor ou igual a 30 anos (p=,01); formação profissional clínico geral (p 0,03). Foi associado ao alto escore, na Estratégia de Saúde da Família, o tempo suficiente no atendimento aos usuários (p 0,045). Conclusão A avaliação indicou o potencial da Atenção Primária à Saúde para o atendimento das crianças e adolescentes com HIV, especialmente em proporcionar o vínculo, determinante para a continuidade da atenção.

PRIMARY CARE QUALITY FROM PROFESSIONALS’ PERSPECTIVE: HEALTH OF CHILDREN AND ADOLESCENTS WITH HIV

ABSTRACT Objective: evaluate, based on the professionals’ experience, the primary health care quality in home cities of children and adolescents with HIV, treated at a specialized service. Method: cross-sectional study involving 527 professionals in 25 interior cities in Rio Grande do Sul, Brazil, in the first semester of 2014. The Primary Care Assessment Tool was applied. Pearson’s chi-square Test, the Mann Whitney Test and the Poisson Regression were used. Results: the Estratégia Saúde da Família and the primary health care service presented a high score related to the essential attributes: longitudinality (7.17 and 6.74), coordination-integration of care (6.87 and 7.03) and coordination-information systems (8.24 and 8.19); and a low score for the attribute access (3.96 and 3.8). The variables: female gender (0.009), education as general practitioner (<0.001), statutory staff (0.029), coordinator position (0.087) and not having another job (0.027) were also associated with the high score. Conclusion: the coverage of the Estratégia Saúde da Família needs to be expanded and structural and organizational shortages in the access need to be overcome.

Potential drug interactions in patients given antiretroviral therapy

Objective

to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy.

Methods

a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant.

Results

of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity.

Conclusions

the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs.

A five-year review of vertical HIV transmission in a specialized service: cross-sectional study

CONTEXT AND OBJECTIVE:

Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it.

DESIGN AND SETTING:

Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil.

METHODS:

A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children.

RESULTS:

The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported.

CONCLUSIONS:

The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.

[Understanding what is lived by the being-couple in face of the prophylaxis of vertical HIV transmission]

OBJECTIVE

To understand the couple's perspective, the experience of prevention care against the vertical transmission of HIV.

METHOD

Heidegger's phenomenological research conducted with 14 participants, through interviews from December / 2011 to February / 2012 in a hospital in the countryside of Rio Grande do Sul, Brazil. Analysis performed with Martin Heidegger's framework. RESULTS the being-couple unveiled the sense of fear, initially in the variation of dread when terrified due to the HIV infection discovery, and later in the horror variation when treatment was needed during gestation and finally in the terror variation when considering the chances of viral transmission to their child.

CONCLUSIONS

Health care attention that enables the couple to assume a leading role in the prophylaxis of vertical transmission is recommended, which will reflect positively on the health of pregnant women and in reducing neonatal and infant mortality as a result from AIDS.

[Care for women victims of violence: empowering nurses in the pursuit of gender equity]

OBJECTIVES

To study the care of women victims of violence provided by nurses in emergency services and to analyse the practices that target the empowerment of women and gender equity.

METHODS

A qualitative, descriptive study conducted by means of interviews with 10 nurses of an emergency and obstetrics unit of a university hospital and local emergency service of a city in southern Brazil from January to April 2013. We used thematic content analysis and defined gender as the analytical category.

RESULTS

Clinical elements refer to nursing procedures and techniques. Non-clinical elements refer to conversation, listening and orientation to the women and their families.

CONCLUSION

Revealing these actions is important to qualify nursing care in relation to the other health professionals and care services for women victims of violence.

Quality of Primary Health Care for children and adolescents living with HIV

Objective:

to evaluate the quality of health care for children and adolescents living with HIV, among the different types of Primary Health Care services of Santa Maria, Rio Grande do Sul.

Method:

cross-sectional study, developed with 118 Primary Health Care professionals. The Primary Care Evaluation Instrument, Professional version, was used. For verification of the variables associated with the high score, Poisson Regression was used.

Results:

the professionals of the Family Health Strategy, when compared to those of the Primary Health Units, obtained a greater degree of orientation to primary care, both for the overall score and for the derived attributes score, as well as for the integrality and community orientation attributes. A specialization in Primary Health Care, other employment and a statutory work contract were associated with quality of care.

Conclusion:

the Family Health Strategy was shown to provide higher quality health care for children and adolescents living with HIV, however, the coverage is still low. The need was highlighted to expand this coverage and invest in vocational training directed toward Primary Care and making the professionals effective, through public selection procedure, as well as an improvement program that recognizes the care requirements, in these settings, of children and adolescents infected with HIV.

Evaluation of the quality of primary health care for children and adolescents with HIV: PCATool-Brasil

OBJECTIVE

Assess the overall score of the Primary Health Care in municipalities where children and adolescents living with HIV reside, according to the PCATool-Brazil instrument, professional version.

METHODS

Quantitative study with 527 professionals in 25 municipalities where children and adolescents living with HIV reside. Data collection took place between March and August 2014, by applying PCATool-Brazil instrument, professional version. In the data analysis, we used Pearson's chi-square test, the Mann Whitney test and Poisson regression. All ethical aspects were respected.

RESULTS

The overall assessment of the Basic Health Unit (BHU) and the Family Health Strategy's (FHS) service quality was satisfactory (6.80). When BHU and FHS were compared, only the latter showed a high score (7.06).

CONCLUSIONS

Despite the satisfactory overall score, the need to expand the FSH coverage, and encourage the promotion of competitive public service examinations and the qualification of these professionals.