Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-01-14T19:50:39Z No. of bitstreams: 1 MarcellySantosCossi_DISSERT.pdf: 2107185 bytes, checksum: 4181729d56c11e4df10c9c1cd6b8fc50 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-01-18T19:57:13Z (GMT) No. of bitstreams: 1 MarcellySantosCossi_DISSERT.pdf: 2107185 bytes, checksum: 4181729d56c11e4df10c9c1cd6b8fc50 (MD5) / Made available in DSpace on 2016-01-18T19:57:13Z (GMT). No. of bitstreams: 1 MarcellySantosCossi_DISSERT.pdf: 2107185 bytes, checksum: 4181729d56c11e4df10c9c1cd6b8fc50 (MD5) Previous issue date: 2014-12-12 / O estudo tem por objetivo analisar as concep??es e as pr?ticas desenvolvidas pelos enfermeiros no ?mbito da sa?de do trabalhador na Aten??o B?sica, e justifica-se pela necessidade de amplia??o do conhecimento dessa ?rea tem?tica. Estudo anal?tico com abordagem qualitativa realizado nas unidades de sa?de da aten??o b?sica dos distritos sanit?rios da cidade de Natal-RN, em apenas uma unidade de sa?de de cada bairro. A coleta das informa??es aconteceu entre agosto e outubro de 2014, por meio de entrevistas semiestruturadas, na seguinte sequ?ncia: sele??o dos entrevistados e marca??o da entrevista; realiza??o das entrevistas e aplica??o do instrumento de coletas de dados, a fim de tra?ar o perfil sociodemogr?fico da popula??o alvo; transcri??o das entrevistas; categoriza??o das informa??es e an?lise ? luz da hermen?utica-dial?tica. O conceito de Sa?de do Trabalhador referido pelos sujeitos investigados, apesar de simplificado no tocante ?s especificidades dos trabalhadores, revelou-se com uma dimens?o ampla, com a perspectiva da abordagem do trabalhador no seu ?mbito f?sico, ps?quico e social, sugerindo uma boa apreens?o de acordo com o conceito ampliado de sa?de. Al?m disso, foi poss?vel afirmar o reconhecimento de uma atua??o ainda incipiente dos enfermeiros da Aten??o B?sica sobre a Sa?de do Trabalhador, cujo desempenho foi apontado como falho. Foram citadas, em geral, algumas a??es pontuais de Sa?de do Trabalhador realizadas nas unidades de sa?de. Outras atividades mostraram-se rotineiras, sendo realizadas por uma minoria de profissionais conscientes sobre a import?ncia e necessidade de atingir esses usu?rios, a fim de engaj?-los na rotina da unidade de sa?de. A maioria dos profissionais relatou a n?o abordagem da Sa?de do Trabalhador durante a gradua??o em enfermagem, destacando uma car?ncia no campo te?rico e pr?tico na ?rea / This study aims to analyze concepts and practices developed by nurses in occupational health in primary care, and it is justified by the need to expand knowledge of this thematic area. This is an analytical qualitative study carried out in primary care units of health districts of the city of Natal-RN, in one health unit in each neighborhood. Data collection was held from August to October 2014, through semistructured interviews, in the following order: Selection of respondents and scheduling of interview; interviews and application of data collection instrument in order to trace socio-demographic profile of the target population; transcription of interviews; categorization of information and analysis in light of hermeneutic-dialectic. The concept of Occupational Health reported by subjects investigated, although simplified with respect to specificities of workers, was revealed with a wide dimension, with perspective of workers? approach in their physical, mental and social context, suggesting a good seizure according to the expanded concept of health. Furthermore, it was possible to affirm the recognition of an incipient performance of primary care nurses on Occupational Health, whose performance was appointed as defective. In general, some specific actions of Occupational Health, carried out in health facilities, were cited. Other activities showed up to be routine, being held by a minority of professionals aware of the importance and need to reach these users, in order to engage them in the routine of the health unit. Most professionals reported not having approached Occupational Health during undergraduate nursing, highlighting a lack in theoretical and practical aspects of the area

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-01-27T19:12:33Z No. of bitstreams: 1 MarcosOliveiraDiasVasconcelos_DISSERT.pdf: 1381611 bytes, checksum: c6733087c61cc59b9df5d093ba466eb9 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-02-02T22:51:49Z (GMT) No. of bitstreams: 1 MarcosOliveiraDiasVasconcelos_DISSERT.pdf: 1381611 bytes, checksum: c6733087c61cc59b9df5d093ba466eb9 (MD5) / Made available in DSpace on 2016-02-02T22:51:49Z (GMT). No. of bitstreams: 1 MarcosOliveiraDiasVasconcelos_DISSERT.pdf: 1381611 bytes, checksum: c6733087c61cc59b9df5d093ba466eb9 (MD5) Previous issue date: 2014-12-22 / Ao longo do tempo, os avan?os na ci?ncia e na tecnologia biom?dica foram cada vez mais incrementados, contribuindo para a falsa ideia sobre a possibilidade de controle e dom?nio da morte. A morte ? um tema interditado, evitado tanto na sociedade leiga quanto no di?logo entre m?dicos e pacientes, pois ? encarada como um fracasso profissional na ?rea da sa?de. O ensino do lidar com a morte na educa??o m?dica tem sido objeto de aten??o de alguns autores, mas mudan?as na forma??o m?dica com o aprofundamento dessa tem?tica ocorrem muito lentamente. O objetivo desta pesquisa foi compreender os caminhos do ensino do lidar com a morte no contexto da Aten??o Prim?ria ? Sa?de (APS). Trata-se de uma pesquisa qualitativa feita a partir da colabora??o de professores do curso de medicina da Universidade Federal da Para?ba (UFPB), escolhidos entre os docentes envolvidos em experi?ncias curriculares na APS. Foram combinadas duas estrat?gias tecno-metodol?gicas: entrevistas em profundidade com roteiro e oficina com utiliza??o de ?cenas? projetivas. Recorremos ? Hermen?utica Gadameriana para a an?lise e interpreta??o dos discursos. Nos resultados, identificamos que, para os docentes, o lidar com a morte pode ser concebido por quatro pap?is ou compet?ncias na busca de um cuidado humanizado: tentar salvar, promover qualidade de morte, estar presente at? o fim e valorizar a dimens?o da espiritualidade. Para os docentes, o ensino do lidar com a morte deveria acontecer a partir de uma abordagem multidimensional, ao longo de toda a forma??o m?dica. Apesar de, nas pr?ticas pedag?gicas em APS, haver uma proposta de ensino-aprendizagem ativa, baseada na problematiza??o de situa??es concretas, que busca diminuir a dist?ncia entre a forma??o t?cnica e humana, os docentes apontaram que o ensino do lidar com a morte na UFPB, de forma geral, ? insuficiente e hegemonicamente tecnicista. Assim, s?o limites dos espa?os curriculares na APS para o ensino do lidar com a morte: pr?ticas de ensino tecnificadas, fragmentadas, com avalia??es e metodologias tradicionais; a necessidade de maior aprofundamento pedag?gico e de integra??o no curr?culo m?dico; e as fragilidades dos servi?os de APS. Foram pot?ncias dos espa?os curriculares na APS para o ensino do lidar com a morte: a aproxima??o com as din?micas de adoecimentos e lutas da popula??o; e a constru??o de pr?ticas mais dial?gicas e voltadas para a valoriza??o do protagonismo estudantil e do trabalho interdisciplinar. Neste sentido, a APS pode contribuir na implementa??o de pr?ticas pedag?gicas mais integradas, cont?nuas, longitudinais, contextualizadas e centradas nas pessoas. Ao mesmo tempo, que a rela??o ensino-servi?o, preocupada com o aprimoramento do cuidado no adoecer e no morrer, pode qualificar e fortalecer a APS. / Along time, progress in science and in the biomedical technology was increasingly expanded, contributing to the false idea of a possible control and domination of death. Death is an interdicted theme, avoided both in the lay society and in the dialogue between physicians and patients, as it is considered a professional failure in the health field. Teaching how to deal with death in the medical education has been the object of attention of some authors, but changes in the medical education to deepen this theme have occurred in a very slow pace. The aim of this research was to understand the trajectories of teaching how to deal with death within the context of Primary Health Care (PHC). It is a qualitative study based on the collaboration of teachers from the undergraduate medicine course at the Federal University of Para?ba (UFPB), who were chosen among the teachers involved in curriculum experiences within PHC. Two techno-methodological strategies were combined: in-depth interviews following a script and workshops using projective ?scenes?. Gadamer?s Hermeneutic was used for the analysis and interpretation of the discourses. We have identified in the results that, to the teachers, dealing with death can be conceived according to four roles or competences in the search for a humanized care: trying to save, promoting quality of death, being present until the end, and enhancing the dimension of spirituality. For the teachers, teaching how to deal with death should be based on a multidimensional approach, along the whole medical education. In spite of the existence, in the PHC pedagogical practices, of an active teaching-learning proposal, based on the problematization of concrete situations, aiming to shorten the distance between technical and human education, the teachers have expressed that teaching how to deal with death in UFPB is, in general, insufficient and mostly technicist. Thus, limits of the PHC curriculum spaces to teach how to deal with death are: technified, fragmented teaching practices with traditional evaluation and methodologies; the need for greater pedagogical depth and integration in the undergraduate medical curriculum; and the weaknesses of the PHC services. Strengths of the PHC curriculum spaces to teach how to deal with death were: closeness to the dynamics of the illness process and fights of the population; and the construction of more dialogical practices, aimed to the enhancement of the students? protagonism and the interdisciplinary work. This way, PHC can contribute to the implementation of more integrated, continuous, longitudinal, contextualized, and person-centered pedagogical practices. At the same time, the teaching-service relationship, concerned with the improvement of the care in the illness process and in dying, can qualify and strengthen PHC

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-02-01T21:54:02Z No. of bitstreams: 1 FranciscoDeSalesClementino_TESE.pdf: 1510623 bytes, checksum: fdf66297c2127011707b0004cc2aa57f (MD5) / Approved for entry into archive by Elisangela Moura (lilaalves@gmail.com) on 2016-03-07T21:04:06Z (GMT) No. of bitstreams: 1 FranciscoDeSalesClementino_TESE.pdf: 1510623 bytes, checksum: fdf66297c2127011707b0004cc2aa57f (MD5) / Made available in DSpace on 2016-03-07T21:04:06Z (GMT). No. of bitstreams: 1 FranciscoDeSalesClementino_TESE.pdf: 1510623 bytes, checksum: fdf66297c2127011707b0004cc2aa57f (MD5) Previous issue date: 2014-12-11 / No Brasil, a Reforma Psiqui?trica organiza-se com base nos pressupostos da Reforma Sanit?ria e da Psiquiatria Democr?tica Italiana com vistas a eliminar o modelo hospitaloc?ntrico. Objetivo: Avaliar a estrutura e o processo de trabalho desenvolvido nos Centros de Aten??o Psicossocial (CAPS), englobando a satisfa??o, o perfil, as condi??es e a sobrecarga de trabalho dos profissionais. Aprovado pela Comiss?o de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte (UFRN), protocolo n? 719.435, de 30/05/2014. M?todos: Estudo descritivo, com abordagem quantitativa, desenvolvido em cinco Centros de Aten??o Psicossocial, a saber: 02 CAPS I, 01 CAPS II, 01 CAPS III e 01 CAPSAD, de Campina Grande-PB. A popula??o do estudo constitui-se de todos os coordenadores dos cinco CAPS, incluindo 42 profissionais de n?vel superior, 71 de n?vel m?dio (t?cnicos e auxiliares de enfermagem, e cuidadores), e os prontu?rios referentes a 2.297 usu?rios atendidos. Para assegurar a representatividade das informa??es, calculou-se uma amostra aleat?ria estratificada com partilha proporcional, considerando-se os seguintes par?metros: erro ? de 5%, n?vel de confian?a de 95%, poder do estudo de 80%, estimativa de propor??o de 10% e o ?ndice de proporcionalidade espec?fico para os profissionais de n?vel (superior e m?dio) e os prontu?rios. Coletou-se os dados atrav?s de question?rios validados, elaborados para o estudo CAPSUL (Avalia??o dos CAPS da Regi?o Sul do Brasil), entre julho e outubro de 2014. Os question?rios foram duplamente digitados e submetidos ? valida??o no sub-programa Validate do Epi Info 3.5.4, utilizado juntamente com o SPSS, 17.0 para o processamento das an?lises estat?sticas. Resultados: A partir da an?lise dos prontu?rios dos usu?rios atendidos nos CAPS, observou-se um predom?nio de mulheres na faixa et?ria adulta. Destacou-se como psicopatologia mais frequente, ? esquizofrenia. Quanto ?s interna??es antes e ap?s o ingresso nos CAPS, registrou-se para o hospital geral 14 interna??es (3,5%) antes e sete (1,7%) depois, diferen?a n?o significante (p=0,612). Ressalta-se que, em hospitais psiqui?tricos, ap?s o ingresso, houve redu??o para o m?ximo de tr?s interna??es. O n?mero total reduziu de 117 (29,1%) para apenas 11 (2,7%); redu??o estatisticamente significante (p=0,002). Quanto ?s formas de contra??o dos profissionais de sa?de, os resultados evidenciam a exist?ncia de contrato tempor?rio. A maior propor??o de insatisfa??o com todos os par?metros avaliados deu-se naqueles profissionais que se consideram sobrecarregados no trabalho. Entretanto, a ?nica diferen?a estatisticamente significante estava relacionada com o ?grau de responsabilidade? (90,9%; p=0,04). Observou-se forte associa??o da insatisfa??o dos profissionais de sa?de com fatores relacionados ao conte?do e ?s condi??es de trabalho no CAPS, relativa ?s medidas de seguran?a, conforto e apar?ncia dos CAPS, contato entre as equipes e usu?rios, e tratamento das fam?lias por parte das equipes. Chama ? aten??o que estes aspectos s?o aqueles que n?o dependem diretamente da atua??o dos profissionais. Conclui-se que o fortalecimento dos CAPS requer e exige um compromisso intersetorial, a partir do n?vel governamental, em garantir os recursos para a operacionaliza??o de suas a??es e assegurar aos usu?rios e ? sua fam?lia a oferta e o acesso aos servi?os de sa?de. / Objective: Evaluate the work structure and process in Psychos ocial Care Centers (CAPS) and the professionals profile, the satisfaction, conditions and work overload. Methods: Cross - sectional study conducted in five CAPS in Campina Grande city. The study sample consisted of five coordinators, 42 graduate professional s, 26 mid - level (technical and auxiliary nurses, and caregivers), and the medical records pertaining to 413 users followed up. Data were collected using validated questionnaires (CAPSUL - rating CAPS in southern Brazil) and adapted to the study, between July and October 2014. The questionnaires were double entered and submitted to validation in the sub - program ?Validate Epi Info 3.5.4? , used along with the ?SPSS 17.0? for processing the statistical analyzes. Measures of central tendency and dispersion were ap plied to the descriptive analyzes; ?Fisher's? exact test to check the CAPS impact on hospital admissions and the ?Bonferroni? adjusted to verify the diagnoses according to sex. 5% significance level was adopted. The study was approved by the Ethics Committ ee of the Rio Grande do Norte Federal University (UFRN), protocol 719.435, of 05.30.2014. Results: From the structure analysis were identified contextual factors that influenced the work process of CAPS professionals, such as: deficiencies with regard to h uman resources; forms of health professionals employment and qualifications; temporary contract existence. As to process dimension, it was found that the home visits performance by health professionals shows to be ineffective, given its insufficiency and i rregularity, which can be explained by the high demand, reduced staff and transportation lack. It was low coverage of items inherent to Therapeutic Individual Project, as the income generation program, insertion at work and home visit. The reference and co unter reference flow are still not satisfactorily organized. There was statistically significant difference for the diagnosis, with a predominance of mood disorders related to stress among women and those related to alcohol and other drugs among men (p <0. 05). There was an association between the degree of health professionals satisfaction and working conditions, overload and factors related to the content and working conditions, the security measures, comfort and CAPS appearance, contact between the teams and users, families treatment by the teams, temporary employment relationship. Conclusion: The data collected indicate the need for the CAPS organization through increased investments in the sector in order to enhance the infrastructure as potentiating el ement of practices with a view to changing the care model for mental health proposed by the Psychiatric Reform. It is hoped therefore that this research will contribute to better planning in CAPS unit management, with another tool to improve the dimensions involving the structure and the professional work process and improve this mental health care model.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-02-01T21:54:03Z No. of bitstreams: 1 KalyaneKellyDuarteDeOliveira_TESE.pdf: 4371547 bytes, checksum: 0c56e32ff360130ff50c666f79e48635 (MD5) / Approved for entry into archive by Elisangela Moura (lilaalves@gmail.com) on 2016-03-07T21:33:34Z (GMT) No. of bitstreams: 1 KalyaneKellyDuarteDeOliveira_TESE.pdf: 4371547 bytes, checksum: 0c56e32ff360130ff50c666f79e48635 (MD5) / Made available in DSpace on 2016-03-07T21:33:34Z (GMT). No. of bitstreams: 1 KalyaneKellyDuarteDeOliveira_TESE.pdf: 4371547 bytes, checksum: 0c56e32ff360130ff50c666f79e48635 (MD5) Previous issue date: 2014-12-10 / Este estudo objetivou avaliar a atua??o dos profissionais no atendimento as fam?lias nos Centros de Aten??o Psicosocial (CAPS) do Rio Grande do Norte (RN), a partir dos pap?is e fun??es desempenhados pelos profissionais nestes servi?os. Para isso, apontou-se como objetivos espec?ficos: Descrever o perfil e as atividades desenvolvidas pelas equipes de sa?de mental nos CAPS do RN; Conhecer a opini?o dos profissionais das equipes de sa?de mental quanto ? pol?tica, ?s pr?ticas e ? forma??o em sa?de mental; Verificar a adequabilidade dos papeis e fun??es dos profissionais que atuam nos CAPS do RN em rela??o ao atendimento as fam?lias. Trata-se de um estudo anal?tico, transversal, de abordagem quantitativa e qualitativa. Coletaram-se os dados por meio de question?rio, em 33 CAPS do RN, entre mar?o e outubro de 2014, ap?s a aprova??o pelo Comit? de ?tica em Pesquisa/UFRN, parecer n?217.808, CAAE: 10650612.8.1001.5537, em 1 de mar?o de 2013. Adotou-se a amostra, definida atrav?s de crit?rios de inclus?o e exclus?o, compondo-se de 183 profissionais. A prepara??o do banco de dados seguiu dois passos: 1. Preparo e tratamento dos dados das quest?es fechadas do instrumento de pesquisa relativas ? caracteriza??o e pr?ticas em sa?de mental dos sujeitos da pesquisa por meio do recurso informacional do Statistical Package for the Social Scienses (SPSS) Statistics vers?o 20.0; 2. Para verificar o n?vel de signific?ncia optou-se pela aplica??o do teste Qui-quadrado e o Kruskal Wallis Test. Preparo e tratamento do corpus formado pelas respostas ?s quest?es abertas relativas ?s pol?ticas, pr?ticas e forma??o na psiquiatria por meio do software Analyse Lexicale par Contexte d?un Ensemble de Segments de Texte (ALCESTE) e categorizados conjuntamente pela t?cnica de An?lise de Conte?do. A an?lise de dados apoia-se na literatura pertinente. Explicitaram-se os resultados atrav?s de tr?s artigos que enceram os seguintes resultados: O primeiro artigo, perfil dos participantes, caracterizou-se por predomin?ncia do sexo feminino (76,5%), na faixa et?ria de 40 a 58 anos (61,7%). Trabalham entre 30 e 40 horas semanais (63,5%), com atua??o na sa?de mental h? mais de 10 anos (98,4%). A amostra estudada direciona o atendimento a grupos familiares (65,7%), predominando o atendimento em equipe entre os assistentes sociais, enfermeiros, psic?logos e terapeutas ocupacionais. O m?dico realiza os atendimentos sem intera??o com a equipe (48,6%). Sobre as dificuldades encontradas nos servi?os ordenam-se em: materiais e insumos (75,1%), financeiras (78,5%) e estruturais (66,9%). O segundo artigo encerra dados qualitativos organizados em cinco categorias: Promo??o da reabilita??o dos usu?rios dos CAPS; Necessidades de capacita??es; Conflitos e satisfa??es do trabalho em equipe; Pr?ticas desenvolvidas nos CAPS; Dificuldades de efetiva??o da Pol?tica de Sa?de Mental. O terceiro artigo evidencia a inadequabilidade do atendimento destinado as fam?lias (93,4%) e comparando-se os atendimentos as fam?lias e aos grupos nos CAPS os dois tipos mostram-se inadequados: fam?lia (92,63%), grupos (92,60%). Os principais dados obtidos revelam a necessidade urgente de transforma??o na aten??o psicossocial. Evidencia-se ainda, a import?ncia de investimentos em insumos, estrutura f?sica e na capacita??o de recursos humanos para os CAPS. / This study aimed to evaluate the work of professionals to care for families in Psychosocial Care Centers ( C APS) of Rio Grande do Norte ( RN), from the roles and functions performed by these professional services. For this, it was pointed out the following objectives: To describe the profile and the activities conducted by mental health teams in the RN CAPS ; Know the opinion of professionals in the mental health teams of the poli ti c , practices and training in mental health; Check the suitability of the roles and functions of professionals working in the RN CAPS in relation to care for families . This is an analytic al cross - sectional study of quantitative and qualitative approach . Data were c ollected through a questionnaire in 33 CAPS RN, between March and October 2014 , after being approved by the Research Ethics Committee / UFRN , opinion n?217.808 , CAAE : 10650612.8. 1001.5537 , on March 1 2013. T he sample was adopted , defined by inclusion and exclusion criteria , and is composed of 183 professionals. The database preparation followed two steps: 1. Preparation and processing of data of closed questions of the questionnai re concerning the characterization and practices in mental health research subjects through informational resource Statistical Package for Social Scienses (SPSS) Statistics version 20.0 ; 2. To check the significance level was chosen by applying the chi - squ are test. Preparation and treatment of the corpus formed by the answers to open questions relating to the policies, practices and training in psychiatry through Analyse lexicale pair Contexte software d' un Ensemble of Segments of Texte ( ALCESTE) together a nd categorized by content analysis technique , Bardin (2004) . The data analysis is supported in the literature . It m ade explicit the results through three articles waxing the following results. In the first, participants profile was characterized by a predo minance of females (76.5 %), aged 40 - 58 years ( 61.7 %). They work between 30 and 40 hours per week (63.5 %), working in mental health for over 10 years ( 98.4%). The sample directs the care of family groups ( 65.7%), predominantly the care team of social worke rs, nurses, psychologists and occupational therapists . The doctor performs emergency care without interaction with the staff (48.6%) . On the difficulties encountered in services are ranked in : materials and supplies ( 75.1%), financial ( 78.5%) and structura l ( 66.9%). The second article contains qualitative data organized into five categories : Promoting the rehabilitation of users of CAPS ; Needs training ; Conflicts and satisfactions of teamwork ; Practices developed in CAPS ; Effective difficulties of Mental He alth Policy . The third article highlights the inadequacy of care for families ( 93.4%) and comparing the care families and groups in CAPS both types show to be inadequate : family ( 92.63%), groups ( 92, 60%). The main data obtained reveal the urgent need for transformation in psychosocial care . It shows also the importance of investments in inputs, physical structure and training of human resources for the CAPS.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-02-17T22:52:16Z No. of bitstreams: 1 BiancaNunesGuedesDoAmaralRocha_TESE.pdf: 41726587 bytes, checksum: 526b3c8683786842d992e6fd5ea28954 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-02-19T23:06:43Z (GMT) No. of bitstreams: 1 BiancaNunesGuedesDoAmaralRocha_TESE.pdf: 41726587 bytes, checksum: 526b3c8683786842d992e6fd5ea28954 (MD5) / Made available in DSpace on 2016-02-19T23:06:43Z (GMT). No. of bitstreams: 1 BiancaNunesGuedesDoAmaralRocha_TESE.pdf: 41726587 bytes, checksum: 526b3c8683786842d992e6fd5ea28954 (MD5) Previous issue date: 2015-03-03 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico - CNPq / A gravidez, n?o planejada, ? vivenciada por milh?es de mulheres em todo o mundo. Esse fato aumenta o risco de morbimortalidade ligada ao aborto. Este estudo objetivou avaliar os avan?os e desafios da implanta??o da Aten??o Humanizada ao Abortamento em Maternidade-Escola, em Natal, Rio Grande do Norte. A Pesquisa foi avaliativa, precedida por um Estudo de Avaliabilidade e seu delineamento um Estudo de Caso. A amostra intencional totalizou 102 sujeitos, sendo 60 usu?rias, 39 profissionais e 3 gestores. As t?cnicas de coleta foram an?lise documental, entrevista-semiestruturada e observa??o com di?rio de campo. A an?lise documental foi descritiva e para as entrevistas e o di?rio de campo utilizou-se a An?lise de Conte?do de Bardin. No estudo de avaliabilidade, verificou-se que a aten??o humanizada ao abortamento ? um programa avali?vel com elabora??o e pactua??o do modelo l?gico, da matriz dos indicadores e das perguntas avaliativas. No Estudo de Caso, as usu?rias demonstraram satisfa??o quanto ? resolutividade do atendimento e ao acesso. Contudo, identificaram inadequa??o na ambi?ncia, na escuta qualificada e no planejamento reprodutivo. Os profissionais retrataram que a defici?ncia do servi?o consiste na infraestutura e na ambi?ncia, consideradas insuficientes e inadequadas para uma assist?ncia humanizada, sobretudo, em rela??o ?s acomoda??es das pacientes, ? escassez de leitos, ao n?mero reduzido de salas no centro cir?rgico e ? falta de laborat?rio dentro da Maternidade. Al?m disso, o planejamento reprodutivo n?o consiste em uma pr?tica institucionalizada no servi?o, e n?o se efetiva a integralidade com outros servi?os e nem a parceria com a comunidade. Conclui-se que apesar da satisfa??o das usu?rias quanto ? resolutividade do atendimento e facilidade no acesso, h? a necessidade da implementa??o dos sistemas de escuta qualificada, efetiva??o da sistematiza??o do trabalho em equipe, implementa??o de ouvidorias e pesquisas de satisfa??o; n?o prevaleceu o direito de escolha compartilhada entre as mulheres e os profissionais acerca da op??o pelo procedimento de esvaziamento uterino; a ambi?ncia foi a categoria apontada como a que mais necessita de mudan?as, visto como um fator limitante para o desenvolvimento de pr?ticas humanizadas e acolhedoras; os profissionais de sa?de n?o instituem uma rotina peri?dica de planejamento das condutas e estas n?o est?o articuladas com a Norma T?cnica; ? preciso haver a incorpora??o de orienta??es e disponibiliza??o de uma pluralidade de m?todos e possibilidades de escolhas para o planejamento familiar; n?o h? institucionaliza??o da refer?ncia e contrarefer?ncia e nem parcerias com a comunidade, inviabilizando a integralidade da aten??o. A Norma precisa ser inclu?da nos planos de a??es dos gestores, como uma das prioridades na constru??o das estrat?gias de aten??o ? sa?de da mulher, de maneira a viabilizar, aliada a outras iniciativas, a real integra??o entre servi?o de conduta segura, rede de cuidados prim?rios e organiza??es sociais, a fim de garantir o respeito aos direitos humanos e a um atendimento humanizado adequado, como forma de aten??o e preven??o do aborto. / Unplanned pregnancy is experienced by millions of women worldwide. Such fact increases the risk of abortion-related morbimortality, which represents a serious public health problem. This study aims to evaluate the advances and challenges of the implementation of Humanized Abortion Care at the Maternity-School in Natal, state of Rio Grande do Norte. The research was evaluative, was preceded by an Evaluative Study, and resulted in a Case Study. The intentional sample totaled 102 subjects (60 users, 39 professionals and 3 managers). The collection techniques included documental analysis, semi-structured interview and observation with a field diary. The documental analysis was descriptive, while the Content Analysis by Bardin was used for semi-structured interviews and field diary. The Evaluative Study observed that Humanized Abortion Care is an evaluative program with preparation and pact of the logical model, of the matrix of indicators and evaluative questions. The Case Study showed that users were satisfied with the problem-solving capacity and access to the service; however, is also showed that they pointed out inadequacy in terms of environment, qualified hearing and reproductive planning. Professionals reported that the inefficiency of service consists of infrastructure and environment, which are considered inefficient and inadequate to humanized care, especially regarding patient accommodation, the lack of hospital beds, the reduced number of rooms in the surgical center and the lack of laboratory inside the maternity. Moreover, reproductive planning does not consist of an institutionalized practice in the service, and integrality with other services or partnership with the community is not in place. The Maternity Board emphasizes that the excessive demand of patients is one of the reasons that hinders the appropriate implementation of the technical standard. We then conclude that although satisfied regarding problem-solving capacity in terms of service and ease of access, there is room for improvement in qualified hearing systems, in the creation of a system to promote team work, implementation of ombudsman and satisfaction surveys. The right of shared choice did not prevail among users and health professionals with regard to the option of uterine evacuation procedure. Environment was the most mentioned category as that requiring more changes, seeing as a limited factor for the development of humanized and welcoming practices. Health professionals do not establish a periodic routine of planning practices, and such practices are not aligned with the Technical Standard. Incorporation of guidelines and availability of a plurality of methods and possibilities of choices for family planning are required. There is no institutionalization of reference and counter-reference, or partnerships with the community, which makes integrality of care not viable. The Standard needs to be included in the action plans of managers as one of the priorities in the construction of care strategies for women's health, in order to enable, allied to other initiatives, the real integration among safe conduct service, primary care network and social organizations. As a result, respect for human rights and adequate humanized care, as a way of attention and prevention of abortion, can be secured.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-03-03T19:37:37Z No. of bitstreams: 1 BheatrizGondimLambertMoreira_DISSERT.pdf: 2653327 bytes, checksum: 34546767c287459868134f088ad4dca0 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-03-07T19:18:11Z (GMT) No. of bitstreams: 1 BheatrizGondimLambertMoreira_DISSERT.pdf: 2653327 bytes, checksum: 34546767c287459868134f088ad4dca0 (MD5) / Made available in DSpace on 2016-03-07T19:18:11Z (GMT). No. of bitstreams: 1 BheatrizGondimLambertMoreira_DISSERT.pdf: 2653327 bytes, checksum: 34546767c287459868134f088ad4dca0 (MD5) Previous issue date: 2014-12-17 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico - CNPq / A Insufici?ncia Venosa Cr?nica caracteriza-se como um conjunto de altera??es f?sicas que incluem como complica??o mais s?ria a ?lcera venosa, caracterizada pela perda irregular e progressiva da continuidade da pele. A ocorr?ncia da ?lcera venosa nas pessoas com insufici?ncia venosa cr?nica gera depend?ncia dos mesmos com servi?os de sa?de, com tratamentos de longa dura??o que provocam limita??es e altera??es de grande impacto, repercutindo em sua qualidade de vida, afetando os aspectos f?sicos, psicol?gicos, sociais, culturais e espirituais, constituindo um importante problema de sa?de p?blica. Este estudo objetivou narrar a experi?ncia de possuir uma ?lcera venosa, no cen?rio dos servi?os de Aten??o Prim?ria ? Sa?de, que compreende Unidades de Aten??o B?sica e de Estrat?gia de Sa?de da Fam?lia no Munic?pio de Natal/RN, partindo das hist?rias de vida dos usu?rios. Trata-se de um estudo de abordagem qualitativa, explorat?rio-descritivo, tendo a Hist?ria Oral de Vida como referencial metodol?gico. A partir do ponto zero houve o recrutamento dos participantes que compuseram a rede, totalizando seis colaboradores, de ambos os sexos, e idade entre 57 e 79 anos. Ap?s aprova??o pelo Comit? de ?tica em Pesquisa - UFRN, sob o Protocolo 653.788/2014 e CAAE 30408014.0.0000.5537, realizou-se a coleta de dados, entre os meses de julho e agosto, atrav?s de entrevista, utilizando instrumento de identifica??o e caracteriza??o dos colaboradores e perguntas abertas. As entrevistas foram gravadas, transcritas, transcriadas e retornadas aos colaboradores para confer?ncia. As narrativas foram submetidas ? t?cnica de An?lise Tem?tica de Conte?do, segundo Bardin, possibilitando a constru??o de tr?s eixos tem?ticos que englobam categorias, a saber: Eixo I - Olhares sobre as mudan?as: o impacto da ferida nas rela??es sociais (mudan?as ocorridas com a ?lcera venosa; a ?lcera venosa e as rela??es sociais e familiares); Eixo II - Marcas no corpo e na alma: trajet?ria do ser ferido (concep??es sobre o corpo ferido; itiner?rio terap?utico nos servi?os de aten??o b?sica); e Eixo III - Reconstru??o do ser ferido: mecanismos de enfrentamento (ressignifica??o do corpo ferido; resili?ncia frente ? ferida cr?nica). O impacto de ter uma ?lcera venosa cr?nica gera repercuss?es de ordem f?sica, psicol?gica e social. Como aspectos relacionados ?s mudan?as ocorridas ap?s o aparecimento da ?lcera venosa, os participantes da pesquisa relataram a presen?a de dor, limita??es f?sicas, sofrimento ps?quico, isolamento social e afetivo, incapacidade laboral, desconforto est?tico e depend?ncia dos servi?os de sa?de; a fam?lia foi o aspecto que n?o apresentou modifica??o consider?vel ap?s a ocorr?ncia da ferida para a maioria dos participantes, sendo uma aliada no processo terap?utico como rede de apoio. A ressignifica??o do corpo e da ferida constituem o principal mecanismo de enfretamento da condi??o cr?nica. Os servi?os que comp?em a Rede de Aten??o Prim?ria t?m papel fundamental na reabilita??o dos portadores de ?lcera venosa, embora existam dificuldades de acesso ao tratamento adequado e necessidade de amplia??o dos servi?os, com capacita??o permanente dos profissionais das equipes de sa?de e disponibiliza??o pelos gestores de recursos para o fortalecimento do cuidado integral da pessoa com ?lcera venosa nos servi?os de Aten??o Prim?ria ? Sa?de. / The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-01T19:43:14Z No. of bitstreams: 1 BrunoErickDeBarrosLucena_DISSERT.pdf: 2770852 bytes, checksum: ceeb159c1376eb514861bb67fd8c345a (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-07T20:19:51Z (GMT) No. of bitstreams: 1 BrunoErickDeBarrosLucena_DISSERT.pdf: 2770852 bytes, checksum: ceeb159c1376eb514861bb67fd8c345a (MD5) / Made available in DSpace on 2016-04-07T20:19:51Z (GMT). No. of bitstreams: 1 BrunoErickDeBarrosLucena_DISSERT.pdf: 2770852 bytes, checksum: ceeb159c1376eb514861bb67fd8c345a (MD5) Previous issue date: 2015-05-05 / No Brasil, com o intuito de qualificar a Aten??o B?sica, o Minist?rio da Sa?de implementou o Programa Telessa?de Brasil Redes para fornecer atividades assistenciais (teleassist?ncia) e de suporte ? educa??o permanente em sa?de (tele-educa??o). Nesse aspecto, um dos principais servi?os oferecidos ? o de teleconsultorias. Como parte da expans?o nacional do programa, foi criado, no Rio Grande do Norte, um n?cleo local de telessa?de, denominado Telessa?de/RN. Esta pesquisa teve como objetivo implementar o servi?o de teleconsultoria na especialidade de cardiologia no Telessa?de/RN, analisando as caracter?sticas das teleconsultorias em cardiologia solicitadas. Ademais, analisar as Segundas Opini?es Formativas em cardiologia dispon?veis no Portal Teless?ude Brasil. Trata-se de estudo quantitativo, com desenho observacional e car?ter descritivo. Foram identificadas 56 Segundas Opini?es Formativas relacionadas ? cardiologia no portal Telessa?de Brasil, sendo a maioria referentes ? hipertens?o arterial sist?mica (29%), solicitadas por m?dicos (59%) e com abordagem sobre aspectos relativos a apoio ao tratamento (30%). No n?cleo de Telessa?de do Rio Grande Norte, foram realizadas 47 teleconsultorias em cardiologia, sendo a maior parte delas tamb?m relativa ? hipertens?o arterial (50%), requeridas em sua maioria por agentes comunit?rios de sa?de (45%) e com enfoque direcionado a apoio ao tratamento (52%). A teleconsultoria em cardiologia foi implementada no n?cleo Telessa?de/RN, sendo realizada sistematicamente desde abril de 2014 e representa uma estrat?gia pr?tica e eficiente, capaz de garantir a oferta de servi?os de sa?de, alcan?ando aqueles que vivem em ?reas distantes e carentes. Conhecer a demanda das teleconsultorias ? de extrema relev?ncia, pois fornece informa??es necess?rias para suprir as defici?ncias existentes, quer sejam de natureza assistencial, gerencial e/ou educacional, como tamb?m possibilita pensar em estrat?gias p?blicas que melhorem as demandas identificadas nas solicita??es de teleconsultoria. / In order to qualify Primary Health Care in Brazil, the Ministry of Health implemented the Brazilian Telehealth Program to provide health support (telecare) and permanent health education (tele-education). In this respect, one of the primary services offered is teleconsultation. As part of the national expansion of the program, a local Telehealth Center, called Telehealth/RN, was created in Rio Grande do Norte state. The aim of this study was to describe the implementation of cardiological teleconsultations at Telehealth/RN, and analyze the characteristics of the teleconsultations in cardiology requested. Formative Second Opinions in cardiology, available at the web site of the Brazilian Telehealth Program, were also examined. This is a quantitative study with a descriptive, observational design. A total of 56 Formative Second Opinions in cardiology were identified, a majority related to hypertension (29%), focused on treatment support (30%), and requested by doctors (59%). At Telehealth/RN, 47 teleconsultations in cardiology were carried out, a majority also related to hypertension (50%), requested by community health workers (45%) and focused directly on treatment (52%). Cardiological teleconsultation, implemented at the Telehealth/RN in April 2014, is a practical and efficient strategy capable of ensuring health services and reaching those who live in remote areas. Knowing the demand for teleconsultations is extremely important, given that they provide the information needed to correct existing inadequacies related to care, management and/or education, as well as providing the basis for public policies that meet the demands of teleconsultation.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-01T20:32:21Z No. of bitstreams: 1 PauloRobertoDeAndradeSantos_DISSERT.pdf: 1763843 bytes, checksum: 64b7cbd5b297418150e41d50fb7cb6df (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-07T22:36:46Z (GMT) No. of bitstreams: 1 PauloRobertoDeAndradeSantos_DISSERT.pdf: 1763843 bytes, checksum: 64b7cbd5b297418150e41d50fb7cb6df (MD5) / Made available in DSpace on 2016-04-07T22:36:46Z (GMT). No. of bitstreams: 1 PauloRobertoDeAndradeSantos_DISSERT.pdf: 1763843 bytes, checksum: 64b7cbd5b297418150e41d50fb7cb6df (MD5) Previous issue date: 2015-04-27 / O estudo teve como objetivo identificar a percep??o dos profissionais e estudantes dos cursos da ?rea da sa?de, que atuam em uma Unidade B?sica de Sa?de na cidade do Natal/RN, frente ao atendimento de pacientes surdos, bem com, identificar as necessidades da popula??o com surdez em rela??o ? assist?ncia ? sa?de. Trata-se de um estudo transversal, explorat?rio, descritivo, realizado no per?odo de abril a julho de 2014, com uma popula??o composta por 21 profissionais de sa?de, 17 estudantes e oito usu?rios surdos. Para o levantamento dos dados foi utilizado um question?rio estruturado composto por quest?es abertas e fechadas, aplicado aos grupos formados por profissionais da sa?de, m?dico, dentista, enfermeiro e agentes de sa?de, e estudantes dos cursos de medicina, enfermagem, educa??o f?sica, nutri??o e servi?o social. Os profissionais/estudantes responderam ao question?rio acera das poss?veis dificuldades enfrentadas no atendimento ao surdo. A coleta de dados com os usu?rios surdos foi realizada atrav?s de comando dado em L?ngua brasileira de Sinais (Libras), sendo a entrevista filmada para que a Libras pudesse ser interpretada para o portugu?s, pelo pesquisador. Com os surdos foi realizado um levantamento de suas rea??es ao procurar um atendimento no servi?o de sa?de. A an?lise dos resultados se deu a partir da estat?stica descritiva simples (frequ?ncias absolutas e relativas). As quest?es abertas foram analisadas atrav?s da t?cnica de tem?tica categorial, a qual permitiu o processo de categoriza??o preservando todos os aspectos levantados na discuss?o, de forma que as falas foram representativas da totalidade. A partir da analise das entrevistas com os profissionais e estudantes no que se refere ? atitude utilizada para se comunicar com poss?veis pacientes surdos emergiram as seguintes categorias: a ?escrita?, os ?gestos? e o ?aux?lio a terceiros?. J? os surdos quando questionados sobre suas experi?ncias ao buscar atendimento em sa?de, as categorias elucidadas foram: ?assist?ncia ao surdo?, ?comunica??o com o surdo? e ?depend?ncia de terceiros?. As quest?es fechadas foram mensuradas e adaptadas a Escala de Likert em 5 graus de varia??o, que compuseram tr?s destas quest?es: grau de dificuldade na comunica??o ao atender um paciente com d?ficit auditivo (m?nima a grande dificuldade); sentimento de conforto para utilizar a l?ngua de sinais (m?nimo a grande desconforto); e conhecimento sobre a Lei 10.436, que disp?e sobre a L?ngua Brasileira de Sinais (Libras) (baixo conhecimento a totalmente esclarecido). Os dados coletados com os profissionais e estudantes revelaram certo desconhecimento e desconforto no atendimento em sa?de aos pacientes surdos, realidade tamb?m evidenciada na opini?o dos surdos participantes. Este estudo permitiu identificar problemas na comunica??o, resultando em consequ?ncias negativas no atendimento a essa popula??o. Este diagn?stico poder? ser relevante para elabora??o de pol?ticas p?blicas e diretrizes curriculares essenciais ? forma??o dos profissionais da sa?de, inclus?o e melhoria da assist?ncia aos surdos. / The study aimed to identify in the professionals and students of health courses that work in a health Basic Unit in the city of Natal/RN their perceptions of the care of deaf patients, and with the population's needs with hearing loss in relation to health care. This is a cross-sectional, exploratory, descriptive study, conducted between April to July 2014, with a population composed of 21 health professionals, 17 students and 8 deaf users. For data collection, we used a structured questionnaire with open and closed questions applied to groups composed of health professionals (doctors, dentists, nurses and health workers) and students of medical schools, nursing, physical education, nutrition and social service. The professionals/students answered a semi-structured questionnaire with open and closed questions concerning the possible difficulties the care of the deaf and hearing impaired. Data collection with deaf users was conducted through filmed interview for the Brazilian Sign Language (Libras) could be interpreted as to the Portuguese by the researcher. With the latter it was conducted a survey of their reactions when looking for a care in the health service. Regarding the profile of identification of the subjects, it was analyzed by simple descriptive statistics (absolute and relative frequencies). The open questions were analyzed through the content analysis technique which allowed the categorization process preserving all the points raised in the discussion so that the lines were representative of the whole. When asked about the professionals and students attitude used to communicate with deaf patients possible the following categories emerged: the "writing", the "gestures" and the "third party assistance". With regard of the deaf, when asked about their experiences in seeking care in health, the elucidated categories were: "quality of care to the hearing impaired", "communication with the hearing impaired adequacy" and "dependence on third parties." The closed questions were measured and adapted to the 5 degrees of variation Likert Scale, which comprised three of these issues: degree of difficulty in communication to meet a patient with hearing loss (minimum to great difficulty); feeling of comfort while using sign language (minimum to severe discomfort); and knowledge of the Law 10.436, which provides for the Brazilian Sign Language (Libras) (low knowledge to entirely clear). The data collected with professionals and students revealed some misunderstanding and discomfort in health care for deaf patients, reality also evidenced in the opinion of the deaf participants. This study revealed problems in communication, resulting in negative consequences in serving this population. This diagnosis may be relevant to public policy development and curriculum guidelines essential to the training of health professionals, inclusion and improving assistance to deaf.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-05-04T00:22:52Z No. of bitstreams: 1 LygiaMariaDeFigueiredoMelo_TESE.pdf: 1948122 bytes, checksum: 9bcf49eb54beb8b850005b34d139712c (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-05-06T20:18:53Z (GMT) No. of bitstreams: 1 LygiaMariaDeFigueiredoMelo_TESE.pdf: 1948122 bytes, checksum: 9bcf49eb54beb8b850005b34d139712c (MD5) / Made available in DSpace on 2016-05-06T20:18:53Z (GMT). No. of bitstreams: 1 LygiaMariaDeFigueiredoMelo_TESE.pdf: 1948122 bytes, checksum: 9bcf49eb54beb8b850005b34d139712c (MD5) Previous issue date: 2015-08-03 / Objetivou-se analisar o Apoio Institucional na Aten??o B?sica ofertado ?s equipes pelas gest?es municipais das capitais brasileiras que aderiram ao Programa de Melhoria do Acesso e da Qualidade da Aten??o B?sica (PMAQ-AB). Possuiu car?ter explorat?rio descritivo, com abordagens qualitativa e quantitativa para an?lise dos dados. A coleta de dados foi realizada no per?odo de fevereiro a outubro de 2014 com dois grupos amostrais, sendo o primeiro composto pelos respondentes do m?dulo II que correspondeu a 2941 equipes, das 23 capitais que aderiram ao Programa e o segundo por 22 gestores da Aten??o B?sica das capitais brasileiras que responderam ao m?dulo IV (on line). Na fase quantitativa as vari?veis foram analisadas atrav?s da estat?stica descritiva, com uso do Software IBM SPSS Statistics 20 e os resultados organizados e agrupados em tr?s dimens?es: caracter?sticas do Apoio Institucional; processo de trabalho do Apoiador Institucional e Apoio ?s equipes para administrar e planejar processos de trabalho. Na fase qualitativa, analisaram-se as diretrizes gerais para o Apoio Institucional no munic?pio, descritos pelo gestor municipal no formul?rio on line. Para organiza??o e categoriza??o dos dados qualitativos foi utilizado o Atlas ti.7.1, e como m?todo de interpreta??o, a an?lise de conte?do. A partir da concep??o do Apoio como ferramenta democratizante, procedeu-se a aproxima??o de conceitos do Apoio Paideia (Campos), das rela??es de poder (Foucault) e da an?lise institucional (Lourau). Elencou- se as seguintes categorias de an?lise: Categoria 1- Dimens?o administra??o e planejamento de processos de trabalho com as Subcategorias: Apoio ? organiza??o do processo de trabalho das equipes; Apoio ao planejamento, monitoramento e avalia??o; Apoio ?s a??es das equipes; Apoio ao fortalecimento das redes de aten??o ? sa?de e a??es intersetoriais e estrutura organizacional e administrativa do Apoio no munic?pio. Categoria 2- Dimens?o Pol?tica com as Subcategorias: Apoio aos processos participativos de gest?o e est?mulo ao controle social; Apoio a constru??o de rela??es democr?ticas, cooperativas e dial?gicas; Apoio ?s a??es vinculadas ao PMAQ; descri??o do Apoio Institucional utilizando a mesma reda??o dos documentos oficiais do MS. Categoria 3- Dimens?o Pedag?gica com a Subcategoria: processos de forma??o e qualifica??o de profissionais e gestores. Observou-se que o Apoio Institucional ? uma realidade no contexto da Aten??o B?sica no Brasil, por?m identificou-se que, tanto nas a??es apoiadas quanto nas diretrizes propostas pelas gest?es evidencia-se um tra?o normalizador e burocr?tico nesse processo. Houve avalia??o positiva pelas equipes do Apoiador Institucional, embora esses profissionais encontrem-se sobrecarregados no exerc?cio dessa fun??o pelo n?mero excessivo de equipes sob sua responsabilidade, evidenciando-se a necessidade de um dimensionamento que leve em considera??o o modo de operar a fun??o Apoio. Nas capitais brasileiras observaram-se fragilidades nas condi??es de gerir os processos para a institucionaliza??o do Apoio, inferindo-se que as gest?es e equipes de gest?o da Aten??o B?sica precisam ser apoiadas na condu??o desse processo. Prop?e-se, assim, o aprofundamento da tem?tica e que nos outros ciclos do PMAQ-AB haja adequa??o dos instrumentos utilizados na avalia??o externa, referente ? dimens?o Apoio Institucional, a fim de avan?ar na valoriza??o das singularidades do Apoio, principalmente, no tocante ? cogest?o enquanto processo coletivo e democr?tico. / It was aimed to analyze one of dimensions of the Basic Attention offered by in primary care team by the municipal administrations of Brazilian cities that have joined Access Improvement Programme and Quality of Primary Care (PMAQ-AB in portuguese). Owned descriptive exploratory, by qualitative and quantitative approaches to data analysis. Data collection took place between February-October 2014 by two sample groups, the first one consisting of respondents of module II corresponding to 2941 teams of 23 capitals that have joined the program and the second one by 22 managers of Primary Care Brazilian cities that responded to the module IV (on line). In quantitative phase variables were analyzed using descriptive statistics, using IBM SPSS Statistics Software 20 and organized and grouped results in three dimensions: characteristics of Institutional Support; Institutional Sketchpad the work process and support teams to manage and plan work processes. In qualitative phase, it was analyzed general guidelines for the Institutional Support in the municipal, as described by the municipal manager in online form. For organization and categorization of qualitative data was used Atlas ti.7.1, and as a method of interpretation, content analysis. From the conception of support as a democratizing tool, it was proceeded to approach concepts Support Paideia (Campos), power relations (Foucault) and institutional analysis (Lourau). It was defined following categories of analysis: Category 1 - Dimension administration and planning work processes by subcategories: Support for organization of work process of teams; Support planning, monitoring and evaluation; Support the actions of teams; Support for the strengthening of health care networks and intersectoral actions and organizational and administrative structure of support in the city. Category 2 - Dimension Policy by following subcategories: Support for participative process management and stimulation of social control; Support the building of democratic relations, cooperatives and dialogical; Support for actions related to PMAQ; description of Institutional Support using the same wording of official documents of health ministry. Category 3 - Pedagogical dimension formed by Subcategory: formation and training of professionals and managers. It was observed that Institutional Support is a reality in context of Primary Care in Brazil, but it was found that in both actions supported as the guidelines proposed by managements is evident in a normalizing and trace this process. There was a positive evaluation by teams Sketchpad Institutional, although these professionals find themselves overwhelmed when exercising that function by excessive number of teams under their responsibility, demonstrating the need for a design that takes into account how to operate the Support function. In Brazilian cities were observed weaknesses in a position to manage the processes for institutionalization of support, the conclusion was that managements and management teams in Primary Care need to be supported in conducting this process. It is proposed thus deepening the theme and when other PMAQ-AB cycles tooccur be made adequacy of instruments used in external evaluation concerning the importance Institutional Support in order to advance the appreciation of uniqueness of support, especially regard to co-management as a collective and democratic process.

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No. of bitstreams: 1 SheniaMariaFelicioFelix_DISSERT.pdf: 1059481 bytes, checksum: 300825f13ac8f9d679f3ce4de4db18ff (MD5) Previous issue date: 2013-12-20 / A Pol?tica Nacional da Aten??o B?sica (PNAB), regulamentada pela portaria N? 2488 de outubro de 2011 reafirma a Estrat?gia de Sa?de da Fam?lia (ESF) como estrat?gia priorit?ria de expans?o, consolida??o e qualifica??o da aten??o b?sica ? sa?de no Brasil; para isso, os munic?pios, com coopera??o dos demais entes federativos, devem reorientar seu processo de trabalho aprofundando os princ?pios, diretrizes e fundamentos da Aten??o B?sica (AB). Al?m da ESF, a nova PNAB disp?e sobre os N?cleos de Apoio ? Sa?de da Fam?lia (NASF), reafirmando seu papel de ampliar o escopo das a??es da aten??o b?sica, e de sua resolutividade, ratificando seu car?ter de compartilhar saberes e de ser apoio junto aos profissionais da AB. Frente a isso, o objetivo deste trabalho ? investigar como o N?cleo de Apoio a Sa?de da Fam?lia - NASF est? estruturado em Jo?o Pessoa e quais as a??es por ele desenvolvidas no ?mbito da Sa?de Mental, e tem como objetivos espec?ficos: analisar as pr?ticas desenvolvidas pelos profissionais de Sa?de Mental que comp?em as equipes NASF e se elas se diferenciam das realizadas pelos demais membros das equipes; discutir a articula??o do NASF na operacionaliza??o das a??es em sa?de mental, no que se refere a sua organiza??o interna e na rede de sa?de municipal; e identificar as estrat?gias utilizadas para organiza??o das a??es em sa?de mental na Aten??o B?sica. Para o alcance dos objetivos, foram realizadas entrevistas individuais com duas gestoras municipais e quatro trabalhadoras do NASF que participavam do colegiado de sa?de mental como representantes dos seus distritos sanit?rios, al?m disso, foi realizado um grupo focal com diferentes apoiadores NASF, contemplando a diversidade de categorias profissionais que trabalham nas equipes e nos diferentes distritos sanit?rios. Foi poss?vel identificar no NASF em Jo?o Pessoa, uma organiza??o pautada pelo apoio matricial na qual as demandas da gest?o e do cuidado assistencial refletem um conjunto de pr?ticas desenvolvidas junto ?s ESF. Dentre as a??es realizadas pelo NASF, e no ?mbito da sa?de mental, destaca-se o matriciamento, as visitas domiciliares e o Projeto Terap?utico Singular; essas atividades foram descritas e dialogadas no grupo focal e faz parte do cotidiano de trabalho de todos dos apoiadores do NASF, independente de sua categoria profissional. Com vistas ao fortalecimento da AB frente ? amplia??o das a??es das equipes de sa?de da fam?lia, o NASF se apresenta como uma potente estrat?gia de qualifica??o e apoio no SUS. / The National Police for Basic Care (PNAB), regulated by ordinance n?2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in Jo?o Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in Jo?o Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams?actions.