The purpose of this study was to explore the lived experiences of the newly qualified professional nurses in midwifery section doing community service. A qualitative descriptive, interpretative phenomenological research was conducted to determine the experiences. The sample included newly qualified professional nurses doing community service. Data collection was conducted by means of unstructured interviews from ten (n=10) informants. Each interview was approximately 45 minutes. Ethical issues were considered. Hussel and Heidergadian’s data analysis steps were followed. Four (4) themes and eleven (11) sub-themes emerged from the data collected. The findings revealed that the newly qualified professional nurses were in a state of reality shock, demonstrated by challenges such as shortage of human and material resources; overcrowding; lack of support; and the placement of Midwifery Nursing Science in the curriculum has impacted negatively on midwives’ registration as professional nurses. Based on the current practical nursing education environment and further research, this study concludes by presenting its recommendations and limitations. / Health Studies / M. A. (Health Studies)

Submitted in Fulfillment of the requirements for the Master’s Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The aim of the study was to examine students’ perspectives regarding their learning in a community based undergraduate nursing programme at the Durban University of Technology in South Africa. Methodology A quantitative descriptive design was used to examine student nurses’ perspectives regarding their experiences in community-based education (CBE), with specific reference to perceived academic gains, local and global gains, intrapersonal gains and interpersonal gains. Hours spent by students outside their CBE schedule as well as most preferred clinical practice Participants included 203 undergraduate nursing students drawn from the 2010, 2011 and 2012 cohorts. A stratified random sampling technique was used. A modified 4-point Likert scale version of a questionnaire designed by Ibrahim (2010), which also comprised of open-ended questions for supportive qualitative information, was used to collect data. Analysis was done accomplished using SPSS Version 22 for the quantitative data and identification of themes for the supportive qualitative information. Results The study results revealed that students had benefited from CBE in all the four domains under study. Participants rated the impact of CBE on academic gains lowest ( ̅x = 3.09, SD = .38) with perceived impact of CBE on local and global gains rated highest ( ̅x = 3.33, SD = .38). The personal gains subscale was the second highly rated subscale with a mean of 3.27 (SD = .43), followed by the intrapersonal gains domain ( ̅x = 3.15, SD .48). No significant differences were found between groups on all the variables of interest. Furthermore, the results revealed that participants spent a varying number of hours outside of scheduled CBE placement. The majority of the participants spent 200 hours to 399 hours (n= 119) = 58.6% in the first semester and (n = 120) = 59% in the second semester. The majority (72%) of the participants indicated that their preferred clinical practice environment was Primary Health Care. / M

Several issues have impacted on district nursing practice and education within the UK, which can be conceptualised within four main areas: national policy; local organisational structures and practice; professional and disciplinary theory; and practice of individuals (Bergen and While 2005). However, there has been a lack of direction in district nursing in recent years within the UK, with a decline in the number of district nurses being educated (Queen’s Nursing Institute 2014a) and the educational standards supporting district nurse education being over 20 years out of date (Nursing and Midwifery Council 2001). In addition to this, the standards of education for pre-registration nursing (Nursing and Midwifery Council 2010) have supported a graduate workforce with an increasing focus on nursing in the community. This was identified as a consideration for me as an educator when examining the future educational requirements of nurses beyond the point of registration in the community, and became the focus of this study. Knowing in practice is a key concept within this thesis, that is, the particular awareness that underpins the being and doing of a district nurse in practice (Chinn and Kramer 2008). This study explores the unique knowing of district nursing in practice, and how this professional knowing is developed. Understanding the knowing of district nurses and how this is developed will contribute to future educational frameworks and ways of supporting professional development within community nursing practice. A question that is often asked is what makes district nurse knowing different from nursing in inpatient settings, and this emerges in this thesis. A qualitative study using an interpretative approach within a case study design was adopted using three Health Boards within Scotland as the cases. Within each Health Board area, interviews were undertaken with key informants and also, group interviews with district nurses were undertaken using photo elicitation as a focussing exercise. The data were analysed using framework analysis (Spencer et al. 2003). This approach illuminated a depth and breadth of knowing in district nurse practice and how this knowing is developed. The study findings depict the complexity of knowing in district nursing, acknowledging the advancing role of district nursing practice, where the context of care is an essential consideration. The unique knowing can be described as a landscape that the district nurse must travel: crossing a variety of socio-economic areas; entering the private space of individuals, and the public space of communities; as well as acknowledging professional practice; navigating the policy agenda while maintaining clinical person-centred care; and leading others across the terrain of interprofessional working. The unique knowing in practice that characterises the expertise of district nurses is a matrix of elements that incorporates different aspects of knowing that contribute to leadership, as suggested by Jackson et al. (2009). The participants in this study recognised that due to the complexity of the district nurse role, and its continuing advancements, that district nurse education needs to move to a Master's level preparation and it needs to continue to be supported by a suitably qualified practice teacher. Furthermore, the findings within this study demonstrate that the development of the unique knowing in district nurses does not happen in isolation and it is very complex. It consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. Theory and practice are mutually dependent on each other; change is inevitable and is unpredictable; and practices change by having experiences, therefore change is integral to practice. Consequently, it was concluded that the interdependent elements, which interact, develop the unique knowing of district nurses in practice. Finally this thesis makes recommendations and discusses future implications for policy, practice and research.

Dissertation submitted in partial compliance with the requirements for the Master's Degree of Technology: Nursing, Technikon Natal, 2002. / The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested. / M

Introdução: Estima-se que no Brasil, cerca de 20% dos usuários de serviços de Atenção Primária à Saúde (APS) apresentam padrão de consumo de álcool problemático, sendo escassas as estratégias para o enfrentamento desse fenômeno. Apesar de as Intervenções Breves (IBs) serem apontadas como recurso importante na redução do consumo nocivo do álcool no cenário da APS, existem diversas barreiras que dificultam a sua implantação no país, carência de recursos humanos, falta de tempo dos profissionais e a alta demanda de usuários nos serviços tem sido apontadas como as principais dificuldades a serem enfrentadas. Objetivo: Verificar a efetividade Intervenção Breve Grupal (IBG) realizada por enfermeiros, na redução do uso de risco e nocivo de álcool em usuários de um serviço de APS. Método: Tratou-se de um ensaio clínico, controlado com follow-up de 90 dias, realizado em uma Unidade Básica de Saúde (UBS). A amostra foi composta 180 sujeitos que apresentaram pontuação sugestiva de padrão de uso de risco ou nocivo de álcool no AUDIT. Os usuários que foram randomizados para o Grupo Experimental (GE), foram submetidos à IBG, enquanto os indivíduos alocados no Grupo Controle (GC) receberam um folheto informativo sobre problemas relacionados ao consumo nocivo de álcool. Ambos os grupos participaram de uma avaliação de seguimento após 90 dias. A IBG foi composta por quatro sessões grupais, com encontros semanais e uma sessão de seguimento após 90 dias. Para coleta de dados foram aplicados os instrumentos de caracterização sociodemográfica, clínica e comportamental, o AUDIT e a Régua de Prontidão para Mudança (RPM). O modelo linear misto foi utilizado para avaliar a efetividade da IBG na redução do consumo de álcool e na alteração do estágio de prontidão para mudança. O nível de significância adotado foi de 5%. Resultados: Dos 180 sujeitos que faziam uso de risco/nocivo de álcool, n=44 completaram todas as fases da pesquisa. O GE apresentou redução estatisticamente significativa (p 0,01) de cerca de 10 pontos no escore do AUDIT após a IBG (Antes IBG=15,89±6,62 - uso de risco; Após IBG=6,40±5,05 - uso de baixo risco) mantendo o uso de baixo risco no seguimento (6,69±6,38 uso de baixo risco). O GC apresentou redução estatisticamente significativa (p 0,01) de cerca de 3 pontos no escore do AUDIT (Antes =13,11±4,54 - uso de risco; Após =9,83±5,54 - uso de risco) voltando ao padrão de uso de álcool igual a aquele identificado no início, no seguimento (13,00±5,70 - uso de risco). As diferenças entre os dois grupos (GE x GC) na redução do consumo foram estatisticamente significativas (p 0,01). Com relação à efetividade da intervenção nos estágios de prontidão para mudança do padrão do uso do álcool observou-se que o GE apresentou aumento dos escores de motivação após a IBG (Antes IBG=6,55±3,41 preparação; Após IBG=8,00±2,88 ação) e manteve os escores de motivação elevados no seguimento (7,92±3,06-ação). No GC houve um aumento da motivação inicial (Antes=5,42±3,26 preparação; Após =6,67±3,05 - preparação) e redução dos escores de motivação no seguimento (4,80±2,86 - contemplação), evidenciando diferenças estatisticamente significativas (p=0,03) no seguimento entre os grupos. Conclusão: Evidenciou-se que a intervenção breve grupal realizada pelo enfermeiro no contexto da APS foi efetiva para redução do consumo de álcool em indivíduos com padrão de uso de risco/nocivo, bem como influencia positivamente nos estágios de prontidão para mudança do hábito de beber nesses usuários. / Introduction: In Brazil, about 20% of primary health care facilitiess users presented problematic alcohol consumption pattern, and strategies for combating this phenomenon are scarces. Despite the brief interventions (BIs) are pointed as important feature in reducing harmful alcohol consumption in the Primary health care facilities, there are several barriers that hinder its deployment in the country, lack of human resources, lack of time of the professionals and the high demand of users in the services has been identified as the main difficulties to be faced. Objective: To verify the effectiveness of Brief Intervention Group (BIG) performed by nurses, in reducing the hazardous and harmful use of alcohol in an PHC service users. Methods: This was a controlled clinical trial with follow-up of 90 days, held in a Basic Health Unit (BHU). The sample was composed of 180 subjects who have submitted scores suggestive of usage pattern of hazardous or harmful to alcohol in the AUDIT. Users who were randomized to the Experimental Group (EG), were submitted to BIG, while individuals allocated in the Control group (CG) received a leaflet about problems related to the harmful consumption of alcohol. Both groups participated in a follow-up review after 90 days. The BIG was composed of four group sessions, with weekly meetings and a follow-up session after 90 days. Data collection instruments were applied to sociodemographic, clinical, and behavioral profiling, AUDIT and the readiness to change (RPM). The mixed linear model was used to evaluate the effectiveness of the BIG in reducing alcohol consumption and change in the stage of readiness for change. The significance level adopted was 5%. Results: Of 180 subjects who made of alcohol hazardous and harmful use, n=44 completed all phases of the research. The EG presented statistically significant reduction (p 0.01) of about 10 points in the score of the AUDIT after BIG (Before BIG = 15 .89 ± 6.62-use of risk; After BIG = 6 .40 ± 5.05-low-risk use) while maintaining the use of low risk following (6.69 ± 6.38 use of low risk). The CG presented statistically significant reduction (p 0.01) of about 3 points in the AUDIT score (Before-use of 13.11 ± 4.54 risk; After 9.83 ± 5.54-use of risk) returning to the pattern of use of alcohol equal to that identified in the beginning, following (13.00 ± 5.70-use of risk). The differences between the two groups (EG x CG) in reduced consumption were statistically significant (p 0.01). Regarding the effectiveness of intervention in stages of readiness to change the pattern of alcohol use showed that the EG scores increased motivation after BIG (Before BIG = 6 .55 ± 3.41-preparation; After BIG = 8 .00 ± 2.88-action) and kept the scores high motivation following (7.92 ± 3.06-action). In the CG increased initial motivation (Before = 5 .42 ± 3.26-preparation; After 6.67 ± 3.05-preparation) and reduction of scores of motivation following (4.80 ± 2.86-contemplation), showing statistically significant differences (p = 0 .03) following among groups. Conclusion: It was evidenced that the intervention group performed by nurse soon in the context of the APS was effective for reducing alcohol consumption in individuals with hazardous or harmful use, as well as positively influence in stages of readiness to change the habit of drinking in these users.

Introdução: A anemia e a obesidade infantil representam importantes problemas nutricionais na saúde pública. Estudos realizados na última década evidenciam associação entre anemia, menores níveis de hemoglobina e obesidade, porém são escassos os estudos que avaliam essa associação em crianças, particularmente no Brasil. Objetivos: Avaliar a ocorrência de anemia e sua associação com estado nutricional e outras características infantis, maternas e familiares; investigar associação entre nível de hemoglobina e estado nutricional. Método: Trata-se de subprojeto de uma pesquisa mais ampla, desenvolvida em município de pequeno porte do estado de São Paulo, no período de fevereiro a maio de 2013. Foi realizado em amostra representativa e proporcional de crianças menores de três anos de idade cadastradas nas unidades básicas de saúde do município. A amostra do presente estudo foi constituída por 227 crianças com seis meses ou mais de idade que tinham dosagem do nível de hemoglobina obtida em hemoglobinômetro portátil Agabê®. Para o diagnóstico da anemia, adotou-se a recomendação da OMS (Hb<11g/dL). Verificaram-se peso e estatura; o estado nutricional foi avaliado pelo escore z do IMC/idade e classificado em: magreza; eutrofia; risco de sobrepeso; sobrepeso e obesidade, de acordo com recomendação da OMS. O banco de dados foi construído no software Epi-Info versão 3.5.2, com dupla digitação; as análises foram processadas no Anthro versão 3.2.2 e no software estatístico R. Realizou-se análise univariada com distribuição de crianças anêmicas e não anêmicas e variáveis independentes (infantis, maternas e familiares), utilizando-se teste qui-quadrado. Para investigar associação entre nível de Hb (variável dependente) e variáveis independentes, foram utilizados o teste de correlação de Pearson e a regressão linear múltipla, com inclusão das variáveis com p<0,20. O nível de significância dos testes foi de 5%. O estudo foi aprovado por Comitê de Ética em Pesquisa, autorizado pela Diretoria de Saúde do município e todas as mães assinaram Termo de Consentimento Livre e Esclarecido. Resultados: Anemia afetava 41,8% das crianças, com frequência estatisticamente maior (p<0,05) no segundo semestre de vida (56,3%), entre crianças que não faziam puericultura (60,0%), que se encontravam em aleitamento materno (57,1%), pertencentes a famílias com chefe desempregado (59,3%) e com renda per capita inferior a 0,5 salário mínimo (53,5%). Anemia não se associou com estado nutricional. Os níveis de Hb se associaram (p<0,05) com idade (meses); estado nutricional (escore z de IMC/idade); aleitamento materno na entrevista; fazer puericultura; chefe da família empregado e renda familiar per capita (em salários mínimos). Na análise de regressão linear múltipla, os níveis de hemoglobina se associaram significativamente (p<0,05) apenas com as variáveis fazer puericultura (p<0,003) e estar em aleitamento materno na entrevista (p<0,021): ser acompanhada em consulta de puericultura aumentou os níveis de Hb em 0,96g/dL estar em aleitamento materno no momento da entrevista reduziu os níveis de Hb em 0,50g/dL. Conclusões: Não se constatou associação entre anemia ou menores níveis de Hb e estado nutricional nas crianças menores de três anos de idade, apesar de anemia e excesso de peso constituírem problemas importantes de saúde da criança no município estudado. Os resultados alertam para a necessidade da implementação urgente de intervenções para o controle desses problemas nutricionais na atenção básica. / Introduction: anemia and childhood obesity represent important nutritional problems in public health. Studies carried out in the last decade showed association between anemia, lower levels of hemoglobin and obesity, however there are few studies that evaluate this association in children, particularly in Brazil. Objectives: To evaluate the occurrence of anemia and its association with nutritional status and other characteristics of children, mothers and family members; to investigate the association between hemoglobin level and nutritional status. Method: This is a subproject of a broader research, developed in a small municipality in the state of São Paulo, in the period from February to May of 2013. Was carried out in a representative and proportional sample of children under three years of age enrolled in basic health units in the city. The sample of this study was composed by 227 children with six months or more of age who had dosage of the hemoglobin level obtained in portable hemoglobinometer Agabê®. For the diagnosis of anemia was adopted the WHO recommendation (Hb<11g/dL). Weight and stature were verified; nutritional status was assessed by z score of BMI/age and classified into: thinness; eutrophy, overweight risk; overweight and obesity, in accordance with the WHO recommendation. The database was built in the Epi-Info software version 3.5.2, with double-typing; analyzes were processed in Anthro version 3.2.2 and in the statistical software R. Univariate analysis was performed with distribution of anemic and non-anemic children and independent variables (children, mothers and family), using the chi-square test. To investigate the association between Hb level (dependent variable) and independent variables, were used the Pearson\'s correlation test and multiple linear regression, with inclusion of variables with p<0.20. The significance level was 5%. The study was approved by the Ethics Committee in Research, authorized by the Board of Health of the municipality and all mothers signed the Free and Informed Consent Term. Results: anemia affected 41.8% of the children, with statistically greater frequency (p<0.05) in the second semester of life (56.3%), between children who were not in puericulture (60.0%), who were on exclusive breastfeeding (57.1%), belonging to families with head unemployed (59.3%) and with per capita income of less than 0.5 minimum wage (53.5%). Anemia was not associated with nutritional status. The Hb levels were associated (p<0.05) with age (months); nutritional status (z score of BMI/age); breastfeeding in the interview; do puericulture; head of family employee and per capita family income (in minimum wages). In the multiple linear regression analysis, hemoglobin levels were significantly associated (p<0.05) only with the variables make puericulture (p<0.003) and being in breastfeeding in the interview (p<0.021), be accompanied in puericulture consultation increased levels of Hb in 0.96g/dL and being in breastfeeding at the time of interview reduced the levels of Hb in 0.50g/dL. Conclusions: it was not found association between anemia or lower Hb levels and nutritional status in children below three years of age, although anemia and overweight constitute important problems of child health in the municipality studied. The results alert to the need of urgent implementation of interventions for the control of these nutritional problems in basic care.

Introdução: Estima-se que no Brasil, cerca de 20% dos usuários de serviços de Atenção Primária à Saúde (APS) apresentam padrão de consumo de álcool problemático, sendo escassas as estratégias para o enfrentamento desse fenômeno. Apesar de as Intervenções Breves (IBs) serem apontadas como recurso importante na redução do consumo nocivo do álcool no cenário da APS, existem diversas barreiras que dificultam a sua implantação no país, carência de recursos humanos, falta de tempo dos profissionais e a alta demanda de usuários nos serviços tem sido apontadas como as principais dificuldades a serem enfrentadas. Objetivo: Verificar a efetividade Intervenção Breve Grupal (IBG) realizada por enfermeiros, na redução do uso de risco e nocivo de álcool em usuários de um serviço de APS. Método: Tratou-se de um ensaio clínico, controlado com follow-up de 90 dias, realizado em uma Unidade Básica de Saúde (UBS). A amostra foi composta 180 sujeitos que apresentaram pontuação sugestiva de padrão de uso de risco ou nocivo de álcool no AUDIT. Os usuários que foram randomizados para o Grupo Experimental (GE), foram submetidos à IBG, enquanto os indivíduos alocados no Grupo Controle (GC) receberam um folheto informativo sobre problemas relacionados ao consumo nocivo de álcool. Ambos os grupos participaram de uma avaliação de seguimento após 90 dias. A IBG foi composta por quatro sessões grupais, com encontros semanais e uma sessão de seguimento após 90 dias. Para coleta de dados foram aplicados os instrumentos de caracterização sociodemográfica, clínica e comportamental, o AUDIT e a Régua de Prontidão para Mudança (RPM). O modelo linear misto foi utilizado para avaliar a efetividade da IBG na redução do consumo de álcool e na alteração do estágio de prontidão para mudança. O nível de significância adotado foi de 5%. Resultados: Dos 180 sujeitos que faziam uso de risco/nocivo de álcool, n=44 completaram todas as fases da pesquisa. O GE apresentou redução estatisticamente significativa (p 0,01) de cerca de 10 pontos no escore do AUDIT após a IBG (Antes IBG=15,89±6,62 - uso de risco; Após IBG=6,40±5,05 - uso de baixo risco) mantendo o uso de baixo risco no seguimento (6,69±6,38 uso de baixo risco). O GC apresentou redução estatisticamente significativa (p 0,01) de cerca de 3 pontos no escore do AUDIT (Antes =13,11±4,54 - uso de risco; Após =9,83±5,54 - uso de risco) voltando ao padrão de uso de álcool igual a aquele identificado no início, no seguimento (13,00±5,70 - uso de risco). As diferenças entre os dois grupos (GE x GC) na redução do consumo foram estatisticamente significativas (p 0,01). Com relação à efetividade da intervenção nos estágios de prontidão para mudança do padrão do uso do álcool observou-se que o GE apresentou aumento dos escores de motivação após a IBG (Antes IBG=6,55±3,41 preparação; Após IBG=8,00±2,88 ação) e manteve os escores de motivação elevados no seguimento (7,92±3,06-ação). No GC houve um aumento da motivação inicial (Antes=5,42±3,26 preparação; Após =6,67±3,05 - preparação) e redução dos escores de motivação no seguimento (4,80±2,86 - contemplação), evidenciando diferenças estatisticamente significativas (p=0,03) no seguimento entre os grupos. Conclusão: Evidenciou-se que a intervenção breve grupal realizada pelo enfermeiro no contexto da APS foi efetiva para redução do consumo de álcool em indivíduos com padrão de uso de risco/nocivo, bem como influencia positivamente nos estágios de prontidão para mudança do hábito de beber nesses usuários. / Introduction: In Brazil, about 20% of primary health care facilitiess users presented problematic alcohol consumption pattern, and strategies for combating this phenomenon are scarces. Despite the brief interventions (BIs) are pointed as important feature in reducing harmful alcohol consumption in the Primary health care facilities, there are several barriers that hinder its deployment in the country, lack of human resources, lack of time of the professionals and the high demand of users in the services has been identified as the main difficulties to be faced. Objective: To verify the effectiveness of Brief Intervention Group (BIG) performed by nurses, in reducing the hazardous and harmful use of alcohol in an PHC service users. Methods: This was a controlled clinical trial with follow-up of 90 days, held in a Basic Health Unit (BHU). The sample was composed of 180 subjects who have submitted scores suggestive of usage pattern of hazardous or harmful to alcohol in the AUDIT. Users who were randomized to the Experimental Group (EG), were submitted to BIG, while individuals allocated in the Control group (CG) received a leaflet about problems related to the harmful consumption of alcohol. Both groups participated in a follow-up review after 90 days. The BIG was composed of four group sessions, with weekly meetings and a follow-up session after 90 days. Data collection instruments were applied to sociodemographic, clinical, and behavioral profiling, AUDIT and the readiness to change (RPM). The mixed linear model was used to evaluate the effectiveness of the BIG in reducing alcohol consumption and change in the stage of readiness for change. The significance level adopted was 5%. Results: Of 180 subjects who made of alcohol hazardous and harmful use, n=44 completed all phases of the research. The EG presented statistically significant reduction (p 0.01) of about 10 points in the score of the AUDIT after BIG (Before BIG = 15 .89 ± 6.62-use of risk; After BIG = 6 .40 ± 5.05-low-risk use) while maintaining the use of low risk following (6.69 ± 6.38 use of low risk). The CG presented statistically significant reduction (p 0.01) of about 3 points in the AUDIT score (Before-use of 13.11 ± 4.54 risk; After 9.83 ± 5.54-use of risk) returning to the pattern of use of alcohol equal to that identified in the beginning, following (13.00 ± 5.70-use of risk). The differences between the two groups (EG x CG) in reduced consumption were statistically significant (p 0.01). Regarding the effectiveness of intervention in stages of readiness to change the pattern of alcohol use showed that the EG scores increased motivation after BIG (Before BIG = 6 .55 ± 3.41-preparation; After BIG = 8 .00 ± 2.88-action) and kept the scores high motivation following (7.92 ± 3.06-action). In the CG increased initial motivation (Before = 5 .42 ± 3.26-preparation; After 6.67 ± 3.05-preparation) and reduction of scores of motivation following (4.80 ± 2.86-contemplation), showing statistically significant differences (p = 0 .03) following among groups. Conclusion: It was evidenced that the intervention group performed by nurse soon in the context of the APS was effective for reducing alcohol consumption in individuals with hazardous or harmful use, as well as positively influence in stages of readiness to change the habit of drinking in these users.

Introdução: A anemia e a obesidade infantil representam importantes problemas nutricionais na saúde pública. Estudos realizados na última década evidenciam associação entre anemia, menores níveis de hemoglobina e obesidade, porém são escassos os estudos que avaliam essa associação em crianças, particularmente no Brasil. Objetivos: Avaliar a ocorrência de anemia e sua associação com estado nutricional e outras características infantis, maternas e familiares; investigar associação entre nível de hemoglobina e estado nutricional. Método: Trata-se de subprojeto de uma pesquisa mais ampla, desenvolvida em município de pequeno porte do estado de São Paulo, no período de fevereiro a maio de 2013. Foi realizado em amostra representativa e proporcional de crianças menores de três anos de idade cadastradas nas unidades básicas de saúde do município. A amostra do presente estudo foi constituída por 227 crianças com seis meses ou mais de idade que tinham dosagem do nível de hemoglobina obtida em hemoglobinômetro portátil Agabê®. Para o diagnóstico da anemia, adotou-se a recomendação da OMS (Hb<11g/dL). Verificaram-se peso e estatura; o estado nutricional foi avaliado pelo escore z do IMC/idade e classificado em: magreza; eutrofia; risco de sobrepeso; sobrepeso e obesidade, de acordo com recomendação da OMS. O banco de dados foi construído no software Epi-Info versão 3.5.2, com dupla digitação; as análises foram processadas no Anthro versão 3.2.2 e no software estatístico R. Realizou-se análise univariada com distribuição de crianças anêmicas e não anêmicas e variáveis independentes (infantis, maternas e familiares), utilizando-se teste qui-quadrado. Para investigar associação entre nível de Hb (variável dependente) e variáveis independentes, foram utilizados o teste de correlação de Pearson e a regressão linear múltipla, com inclusão das variáveis com p<0,20. O nível de significância dos testes foi de 5%. O estudo foi aprovado por Comitê de Ética em Pesquisa, autorizado pela Diretoria de Saúde do município e todas as mães assinaram Termo de Consentimento Livre e Esclarecido. Resultados: Anemia afetava 41,8% das crianças, com frequência estatisticamente maior (p<0,05) no segundo semestre de vida (56,3%), entre crianças que não faziam puericultura (60,0%), que se encontravam em aleitamento materno (57,1%), pertencentes a famílias com chefe desempregado (59,3%) e com renda per capita inferior a 0,5 salário mínimo (53,5%). Anemia não se associou com estado nutricional. Os níveis de Hb se associaram (p<0,05) com idade (meses); estado nutricional (escore z de IMC/idade); aleitamento materno na entrevista; fazer puericultura; chefe da família empregado e renda familiar per capita (em salários mínimos). Na análise de regressão linear múltipla, os níveis de hemoglobina se associaram significativamente (p<0,05) apenas com as variáveis fazer puericultura (p<0,003) e estar em aleitamento materno na entrevista (p<0,021): ser acompanhada em consulta de puericultura aumentou os níveis de Hb em 0,96g/dL estar em aleitamento materno no momento da entrevista reduziu os níveis de Hb em 0,50g/dL. Conclusões: Não se constatou associação entre anemia ou menores níveis de Hb e estado nutricional nas crianças menores de três anos de idade, apesar de anemia e excesso de peso constituírem problemas importantes de saúde da criança no município estudado. Os resultados alertam para a necessidade da implementação urgente de intervenções para o controle desses problemas nutricionais na atenção básica. / Introduction: anemia and childhood obesity represent important nutritional problems in public health. Studies carried out in the last decade showed association between anemia, lower levels of hemoglobin and obesity, however there are few studies that evaluate this association in children, particularly in Brazil. Objectives: To evaluate the occurrence of anemia and its association with nutritional status and other characteristics of children, mothers and family members; to investigate the association between hemoglobin level and nutritional status. Method: This is a subproject of a broader research, developed in a small municipality in the state of São Paulo, in the period from February to May of 2013. Was carried out in a representative and proportional sample of children under three years of age enrolled in basic health units in the city. The sample of this study was composed by 227 children with six months or more of age who had dosage of the hemoglobin level obtained in portable hemoglobinometer Agabê®. For the diagnosis of anemia was adopted the WHO recommendation (Hb<11g/dL). Weight and stature were verified; nutritional status was assessed by z score of BMI/age and classified into: thinness; eutrophy, overweight risk; overweight and obesity, in accordance with the WHO recommendation. The database was built in the Epi-Info software version 3.5.2, with double-typing; analyzes were processed in Anthro version 3.2.2 and in the statistical software R. Univariate analysis was performed with distribution of anemic and non-anemic children and independent variables (children, mothers and family), using the chi-square test. To investigate the association between Hb level (dependent variable) and independent variables, were used the Pearson\'s correlation test and multiple linear regression, with inclusion of variables with p<0.20. The significance level was 5%. The study was approved by the Ethics Committee in Research, authorized by the Board of Health of the municipality and all mothers signed the Free and Informed Consent Term. Results: anemia affected 41.8% of the children, with statistically greater frequency (p<0.05) in the second semester of life (56.3%), between children who were not in puericulture (60.0%), who were on exclusive breastfeeding (57.1%), belonging to families with head unemployed (59.3%) and with per capita income of less than 0.5 minimum wage (53.5%). Anemia was not associated with nutritional status. The Hb levels were associated (p<0.05) with age (months); nutritional status (z score of BMI/age); breastfeeding in the interview; do puericulture; head of family employee and per capita family income (in minimum wages). In the multiple linear regression analysis, hemoglobin levels were significantly associated (p<0.05) only with the variables make puericulture (p<0.003) and being in breastfeeding in the interview (p<0.021), be accompanied in puericulture consultation increased levels of Hb in 0.96g/dL and being in breastfeeding at the time of interview reduced the levels of Hb in 0.50g/dL. Conclusions: it was not found association between anemia or lower Hb levels and nutritional status in children below three years of age, although anemia and overweight constitute important problems of child health in the municipality studied. The results alert to the need of urgent implementation of interventions for the control of these nutritional problems in basic care.

A Saúde da Família traz para o cenário do Sistema Único de Saúde a proposta de reorganização da assistência a partir da atenção básica. Para sua efetivação, faz-se necessário o comprometimento dos trabalhadores da área da saúde com a reestruturação do processo de trabalho, viabilizando-o de modo que sejam desenvolvidas práticas de saúde que visem ao atendimento das necessidades da população com a presença de atos de fala, escuta, vínculo e negociação. Assim, este estudo, de caráter exploratório-descritivo, caracteriza-se como um estudo de caso na abordagem qualitativa, tendo por objetivos identificar e analisar os atributos mobilizados nas situações de trabalho e que caracterizam os desempenhos das enfermeiras no que diz respeito à área de competência gerencial na Saúde da Família, apoiado nos conceitos teóricos de competência dialógica. Para coleta de dados foi realizada a observação participante do trabalho das enfermeiras atuantes na Saúde da Família em quatro unidades vinculadas à Universidade de São Paulo do município de Ribeirão Preto SP/Brasil, considerando-se uma semana típica de trabalho, num total de 160 horas de observação. Para a análise de dados optamos pela análise de conteúdo, usando a técnica de análise temática, sendo identificados cinco grandes temas. O primeiro, A supervisão como instrumento de controle e educação, aponta a supervisão como atividade inerente ao cotidiano da gestão do trabalho das enfermeiras e mostra que a supervisão apresenta as dimensões de educação (tanto no aspecto de educação de outros trabalhadores quanto no caráter de capacitação) e de controle (de atividades e de pessoal). O segundo, O trabalho em equipe na Saúde da Família, apresenta que o trabalho das enfermeiras está articulado ao da equipe para a produção do cuidado, evidenciando como ocorre tal articulação das ações e a interação entre os trabalhadores. O terceiro, O controle social no processo de gestão, indica o controle e a participação social como instrumentos que possibilitam a construção de cidadania e que se fazem presentes no trabalho das enfermeiras relacionados à Comissão Local de Saúde. O quarto, A organização do trabalho para a produção do cuidado, mostra que o trabalho das enfermeiras se desenvolve no sentido de: organizar o fluxo de usuários e informações tanto na unidade como entre os serviços, realizar controle de infra-estrutura e recursos humanos e previsão e provisão de material. E o último tema, Coordenação e planejamento do trabalho, apresenta que o planejamento está direcionado a atividades mais pontuais (de promoção à saúde e de educação permanente), escalas e ao cuidado; e a coordenação está relacionada à organização do trabalho para a produção do cuidado, sendo raras as iniciativas para o planejamento mais global voltado ao território e para a avaliação das ações individuais, coletivas e de organização da unidade de saúde. A análise dos achados aponta para um conjunto de atributos mobilizados por estas enfermeiras, que pode indicar desempenhos para a Saúde da Família, ainda centrado na organização do trabalho em saúde para o cuidado individual, com raras incursões a uma ação sistematizada e contínua que envolva todas as etapas do planejamento incluindo um processo de avaliação permanente das ações propostas, de forma mais participativa, incluindo outros sujeitos. Assim, consideramos que este estudo aponta questões relevantes para análise dos desempenhos para competência gerencial, mas que necessitam ser validadas pelo conjunto das enfermeiras que atuam na Saúde da Família no cenário de Ribeirão Preto. / health care services based from primary care. To become effective, health care workers should commit to the program by restructuring the work process, making it feasible to develop health care practices that meet the needs of the population. This should be performed through acts of speaking, listening, bonding, and negotiating. Hence, this exploratorydescriptive case study aims to identify and analyze, through a qualitative approach, the attributes mobilized in labor situations by nursing professionals. Such attributes characterize their performance in terms of managerial competence area in the Family Health Program founded on the theoretical concepts of dialogic competence. Data were collected by observing (participant observation) the work of nursing professionals, involved in the Family Health Program, in four primary health care units of the University of Sao Paulo in the city of Ribeirao Preto SP/Brazil. Observation was carried out for 160 hours, considering a typical workweek. Data were analyzed through the technique of thematic content analysis, and five major themes were identified. The first, Supervision as an instrument to control and educate, points supervision as an activity inherent to daily nursing work management and presents the dimensions of education (considering both educating and training workers) and control (activities and staff). The second, Team work in the Family Health Program, suggests that nursing work is articulated with that of the whole team to promote health care, showing how actions and interaction among workers take place. The third, Social control in the managerial process, indicates social control and participation as instruments that promote citizenship and are parts of the nursing work, related to the Local Health Committee. The fourth, Organizing work to produce health care, shows that work in nursing develops toward: organizing the flow of patients and information at the unit as well as among health care services, controlling infrastructure and human resources, and planning and providing material. The final theme, Work coordination and planning, states that planning is directed to punctual activities (concerning health promotion and continuous education), scales, and health care; and coordination is related to the organization of work to promote health care, with rare initiatives toward a more global planning directed to the territory and evaluation of individual and collective actions, and organizing the health care unit. Findings were analyzed and revealed that there is a group of attributes mobilized by these nurses, which could be indicators of performance in the Family Health Program, centered in the organization of work for individual health care, with rare incursions to a systemized and continuous action involving all the steps of planning, including a permanent process of evaluation of the proposed actions, in a more participative way, including other individuals. Thus, this study presents relevant questions for the analysis of performance needed in managerial competence, but needs to be validated by the group of nurses that work with the Family Health Program in Ribeirao Preto.

Introdução: Com o aumento da população idosa e das condições crônicas de saúde, a Atenção Primária à Saúde (APS) é preciso reorganizar esse nível do Sistema Único de Saúde (SUS) para atender às necessidades de saúde decorrentes do novo perfil epidemiológico. Por serem progressivas e incuráveis, as doenças crônico-degenerativas geram crescente demanda por cuidados paliativos (CP). Os CP são indicados desde o diagnóstico de uma doença crônica até o estágio final de vida. Dado o cenário da necessidade de incluir os CP na APS, quais seriam as questões éticas relativas a essa inclusão? Objetivo: Identificar as questões éticas relativas aos Cuidados Paliativos na Atenção Primária à Saúde. Método: Revisão Sistematizada do tipo Scoping Review. As buscas foram nas bases de dados: LILACS, PubMed, CINAHL e EMBASE. Utilizou-se duas estratégias de busca. A primeira cruzou os descritores ética e bioética com atenção primária à saúde. A segunda fez o cruzamento dos dois descritores com cuidados paliativos. Além das buscas nas bases, incluiu-se o acervo de buscas anteriores. Resultados: Foram encontrados 3923 artigos e, após análise, mantiveram-se 16 artigos, referentes a 15 estudos. Os problemas encontrados foram: escassez de recursos; falta de conhecimento dos profissionais de saúde sobre a prática de CP; falta de habilidades comunicacionais; dificuldade em estabelecer limites na relação clínica; sobrecarga de trabalho; falta de apoio de serviços de referência; e falta de comunicação entre os serviços da Rede de Atenção à Saúde (RAS). Esses problemas assemelham-se aos vividos no cotidiano da APS, distinguindo-se pelas especificidades de algumas situações como as de fim de vida. Conclusões: A oferta dos CP na APS tem desafios éticos, além de técnicos e operacionais, como: ultrapassar a assistência oncológica; modificar a visão dos profissionais para iniciar os CP o mais precocemente na vigência das condições crônicas de saúde; fomentar a cultura do cuidado compartilhado e da corresponsabilização pela saúde; e desenvolver continuamente as habilidades e atividades dos profissionais para a comunicação como instrumento do processo de trabalho na APS / Introduction: The increase in the elderly population and chronic health conditions require a new organization of Primary Health Care (PHC) in the Unified Health System (SUS) to meet the health needs from the new epidemiological profile. As these diseases are progressive and incurable, they generate an increasing demand for palliative care (PC). The PC are indicated since the diagnosis of a chronic disease till the end of life. What are the ethical issues related to the inclusion of PC in PHC? Objective: To identify ethical issues related to Palliative Care in Primary Health Care. Method: Scoping Review. Data collection was made in the databases LILACS, PubMed, CINAHL and EMBASE, using two different linkage strategies: ethics and bioethics with primary health care, and ethics and bioethics with palliative care. Besides searching databases, we included articles located by previous searches. Results: We found 3923 articles. After the analysis, remained 16 articles, related to 15 studies. We found the following problems: lack of resources; lack of knowledge of health professionals on the PC practice; lack of communication skills; difficulty in establishing limits in clinical relationship; work overload; lack of referral support; and lack of communication between health services. These ethical issues are similar to those experienced daily in the PHC, except for the specificities of some situations, such as end of life. Conclusion: The offer of PC in the PHC arises ethical and technical challenges: Overcome the treatment of cancer; modify the professional vision to start the PC since the diagnosis of a chronic health condition; foster shared care and co-responsibility for health; and continued development of professionals communication skills as an important tool for the work process in PHC