Submitted by Sandra Pereira (srpereira@ufrrj.br) on 2017-03-23T13:36:03Z No. of bitstreams: 1 2016 - Luciana Janeiro Silva.pdf: 1932605 bytes, checksum: 769b56b9a8925ca62f5ce19ce1f1e204 (MD5) / Made available in DSpace on 2017-03-23T13:36:03Z (GMT). No. of bitstreams: 1 2016 - Luciana Janeiro Silva.pdf: 1932605 bytes, checksum: 769b56b9a8925ca62f5ce19ce1f1e204 (MD5) Previous issue date: 2016-04-28 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The current context of construction of the Brazilian Unique Health System (SUS) has been characterized by a process of expansion of the assistance model, notably observed at Rio de Janeiro municipality with the Family Health Strategy (ESF). This expansion, since 2011, has been implementing under the heading of the Family Health Care Center, in the city of Rio de Janeiro, being designed as a co-management between Social Organizations and the Municipal Health Office. Inside this context, this work has the goal of investigating the sense in which the users of the ESF assisted by the Family Health Care Center of Rio accredit to assistance on health. The main goals are: understand the ways of application and assessment of the Family Health Care Centers by the assisted population, learn how users are building their therapeutic trajectory and their aims related to health and discuss the experiences of the assisted population by the ESF model regarding care practices. The research is based on the health concept developed by the philosopher George Canguilhem and the discussion on care developed by autors of the field of colective health, such as Emerson Merhy, Lu?s Cec?lio Oliveira, Ricardo Ayres, Rubem Araujo Mattos, among others. It is a qualitative study that has used the ?life narrative? modality as a way of construction of the empirical material, understanding it as an opportune way to achieve the leading senses of the research subjects, according to what they remember and to what they elaborate about their lives and, more specifically, on the object of study. Interviews with twelve users nominated by the Family Health team were produced, as well as an empirical material organized in three categories, Family Health Care Center and Care on Health. In the category of Integrality it is possible to notice the limits of integration of the ESF to other assisting or care services, inside or outside health sector. The constant changes of professionals (more strictly related to the medical team) are not satisfactory to the users and have negatively affected the construction of the integrality of the assistance. In the second category we notice that the Family Health Care Center occupies a core role on the lives of the interviewed, being a reference on the search of their health necessities. Besides that, the users also indicate that they build their own nets of assistance after long searches for treatment and social help associations, associating it with the public and private systems. Regarding the Care on Health we can notice that it is expressively credited to biomedical science, diagnosis technologies and to the medication as central and major practices. We can also notice an intense demand of the interviewees for a sensible listening to the different questions that involves their lives and affect their health and care. In this sense, at the same time they value medical-diagnosis treatments and medication, they ask for their doubts, concerns as well as their life knowledge to be better welcomed and understood / A Aten??o B?sica em Sa?de tem se caracterizado por um processo de expans?o do modelo assistencial, notoriamente observado no munic?pio do Rio de Janeiro, com ?nfase na Estrat?gia Sa?de da Fam?la (ESF). Essa expans?o, iniciada em 2011, est? sendo implementada sob a rubrica de Cl?nica da Fam?lia, sendo configurada por um processo de co-gest?o entre Organiza??es Sociais e Secretaria Municipal de Sa?de. Nesse contexto, este trabalho tem como objetivo geral investigar os sentidos que os/as usu?rios/as dos servi?os da ESF atendidos/as nas Cl?nicas de Fam?lia carioca atribuem ao cuidado em sa?de. Os objetivos espec?ficos s?o: conhecer as formas de utiliza??o e valora??o das Cl?nicas de Fam?lia pelos/as usu?rios/as, conhecer o modo como os/as usu?rios/as est?o construindo seus percursos terap?uticos e seus anseios ligados ? sa?de e discutir as experi?ncias da popula??o atendida no modelo da ESF no que se refere ?s pr?ticas de cuidado. A pesquisa se apoia na no??o de sa?de desenvolvida pelo fil?sofo George Canguilhem e na discuss?o sobre cuidado empreendida por autores do campo da sa?de coletiva, como Emerson Merhy, Lu?s Cec?lio Oliveira, Ricardo Ayres, Rubem Araujo Mattos, dentre outros. Trata-se de um estudo qualitativo, que utilizou a modalidade de ?narrativas de vida? como formato de constru??o do material emp?rico, entendendo ser este um caminho prop?cio para chegar aos sentidos protagonizados pelos sujeitos de pesquisa, segundo o que lembram e elaboram acerca da sua vida e, mais especificamente, do objeto em estudo. Foram desenvolvidas entrevistas em profundidade com doze usu?rias indicadas pela equipe de uma Cl?nica da Fam?lia e o material emp?rico produzido foi organizado em tr?s eixos: Integralidade, Cl?nica da Fam?lia e Cuidado em Sa?de. No eixo Integralidade percebemos os limites da integra??o da ESF a outras redes de cuidado, seja dentro do setor sa?de e/ou fora dele. As mudan?as constantes de profissionais (mais estritamente relacionada ? equipe m?dica), s?o tidas como insatisfat?ria pelos/as usu?rios/as e incindem de forma desfavor?vel na constru??o da integralidade do cuidado. No segundo Eixo percebemos que a Cl?nica da Fam?lia ocupa certa centralidade na vida das pessoas entrevistadas, sendo uma refer?ncia de busca de suas necessidades em sa?de. Al?m disso, as/os usu?rias/os tamb?m indicam que v?o costurando suas pr?prias redes de cuidado, a partir das longas buscas por tratamento, de apoios sociais, bem como do uso associado dos sistemas p?blico e privado. Quanto ao Cuidado em Sa?de pudemos notar que ainda ? expressiva sua credita??o ? ci?ncia biom?dica, ?s tecnologias diagn?sticas e ? medica??o como elementos preponderantes e centrais. Observamos, ainda, intensa demanda das entrevistadas por uma escuta sens?vel das diferentes quest?es que envolvem suas vidas e interferem na sa?de e no cuidado com ela. Assim, ao mesmo tempo que valorizam os procedimentos medico-diagn?sticos e a medica??o, pedem que suas afli??es, d?vidas, bem como, seus saberes de vida sejam mais acolhidos e compreendidos

Made available in DSpace on 2015-07-15T13:31:40Z (GMT). No. of bitstreams: 1 Leonor Bastos - Saude Coletival.pdf: 2524442 bytes, checksum: 51d2c5bc14eebe7a44cee874d7735dbc (MD5) Previous issue date: 2008-04-14 / Care has always been part of human life. It is associated to the practice of the women who have thereby, in the everyday life and surrounded by cultural connotations, promoted life in all its forms and taken care of death. Because life is complex and multi-faceted, this care, in order to fulfill its role of protecting and defending life, needs to be drawn from multiple perspectives and wisdoms, in an articulated manner and in multiple technological levels, including the lighter ones. As such, it depends on the enlivened work of an integrated health team. This team should perform careful and constant action involving workers, user, family and community, and be based on social bonds and accountability. Care, as a result of this collective action integrating distinct perspectives and wisdoms, is nowadays the axis of all actions in health service, particularly in Basic Healthcare Units, which are usually the door to the healthcare needs of the local population. This study adopts such a perspective, and examines the process of care of persons with diabetes mellitus (DM) in a Healthcare Center of Feira de Santana. Its objective is to analyze the process of care of persons with DM aiming for the integrality of healthcare attention, and to discuss its guiding devices: access, bond-accountability, team-formation (the construction of subjects, insertion and habilitation), in the everyday dynamics of the Healthcare Unit. The methodology is qualitative and used semi-structured interviews and systematic observations as data collection techniques. As subjects, the study took healthcare workers and users enrolled in the Program of Attention to persons with DM. The method of analysis for the interviews was guided by the Thematic Subject Analysis (MINAYO, 1996) and the Analyzer Flowchart of Merhy (1997), which also grounded the analysis of the observations. The results reveal that the process of caring of persons with DM has as its main intervention core the practice of nursing (in particular that of the nurse). In the everyday context of the healthcare services, that process has been fragmented, disconnected, and guided by the doctor-centered model. Access is limited, focused, and oriented towards low-complexity actions. Bond and user-embracement are still performed distanced from co-accountability (workers, users, service networks) in the definition of the therapeutic project of the persons with DM and who need the Healthcare Unit. In conclusion, the study points as necessary an expansion of the debate on integral care, considering the everyday praxis of those involved in the process. Key-words: Care has always been part of human life. It is associated to the practice of the women who have thereby, in the everyday life and surrounded by cultural connotations, promoted life in all its forms and taken care of death. Because life is complex and multi-faceted, this care, in order to fulfill its role of protecting and defending life, needs to be drawn from multiple perspectives and wisdoms, in an articulated manner and in multiple technological levels, including the lighter ones. As such, it depends on the enlivened work of an integrated health team. This team should perform careful and constant action involving workers, user, family and community, and be based on social bonds and accountability. Care, as a result of this collective action integrating distinct perspectives and wisdoms, is nowadays the axis of all actions in health service, particularly in Basic Healthcare Units, which are usually the door to the healthcare needs of the local population. This study adopts such a perspective, and examines the process of care of persons with diabetes mellitus (DM) in a Healthcare Center of Feira de Santana. Its objective is to analyze the process of care of persons with DM aiming for the integrality of healthcare attention, and to discuss its guiding devices: access, bond-accountability, team-formation (the construction of subjects, insertion and habilitation), in the everyday dynamics of the Healthcare Unit. The methodology is qualitative and used semi-structured interviews and systematic observations as data collection techniques. As subjects, the study took healthcare workers and users enrolled in the Program of Attention to persons with DM. The method of analysis for the interviews was guided by the Thematic Subject Analysis (MINAYO, 1996) and the Analyzer Flowchart of Merhy (1997), which also grounded the analysis of the observations. The results reveal that the process of caring of persons with DM has as its main intervention core the practice of nursing (in particular that of the nurse). In the everyday context of the healthcare services, that process has been fragmented, disconnected, and guided by the doctor-centered model. Access is limited, focused, and oriented towards low-complexity actions. Bond and user-embracement are still performed distanced from co-accountability (workers, users, service networks) in the definition of the therapeutic project of the persons with DM and who need the Healthcare Unit. In conclusion, the study points as necessary an expansion of the debate on integral care, considering the everyday praxis of those involved in the process. / O cuidado faz parte da vida humana desde os seus prim?rdios e est? associado ? pr?tica das mulheres que atrav?s dele, no cotidiano, envolto em conota??es culturais, promovem a vida em todas as suas manifesta??es e cuidam da morte. J? que a vida ? complexa e multifacetada, este cuidado, para que cumpra a sua fun??o de proteger e defender a vida precisa ser constru?do sob v?rios olhares e saberes, de forma articulada, nos diversos n?veis tecnol?gicos, dentre eles o enfoque nas tecnologias leves. Para tanto, depende do trabalho vivo de uma equipe de sa?de integrada, que desenvolva a??es cuidadosas, envolvendo trabalhadores, usu?rio, fam?lia e comunidade, de forma continuada, constru?da com base no v?nculo e na sponsabiliza??o social. O cuidado, fruto dessa a??o conjunta dos diversos olhares e saberes se constitui hoje no eixo das a??es em um servi?o de sa?de, particularmente das Unidades B?sicas de Sa?de que, em geral, s?o utilizadas como porta de entrada para as necessidades de sa?de da popula??o adscrita ? sua ?rea. Nessa perspectiva, este estudo tem como objeto o processo de cuidar de pessoas com DM em um Centro de Sa?de de Feira de Santana. Objetiva analisar o processo de cuidar de pessoas com DM com vistas ? integralidade da aten??o ? sa?de e discutir seus dispositivos orientadores: acesso, ?nculo-responsabiliza??o, forma??o da equipe (constru??o dos sujeitos, inser??o e capacita??o), na din?mica cotidiana da Unidade de Sa?de. A metodologia ? qualitativa. A entrevista semiestruturada e a observa??o sistem?tica utilizadas como t?cnicas de coleta de dados, tendo como sujeitos trabalhadores de sa?de e usu?rios cadastrados no Programa de Aten??o ?s pessoas com DM. O m?todo de an?lise das entrevistas foi orientado pela An?lise de Conte?do Tem?tica (MINAYO, 1996) e o Fluxograma Analisador de Merhy (1997) que fundamentou a an?lise das observa??es. Os resultados revelam que o processo de cuidar das pessoas com DM tem como n?cleo central de interven??o a pr?tica de enfermagem (em especial da enfermeira), ? constru?do no cotidiano dos servi?os de sa?de, de forma fragmentada e parcelar, orientado pelo modelo m?dico-centrado. O acesso ? restrito, focalizado e direcionado ? a??es de baixa complexidade. O acolhimento e v?nculo ainda s?o operados distantes da co-responsabiliza??o (trabalhadores, usu?rios e rede de servi?os) na defini??o do projeto terap?utico das pessoas com DM que demandam ? Unidade de Sa?de. Conclui-se que, ? necess?rio ampliar o debate sobre o cuidado integral, valorizando a pr?xis cotidiana dos sujeitos envolvidos no processo.

Made available in DSpace on 2014-12-17T14:13:21Z (GMT). No. of bitstreams: 1 MaisaPR.pdf: 2067639 bytes, checksum: 1a2a3fa9e8d9a7a58ce31eb1fae8d975 (MD5) Previous issue date: 2007-12-18 / The aim of this study was to learn about the social representations of the care provided by the Family Health Program (FHP) in the city of Natal, Brazil and determine how these representations guide the daily actions of doctors, dentists, nurses, nurse s assistants and oral health assistants during the work process. In this sense, we used the theoreticalmethodological approach to the Theory of Social Representations. For data collection, we used the following instruments: a two-part questionnaire, where the first part recorded sociodemographic data and the second part was adapted to the free word association technique (FWAT), which was applied to 90 professionals belonging to 18 FHP units. Interviews were also used as collection instruments. These were based on inductive stimuli and on direct observations of 30 of these professionals. After a superficial reading of the material, we constructed a corpus from which ten categories emerged. To analyze FWAT we used lexicographic analysis, combining frequency and the mean order of responses. The interviews and sociodemographic variables were analyzed using content analysis and descriptive statistical analysis, respectively. The study showed that the central nucleus of the social representation in question is composed of the elements attention, receptivity and love, revealing that the subjects have different understandings of the FHP care process and that the knowledge accumulated in this respect is supported by an approximate vision of the meaning of care. However, traditional elements with trivializing connotations about care predominate, which compromises the development of strategies to overcome traditional practices. In the set of analyses, we were able to capture the invariance of a contradiction: on one hand, professionals know and affirm the importance of providing care for FHP patients; on the other, the experience of daily practice translates into the negation of this concept. In this contradictory context, professionals build gradual and successive syntheses that allow them to act and affirm themselves by associating information from their academic formation, structured knowledge acquired in other experiences, values and symbols of their daily routine. Thus, they shape and reshape themselves, according to what is concretely and specifically required, at the same time both plural and multiple. The composition of the central nucleus indicates that any measure that intends to modify attitudes that is, the daily actions of FHP professionals with respect to care must take into account and give priority to the debate about the redefining of the semantic fields of the central nucleus (love/attention/receptivity and humanization), especially those of love and attention / Este estudo teve por objetivo apeender as Representa??es Sociais do cuidado das equipes do Programa Sa?de da Fam?lia (PSF) da cidade do Natal-RN e como essas representa??es orientam as a??es cotidianas desses sujeitos (m?dicos, dentistas, enfermeiros, auxiliares de enfermagem e auxiliares de sa?de bucal) durante o processo de trabalho. Nesse sentido, utilizamos como abordagem te?rica-metodol?gica a Teoria das Representa??es Sociais. Para a coleta de dados, lan?amos m?o dos seguintes instrumentos: um question?rio que na sua primeira parte destinava-se ? coleta dos dados sociodemogr?ficos e na segunda parte adaptado ? t?cnica de associa??o livre de palavras (TALP) que foi aplicado junto a 90 profissionais que comp?em as equipes em 18 unidades do PSF. Ainda como instrumentos de coleta foram realizadas entrevistas, a partir de est?mulos indutores, e tamb?m as observa??es diretas junto a 30 destes profissionais. Ap?s uma leitura flutuante do material, foi constitu?do um corpus para a an?lise do qual emergiram dez categorias. Para analisar a TALP utilizamos a an?lise lexicogr?fica combinando a freq??ncia e a ordem m?dia de evoca??es. As entrevistas e as vari?veis s?ciodemogr?ficas foram analisadas respectivamente a partir da an?lise de conte?do e da an?lise estat?stica descritiva. O estudo mostrou que o n?cleo central da representa??o social em quest?o est? composto pelos elementos aten??o, acolhimento e amor, revelando que os sujeitos apresentam diferentes entendimentos sobre o processo do cuidado no PSF e que o conhecimento constru?do a esse respeito est? amparado numa vis?o aproximada do sentido do cuidar. Entretanto, predominam elementos tradicionais e com conota??es banalizadas sobre o cuidado, o que dificulta o desenvolvimento de estrat?gias de supera??o das pr?ticas tradicionais. No conjunto das an?lises, foi-nos poss?vel captar a invari?ncia de uma contradi??o: de um lado, os profissionais sabem e afirmam a import?ncia da produ??o do cuidado junto aos usu?rios do PSF; de outro, a viv?ncia, na pr?tica cotidiana, traduz a nega??o desse fazer-cuidado. Nesse contexto contradit?rio, o profissional passa a construir s?nteses gradativas e sucessivas que lhe permitem agir e afirmar-se associando informa??es advindas da forma??o, de conhecimentos estruturados em outras experi?ncias, valores e s?mbolos demarcadores de seu cotidiano. Assim, ele se configura e xvi reconfigura na pr?tica, segundo o que ? exigido no seu fazer concreto e espec?fico, ao mesmo tempo em que plural e m?ltiplo. A composi??o do n?cleo central indica que qualquer curso ou capacita??o que pretenda modificar atitudes - portanto a a??o cotidiana dos profissionais do PSF relativas ao cuidado - deve levar em conta e priorizar o debate sobre a ressignifica??o dos campos sem?nticos do n?cleo central (amor/aten??o/acolhimento e humaniza??o), especialmente dos elementos aten??o e amor

Made available in DSpace on 2014-12-17T14:19:52Z (GMT). No. of bitstreams: 1 AnaLS.pdf: 754560 bytes, checksum: 4352ce162cb36ae915a586c0706ec693 (MD5) Previous issue date: 2009-11-30 / We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Servi?o Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed / Estuda-se a aten??o ? sa?de centrada no cuidar, em uma rela??o intercessora e dial?gica com o usu?rio, que envolve a constru??o de projetos terap?uticos essenciais para a qualidade do tratamento do usu?rio nos servi?os de sa?de, sendo fundamentais a??es individuais e coletivas. Tem-se como objetivo conhecer e analisar a percep??o dos sujeitos sociais, usu?rios e profissionais, sobre o tratamento dispensado ao usu?rio de um Servi?o Ambulatorial Especializado em DST/HIV/Aids, refer?ncia estadual em Natal, RN. Articulam-se, em uma vis?o transdisciplinar da ci?ncia e do conhecimento, referenciais te?rico-metodol?gicos que possam dar sentido ? express?o das caracter?sticas institucionais da aten??o e do cuidado em sa?de, religando-as ao contexto social. Como estrat?gia de pesquisa, buscam-se as express?es dos 56 sujeitos sociais da investiga??o, que aceitaram participar da amostra, a partir de uma cartografia simb?lica da aten??o, associada a t?cnicas de observa??o e entrevista semi-estruturada. Para an?lise dos resultados, estabeleceram-se cinco categorias de an?lise: significado do servi?o, percep??o do atendimento; processo de comunica??o e intera??o; percep??o do tratamento e organiza??o e avalia??o do servi?o. Discute-se que a aten??o e o cuidado desenvolvem-se em uma assist?ncia tecno-assistencial ? doen?a, centrados em uma aten??o focada no tratamento, na solicita??o de exames e na terap?utica medicamentosa dos anti-retrovirais, reflexo do paradigma tradicional biom?dico de aten??o ? doen?a. Este tamb?m ? o modo de organiza??o das a??es pr?ticas no cotidiano do SAE: a conduta terap?utica mostra-se fragmentada nas diversas especialidades, verticalizada e retro-alimentada no mesmo modelo, gerando tens?o e sobrecarga aos profissionais; evidenciam-se atendimentos impessoais focados em tecnologias estruturadas e informativas, desvinculadas da dial?gica interativa. A partir dos discursos dos sujeitos, o SAE ? interpretado como o lugar do confronto com a doen?a, mas tamb?m possibilita maiores elabora??es do adoecer pelo encontro com os iguais. Conviver com o HIV e Aids ? conviver com receios, apreens?o e medo, mas principalmente com o estigma, o preconceito e a exclus?o, o que requer o sigilo da doen?a. H? circula??o de for?as e de poder, expressos no saber-poder t?cnico-profissional e administrativo, dispositivos que concentram a manuten??o da medicaliza??o do atendimento, consultas r?pidas e com pouca aten??o, o que dificulta a intera??o e a escuta, aliados a falhas estruturais, organizacionais e a um gerenciamento inadequado do servi?o. Conclui-se que h? dimens?es n?o consideradas na din?mica interna das m?ltiplas formas do cuidar, caracterizado pelo modelo conflitante da aten??o, marcado por interven??es individuais relacionadas ? doen?a. Desconsidera-se o sujeito de seu discurso, imputando-lhe discursos tecnicistas, e observa-se a produ??o do cuidado baseada na tecnologia material