Made available in DSpace on 2014-12-17T15:40:38Z (GMT). No. of bitstreams: 1 RenataMV_TESE.pdf: 1551134 bytes, checksum: 5241bc9c940147eb3212cc19ebdea324 (MD5) Previous issue date: 2010-02-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema ?nico de Sa?de SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs / O Programa Canguru foi implantado no Brasil em 2000 atrav?s de uma pol?tica p?blica do Sistema ?nico de Sa?de (SUS), sustentado sob a ret?rica da humaniza??o dos servi?os de sa?de. Este programa adota a pr?tica de colocar o beb? prematuro e/ou de baixo peso em contato pele a pele com sua m?e com o intuito de fortalecer o v?nculo afetivo entre m?e e beb?, incentivar o aleitamento materno e promover maior seguran?a nos cuidados com seu filho. As m?es usu?rias do SUS s?o, dessa forma, solicitadas a residirem na maternidade, participando dos cuidados com o beb?, at? sua alta. No entanto, constatou-se, em observa??es pr?vias, que a participa??o no Programa Canguru tem sido geralmente uma imposi??o para essas usu?rias. Assim sendo, procurou-se interpretar os textos que permeiam o desenvolvimento da pr?tica Canguru. Essa pesquisa foi realizada atrav?s de dois estudos: 1) explora??o hist?rica do conceito de maternidade e an?lise de como a maternidade ? apresentada no m?dulo do documento oficial que orienta o programa; 2) an?lise da din?mica institucional que permeia o Programa Canguru, enfatizando o estudo acerca do processo de trabalho dos profissionais da sa?de e a compreens?o da percep??o das usu?rias sobre sua estadia na maternidade e sobre a din?mica de atendimento. Destaca-se que a rela??o entre esses dois estudos permitiu a compreens?o da forma que os discursos podem influenciar o comportamento dos profissionais de sa?de e que implica??es os discursos destes t?m na pr?tica cotidiana do atendimento em sa?de. A pesquisa, fundamentada na metodologia da Etnografia Institucional, considera as pr?ticas e experi?ncias como socialmente organizadas, procurando entend?-las na sua din?mica e interdepend?ncias. A perspectiva adotada para a an?lise documental, como tamb?m para o estudo dos dados qualitativos constru?dos na pesquisa emp?rica, foi a an?lise do discurso. A pesquisa mostrou que embora o Programa Canguru venha demonstrando resultados positivos, tanto em rela??o ? economia de recursos quanto aos aspectos psicol?gicos e biol?gicos do beb?, por outro lado ele falha em considerar a complexidade social, econ?mica e cultural das m?es e as limita??es estruturais do sistema de sa?de p?blica. O documento oficial deste programa apoia-se na racionalidade m?dica e econ?mica, cuja concep??o centra-se no modelo biom?dico hegem?nico e nas condi??es de vida e estrutura??o de fam?lia de uma popula??o que n?o ? usu?ria do Sistema ?nico de Sa?de. Essa disson?ncia dificulta o sucesso do programa, uma vez que suas a??es s?o planejadas e criadas sem considera??o ?s condi??es de vida e experi?ncias das pessoas que fazem uso desse servi?o. Com rela??o ? din?mica institucional, observou-se que, embora alguns profissionais se diferenciem no tratamento com as usu?rias, a maioria deles desconsidera o papel ativo da m?e nesse m?todo de interven??o. Por outro lado, a pesquisa mostrou que as m?es veem o programa como uma obriga??o e n?o uma op??o que implique em momentos prazerosos no ambiente hospitalar. Ressalta-se, assim, que a implanta??o deste programa requer n?o s? a presen?a e o treinamento para o bom atendimento da equipe de funcion?rios, como tamb?m deve ser levado em considera??o a complexa rede de determinantes sociais da sa?de que podem influenciar na participa??o das m?es no programa. Discutir e problematizar o cotidiano de programas como esse se constitui, dessa forma, um exerc?cio de reflex?o sobre cidadania e governan?a, permitindo espa?os para a melhoria dos programas de sa?de p?blica

Made available in DSpace on 2014-12-17T15:38:32Z (GMT). No. of bitstreams: 1 LucianaFM_TESE.pdf: 854964 bytes, checksum: 132a69f66769754a3d044805d52a783c (MD5) Previous issue date: 2010-06-07 / The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter / A aten??o b?sica e uma de suas principais estrat?gias, a Estrat?gia Sa?de da Fam?lia (ESF), se configuram como a porta de entrada para o Sistema ?nico de Sa?de (SUS). Dessa maneira, boa parte dos problemas de sa?de incidentes e prevalentes na popula??o dscrita deve ser resolvida nesse n?vel de aten??o, incluindo o sofrimento psicol?gico e a denominada queixa de nervoso. Nervos e nervoso denotam uma complexidade que nem sempre ? bem compreendida pelos trabalhadores de sa?de, de maneira que o cuidado a esse tipo de problema geralmente ? inadequado. O objetivo geral desse trabalho ? analisar a rede de discursos e de cuidados no atendimento ao sofrimento psicol?gico que se expressa como nervos, no cotidiano da aten??o b?sica do SUS. Mais especificamente, identificar os princ?pios e diretrizes da aten??o b?sica em sa?de mental; investigar o posicionamento dos trabalhadores de sa?de diante do sofrimento psicol?gico e das queixas de nervos, e analisar as diferentes a??es e pr?ticas de cuidado realizados nas diferentes Unidades de Sa?de diante de queixas como nervos. A perspectiva te?rico-metodol?gica adotada no trabalho foi a Etnografia Institucional. Essa abordagem busca compreender e analisar as rela??es institucionais em determinado contexto considerando as influ?ncias socioestruturais e as rela??es de poder, bem como as pr?ticas e os discursos cotidianos. Foram realizadas entrevistas com trabalhadores de sa?de, conversas informais e observa??es em seis Unidades de Sa?de com equipes da ESF de diferentes distritos sanit?rios do munic?pio de Natal/RN. Constatou-se o alto ?ndice de queixas de nervos, sendo que o encaminhamento a psic?logos e psiquiatras e a prescri??o de psicotr?picos s?o a forma mais comum de interven??o. Em geral, h? uma falta de conhecimento especializado sobre o tema da sa?de mental, bem como aus?ncia de discuss?es sobre as pol?ticas de sa?de mental. De um lado, as condi??es de trabalho e a falta de apoio institucional dificultam a realiza??o de a??es de preven??o de doen?as e promo??o ? sa?de. Por outro, h? diferentes pr?ticas em andamento tais como reuni?es de hipertensos e idosos, caminhadas, visitas, rodas de conversas e terapia comunit?ria embora nem todas visem o cuidado espec?fico ao sofrimento psicol?gico. O apoio matricial, estrat?gia metodol?gica de supervis?o e acompanhamento de casos de sa?de mental, vem sendo implantado por psic?logos em algumas Unidades de Sa?de do munic?pio, por?m ainda n?o est? totalmente implantado na rede. As pr?ticas de cuidado aos problemas de nervos dependem principalmente do envolvimento do trabalhador com as diretrizes da ESF e das pol?ticas de sa?de mental, al?m do apoio sistem?tico, quando dispon?vel, de outro profissional que funciona como apoiador matricial

Made available in DSpace on 2014-12-17T15:40:38Z (GMT). No. of bitstreams: 1 FatimaRRM_TESE.pdf: 870071 bytes, checksum: 0013fd8d1569e1ed87bf96b26d2cfa3f (MD5) Previous issue date: 2010-02-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The practice of medicine related to the gestational processes tend to be organized according to the context and the place of work, being thus dependent of the conditions both social and economical, and of the physical structure and the functionality of the services. The high mortality rate in this process has diminished, since 1986, the study made by the World Health Organization (WHO) as to the technical aspects and the social inequalities that influence this situation in different geographical contexts. This culminated recommendations that proposed the reorientation of the dynamical practice of medicine, with a focus on the safety of maternities. Brazil adopted, in the year 2000, the suggestions of the OMS, emphasizing the humanization as the main reason for these actions. However, this discussion tends to not consider the problems caused by the social inequalities and the epidemiological and social conditionings that define the actions of the Unified Health System (Sistema ?nico de Sa?de SUS). In this area, this research seeks to analyze the practices, cares taken, and the universal symbol that promotes and rewards the assistance to the birth of children by the SUS. Besides the analysis of the public documents that deal with this subject, an ethnographic study was developed in a maternity in Natal/RN, considered a model of humanization after receiving the Galba de Ara?jo prize in 2002. In this stage, the methodological strategies were observed, and the focus of the individual interviews with workers and users of this service. In the analysis of the data, it became evident that the different professional workers and women who gave birth, tend to show concern of the standards the delimit production and reproduction of the practice of medicine, as they favor the absence of a critical posture of the actions destined to the population. Besides this, if became evident that the institutional difficulties associated to the economical, cultural, and political problems also difficult the involvement and the reflection of the workers in favor of assisting changes of the process. There is also a utilization of a perspective prescriptive of humanization in the everyday life of the social workers, without reflection of its meaning. Some workers present, in their statements, a preoccupation with the social and economical aspects that affect the practice of medicine, and with the limitations of the humanization discourse that disarticulates the necessities of those involved in the process of formation, and soon tend to return to the discussion of humanization while a kind practice characterized by the minimization of the interventionist actions. Now the users of the system show themselves before the dynamic of the services, submitting themselves to what is offered while assistance, without questioning and/or reflecting about their usual shortages. Therefore, to think of changes in the know and do of the practice of medicine destined to the birth of children implies reflection on the quotidian production of these practices and of the social contexts that influence the process of assistance in the practice of medicine. Herein it would be possible to predict the appropriation, by different workers concerning their exasperations and necessities, making them active in the pursuit of their rights as citizens / As pr?ticas em sa?de relacionadas ao processo gestacional tendem a se organizar de acordo com o contexto e os espa?os assistenciais, os quais s?o dependentes das condi??es socioecon?micas e da estrutura f?sica e funcional dos servi?os. A elevada morbimortalidade nesse processo desencadeou, desde 1986, a reflex?o pela Organiza??o Mundial de Sa?de (OMS) quanto aos aspectos t?cnicos e ?s iniquidades sociais que influenciam essa situa??o em diferentes contextos, culminando nas recomenda??es que propunham a reorienta??o da din?mica assistencial com foco na maternidade segura. O Brasil adota, no ano 2000, as sugest?es da OMS, enfatizando a humaniza??o como eixo orientador das a??es. Contudo, essa discuss?o tende a desconsiderar os problemas das iniquidades locais e os condicionantes epidemiol?gicos e sociais que definem as a??es no Sistema ?nico de Sa?de (SUS). Nesse sentido, esta pesquisa objetivou analisar as pr?ticas discursivas nas a??es de trabalhadores e usu?rias da Maternidade de Felipe Camar?o em face da organiza??o do cuidado na perspectiva da humaniza??o do parto e do nascimento no contexto institucional de uma maternidade p?blica. Ent?o, al?m da an?lise dos documentos p?blicos que lidam com essa tem?tica, foi desenvolvido um estudo etnogr?fico em uma maternidade em Natal (RN), considerada modelo para a humaniza??o ap?s ter recebido o pr?mio Galba de Ara?jo, em 2002. Nessa etapa, as estrat?gias metodol?gicas foram a observa??o participante, o grupo focal e a pr?tica da entrevista individual com trabalhadores e usu?rias do servi?o. Na an?lise dos dados, evidenciou-se que os diferentes atores, os profissionais e as mulheres em parturi??o, tendem a mostrarem-se alheios aos contextos que delimitam a produ??o e reprodu??o das pr?ticas em sa?de, o que favorece a aus?ncia de uma postura cr?tica diante das a??es destinadas ? popula??o. Al?m disso, ficou evidente que as dificuldades institucionais, associadas ?s quest?es econ?micas, culturais, pol?ticas e de gest?o, tamb?m dificultam o envolvimento e a reflex?o dos trabalhadores em favor de mudan?as assistenciais para o processo. H? tamb?m a utiliza??o de uma perspectiva prescritiva da humaniza??o no fazer cotidiano desses atores sociais, sem uma reflex?o cr?tica acerca do seu significado. Alguns trabalhadores apresentam em seus posicionamentos uma preocupa??o com os aspectos sociais e econ?micos que afetam as pr?ticas em sa?de e com as limita??es do discurso humanizador, que desarticula as necessidades dos envolvidos nesse contexto. Todavia, possivelmente por quest?es culturais e relacionadas ao processo de forma??o, logo tendem a retornar ao discurso da humaniza??o enquanto pr?tica caridosa caracterizada pela minimiza??o das a??es intervencionistas. J? as usu?rias mostram-se passivas diante da din?mica dos servi?os, submetendo-se ao que lhes ? oferecido enquanto assist?ncia, sem questionar e/ou refletir acerca das suas car?ncias usuais. Assim, pensar em mudan?as no saber/fazer em sa?de destinadas ao parto e ao nascimento implica refletir a produ??o cotidiana dessas pr?ticas e os contextos sociais que influenciam o processo assistencial em sa?de. Dessa forma, seria poss?vel antever a apropria??o, pelos diferentes atores, dos seus anseios e necessidades, fazendo-os ativos na busca pelos seus direitos de cidadania

Made available in DSpace on 2014-12-17T15:40:36Z (GMT). No. of bitstreams: 1 VeronicaSP_tese.pdf: 577201 bytes, checksum: e41ce8fd26195606f8650fbf1d39f279 (MD5) Previous issue date: 2007-09-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The proposal of the Unified Health System Policy (SUS) has been considered one of the most democratic public policies in Brazil. In spite of this, its implementation in a context of social inequalities has demanded significant efforts. From a socio-constructionist perspective on social psychology, the study focused on the National Policy for Permanent Education in Health for the Unified Health System (SUS), launched by the Brazilian government in 2004, as an additional effort to improve practices and accomplish the effective implementation of the principles and guidelines of the Policy. Considering the process of permanent interdependencies between these propositions and the socio-political and cultural context, the study aimed to identify the discursive constructions articulated in the National Policy for Permanent Education in Health for the Unified Health System (SUS) and how they fit into the existing power relations of ongoing Brazilian socio-political context. Subject positionings and action orientation offered to different social actors by these discursive constructions and the kind of practices allowed were also explored, as well as the implementation of the proposal in Rio Grande do Norte state and how this process was perceived by the people involved. The information produced by documental analyses, participant observation and interviews was analyzed as proposed by Institutional Ethnography. It evidenced the inter-relations between the practices of different social actors, the conditions available for those practices and the interests and power relations involved. Discontinuities on public policies in Brazil and the tendency to prioritize institutional and personal interests, in detriment of collective processes of social transformation, were some of obstacles highlighted by participants. The hegemony of the medical model and the individualistic and curative intervention practices that the model elicits were also emphasized as one of the drawbacks of the ongoing system. Facing these challenges, reflexivity and dialogism appear as strategies for a transformative action, making possible the denaturalization of ongoing practices, as well as the values and tenets supporting them / Uma das mais significativas propostas de democratiza??o no campo das pol?ticas p?blicas no Brasil, o Sistema ?nico de Sa?de (SUS) vem demandando grandes esfor?os visando sua efetiva implementa??o, em um contexto de gritantes desigualdades sociais. Adotando o referencial da psicologia social de orienta??o s?cio-construcionista, o estudo enfocou a Pol?tica de Educa??o e Desenvolvimento para o SUS, oficializada em 2004, como mais uma tentativa de mudan?a das pr?ticas setoriais para efetiva??o dos princ?pios e diretrizes do SUS. Considerando as interdepend?ncias entre as referidas proposi??es e o contexto s?cio-pol?tico e cultural, o estudo objetivou identificar as constru??es discursivas pr?prias da Pol?tica de Educa??o e Desenvolvimento para o SUS, considerando as posi??es de sujeito e as possibilidades de a??o que ela oferece e o tipo de pr?ticas que as constru??es discursivas promovem, no confronto com o cotidiano dos servi?os de sa?de. A implementa??o dessa proposta de transforma??o no Estado do Rio Grande do Norte e a forma como est?o sendo percebidas pelas pessoas envolvidas, foram tamb?m estudadas em profundidade. A an?lise das informa??es, geradas atrav?s de consulta documental, observa??o participante e entrevistas, desvelou as inter-rela??es entre as pr?ticas dos diversos atores, as condi??es de exerc?cio das mesmas e os interesses e rela??es de poder, locais e translocais, em jogo, segundo a proposta metodol?gica da Etnografia Institucional. A descontinuidade das pol?ticas p?blicas no Brasil, a prioriza??o de interesses institucionais e pessoais, em detrimento dos processos de constru??o coletiva de pr?ticas transformadoras, al?m da desresponsabiliza??o dos envolvidos com a efetiva??o das propostas, foram alguns dos entraves evidenciados. A hegemonia do modelo biom?dico no conjunto da sociedade, e as pr?ticas individuais e curativas dele derivadas foram criticadas de forma contundente. A reflexividade e o dialogismo emergiram como estrat?gias para uma a??o transformadora, propiciando a desnaturaliza??o das pr?ticas vigentes e dos valores e pressupostos que as sustentam