Thesis (M.S.P.H.)--University of Michigan, 1936.

The dominant political ideology emphasises the patient as a consumer and partner in health care. Correspondingly, the move towards patient-centred nursing, based on the principles of humanism and individualism, emphasise the central role patients' should play in the nurse-patient encounter. Additionally, changing social and demographic trends highlight the importance of medication as a health care issue. Thus, current health care policy and practice contexts highlight the importance of patients' participation in health care as consumers and partners and, nurses' ability to make an effective contribution to educating patients about medication as part of their role in health education and promotion. However, despite the significance of this context, little is known about the extent and manner of patient participation, or the contribution that nurses make to this important health promotion activity. Therefore the purpose of this study is to extend knowledge in this area by describing and explaining patient participation in medication interactions, as it occurs within the reality of the clinical context. In order to study patient participation in medication interactions in the reality of the clinical context, a case study approach was adopted. Three case sites were sampled and included: 1) an acute medical ward, 2) a community hospital rehabilitation unit, and 3) a community mental health service. Data collection methods employed to explore and describe patient participation in medication interactions included: non-participant observation, audio-recording of nurse-patient interactions, nurse interviews, patient interviews, reflective field notes, focus groups and documentation. The data analysis framework included the use of conversation analysis for nurse-patient interaction data and content analysis for other qualitative data. The findings indicate that patient participation can be understood at least in part by the communicative practices and choices that nurse and patients/clients make. More specifically a range of conversational strategies were employed by nurses to initiate and control conversations and by doing so inhibited patients' participation. However a comparison of findings across sites indicates that there were both differences and similarities in the extent to which nurses facilitated and inhibited patient participation. A number of influencing factors were identified that helped to explain these findings. These include: power, nurses' communicative style, knowledge, skills and experience, patients' age, acuity of illness and level of knowledge, and the organisation and philosophy of care. The findings from the study make a unique contribution to the body of knowledge in a number of ways. First, as the only study to describe patient participation in medication interactions between nurses and patients, it identifies that participation can occur at an interactional level, as well as a more practical level via, for example, the potential to self medicate and independently manage medications. Related to this, it has also contributed to the conceptual clarity and development of the concept of patient participation. This study has highlighted that patient participation may be realised and understood more fundamentally, at the level of the nurse-patient interaction, in contrast to previous research that conceptualises participation as making choices and involvement in decisionmaking. Furthermore, by the successful use of conversation analysis, this study has also advanced knowledge about potential ways to investigate patient participation at the level of nurse-patient discourse. Finally, this study provides a contribution to advancing theoretical explanations of patient participation through the construction of a framework of explanatory factors influencing patient participation. A framework for enabling participation has been developed based on the specific conclusions and principles for action drawn from the findings and from the philosophy of Freire (1972; 1983), which acknowledges an individual's potential to be empowered and assume control. The framework proposes that addressing attitudinal, interactional, relational, educational and contextual issues, might facilitate patient participation. Implications and recommendations reflect the practice and education requirements needed to implement such a framework.

The aim of this research was to examine nurses' and health care assistants' perspectives of infection control practice on one hospital ward and use this as the basis for the development, implementation and evaluation of an education and support programme for improving practice on the ward. In Phase I of the study, nurses and health care assistants were interviewed using a semistructured interview schedule to explore their views and anxieties about infection control practice and identify their priorities for practice development. Qualitative and quantitative analysis of these data revealed that respondents' concerns related primarily to the use of Contact Precautions for patients with Clostridium difficile associated diarrhoea (CDAD) and Methicillin resistant Staphylococcus aureus (MRS A). Structured observations of practice were employed to confirm the prevalence of the issues raised in relation to this and provide an understanding of their context. The findings of Phase I informed the design of an intervention to improve practice. This involved the development of a practice guideline on Contact Precautions and the availability of practical instruction and support during its implementation. In Phase II of the study, participant observations of practice were conducted to gain an understanding of nurses' and health care assistants' behaviour and in particular, their responses to the supportive intervention. Their perceptions of its impact on their practice were ascertained in Phase III using semi-structured interviews. Qualitative analysis of these data revealed that participants experienced great difficulty understanding and implementing infection control recommendations. Factors that may help explain this include nurses' and health care assistants' knowledge and skills in infection control, their personal belief systems and self-preservation instincts. In addition, the recommendation to use Contact Precautions for patients with infectious conditions such as CDAD and MRS A may itself counteract attempts to promote the routine use of infection control precautions in clinical practice. It is suggested that in relation to infection control, there may be a need to radically re-think the ways in which health care workers are educated and supported in practice. Moreover, it is argued that until the ambivalent evidence base relating to the use of Contact Precautions is resolved, messages about infection control are likely to generate confusion amongst health care workers.

No description available.

Esta pesquisa tomou como objeto de estudo as necessidades de aperfeiçoamento de enfermeiros que trabalham em Unidades de Saúde do Programa Saúde da Família PSF, tendo como enfoque o preparo destes profissionais para a execução da sua prática junto às famílias atendidas nessas unidades. Objetiva identificar o perfil sócio-demográfico das enfermeiras de Unidades de Saúde onde estava implantado o PSF, da Direção Regional de Saúde DIR XXIV, na região de Taubaté /SP, caracterizar suas práticas e identificar e analisar as necessidades de aperfeiçoamento destas no atendimento á estas famílias.Trata-se de um estudo descritivo, desenvolvido no município de Pindamonhangaba/SP, que utilizou um instrumento semi estruturado para a coleta das informações que, posteriormente, foram submetidas ao procedimento de análise de conteúdo de Bardin. A análise dos resultados aponta para duas categorias centrais: o saber e o fazer, observando-se a presença de uma rede complexa entre essas categorias, resultante do trabalho desenvolvido por estas enfermeiras. As considerações, ao final da pesquisa, indicam a insuficiência na formação acadêmica do enfermeiro em subsidiar o atendimento ás famílias, e que os cursos de aperfeiçoamento realizados não estão, muitas vezes, em sintonia com a práxis do enfermeiro na abordagem ás famílias. Reconhecem a importância da intervenção da enfermeira enquanto uma prática social na saúde e, evidenciam necessidades de aperfeiçoamento da enfermeira para atenderem a essa prática. / This research had as study object the necessity of improvement the nurses/male nurses who work in the Family Health Program (FHP) had; and its focus was on the training these professionals received to work with the families registered at these units. Characterizing the nurses - socio-demographic profile at the Health Units where the Family Health Program had been implemented, at the Regional Health Management - DIR XXIV, Taubaté region - SP, and identifying as well as analyzing their need for improvement in attending these families were the objectives of this study. It is a descriptive study developed in Pindamonhangaba town - SP, which used a semi-structured instrument to collect the information that was, later, submitted to Bardin’s content analysis procedure. The analysis of the results points out two main categories: the knowing and the doing, and between the two of them, a complex net was observed, resulting from the work developed by these nurses. The considerations, at the end of the research, reveal an insufficiency in the nurse/male nurse’s academic studies in subsidizing their caring for families; and in many cases, the improvement courses attended by the nurses/male nurses don’t correspond to their praxis in dealing with families. The considerations acknowledge the importance of the nurses intervention as a social practice concerning health, and make the nurses need for improvement evident in order to attend to that practice.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo tem como temática a espiritualidade de pessoas que vivem com HIV/Aids e como objetivo geral analisar as expressões da espiritualidade de pessoas que vivem com HIV/Aids no contexto das construções representacionais acerca da própria síndrome, com vistas à proposição de uma reflexão acerca do cuidado de enfermagem como uma tecnologia que pode estimular esta dimensão humana. Trata-se de uma pesquisa qualitativa, descritiva e exploratória, baseada nas abordagens processual e estrutural da Teoria das Representações Sociais. Quanto à metodologia, possui duas etapas: na primeira, participaram 30 pessoas com HIV/Aids em atendimento ambulatorial de um Hospital Municipal do Rio de Janeiro. Os dados foram coletados através de entrevistas semi-estruturadas e analisados através da análise de conteúdo de Bardin. Na segunda, participaram 100 pessoas atendidas no hospital supracitado. Os dados foram coletados através da técnica de evocações livres e analisados a partir do software EVOC. A partir da análise das entrevistas, emergiram cinco categorias denominadas: do sofrimento à dificuldade de encontrar sentido diante do diagnóstico; dando a volta por cima: o encontro de sentidos; da dificuldade de adesão ao tratamento à esperança de cura; os relacionamentos como forma de expressão da espiritualidade; e a presença da religiosidade no viver com HIV/Aids. Percebe-se que a descoberta diagnóstica é marcada por intenso e inevitável sofrimento, relacionado principalmente à representação social da Aids ligada à morte e à discriminação. Por outro lado, após o impacto do diagnóstico positivo, os participantes encontram um sentido para a vida, passando a ressignificá-la. A dificuldade de adesão é vista como uma vivência prejudicada da espiritualidade. Ressalta-se a esperança na cura, divina ou não-divina e há expressões de espiritualidade nos relacionamentos consigo mesmo, com o outro e com o divino. A religiosidade também se faz presente no viver com HIV/Aids principalmente para explicar a origem da Aids no mundo. Quanto à estrutura representacional da Aids, foram analisadas, comparativamente, as evocações do grupo geral, e as relacionadas ao sexo e à religião dos participantes. O possível núcleo central do grupo geral é composto pelas palavras medo, morte, tristeza e vida, elementos afetivos que também foram identificados nas entrevistas. A estrutura representacional do sexo feminino se sobrepõe a do grupo geral, diferindo-se da dos homens, que assume um caráter mais racional. Conclui-se que o sofrimento relacionado ao impacto do diagnóstico pode levar à dificuldade de encontrar sentido para a vida e, portanto, de vivenciar a espiritualidade. Ainda assim, esta dificuldade passa a ser substituída, com o tempo, por um encontro de sentido para se viver, levando a uma ressignificação da vida. A estrutura representacional permitiu a visualização de como os elementos relacionados à espiritualidade se organizam. Observa-se um processo de transformação das representações sociais da síndrome, que coincide com a presença da espiritualidade. Destaca-se o papel do enfermeiro na promoção do cuidado espiritual à pessoa com HIV/Aids. / This study has as its theme the spirituality of people living with HIV/Aids and its general aim is to analyze the expressions of spirituality of people living with HIV/Aids in the context of representational constructions on the syndrome, aiming to generate the proposal of a reflection on the nursing care as a technology which can stimulate this human dimension. This is a qualitative, descriptive, and exploratory research based on the processual and structural approaches from the Social Representations Theory. With regard to methodology, it has two stages: in the first, thirty people with HIV/Aids undergoing ambulatory treatment at a municipal hospital in Rio de Janeiro city, Brazil, participated. The data were collected through semi-structured interviews and analyzed through Bardin's content analysis. In the second, one hundred people treated in the hospital concerned participated. The data were collected through the free evocations technique and analyzed using the software EVOC. All data were collected on 2009. From analyzing the interviews, five categories emerged, which were named as: from suffering to the difficulty to make sense of the diagnosis; getting over it: making senses; from the difficulty in treatment adherence to the hope of cure; the relationships as a spirituality expression; and the presence of religiosity in the living with HIV/Aids. One realizes that the diagnostic finding is marked by an intense and inevitable suffering, mainly related to the social representation of aids, which is linked to death and discrimination. In the other hand, after the impact of the positive diagnosis, the participants find a sense to life, beginning to re-signify it. The difficulty of adherence is seen as a compromised experience of spirituality. The hope for cure is highlighted, divine or non-divine, and there are expressions of spirituality in the relationships with oneself, the other, and the divine. Religiosity is present in the living with HIV/Aids, especially for explaining the origin of aids in the world. With regard to the representational structure of aids, the evocations from the general group and those related to the participants' gender and religion underwent a comparative analysis. The possible central nucleus of the general group consists of the words fear, death, sadness, and life, affective elements which were identified in the interviews. The representational structure of the female gender overlaps that of the general group and differs from that of men, which assumes a more rational character. One concludes that the suffering to the impact of the diagnosis can lead to the difficulty to find a sense to life and, therefore, to experience spirituality. Even so, as time passes by, this difficulty begins to be replaced by another sense to life, leading to its re-signifying. The representational structure allowed the visualization of how the spirituality elements are organized. One observes a process of transformation of the representations of the syndrome, which coincides with the presence of spirituality. The role of the nurse for the promotion of spiritual is also stressed.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo tem como temática a espiritualidade de pessoas que vivem com HIV/Aids e como objetivo geral analisar as expressões da espiritualidade de pessoas que vivem com HIV/Aids no contexto das construções representacionais acerca da própria síndrome, com vistas à proposição de uma reflexão acerca do cuidado de enfermagem como uma tecnologia que pode estimular esta dimensão humana. Trata-se de uma pesquisa qualitativa, descritiva e exploratória, baseada nas abordagens processual e estrutural da Teoria das Representações Sociais. Quanto à metodologia, possui duas etapas: na primeira, participaram 30 pessoas com HIV/Aids em atendimento ambulatorial de um Hospital Municipal do Rio de Janeiro. Os dados foram coletados através de entrevistas semi-estruturadas e analisados através da análise de conteúdo de Bardin. Na segunda, participaram 100 pessoas atendidas no hospital supracitado. Os dados foram coletados através da técnica de evocações livres e analisados a partir do software EVOC. A partir da análise das entrevistas, emergiram cinco categorias denominadas: do sofrimento à dificuldade de encontrar sentido diante do diagnóstico; dando a volta por cima: o encontro de sentidos; da dificuldade de adesão ao tratamento à esperança de cura; os relacionamentos como forma de expressão da espiritualidade; e a presença da religiosidade no viver com HIV/Aids. Percebe-se que a descoberta diagnóstica é marcada por intenso e inevitável sofrimento, relacionado principalmente à representação social da Aids ligada à morte e à discriminação. Por outro lado, após o impacto do diagnóstico positivo, os participantes encontram um sentido para a vida, passando a ressignificá-la. A dificuldade de adesão é vista como uma vivência prejudicada da espiritualidade. Ressalta-se a esperança na cura, divina ou não-divina e há expressões de espiritualidade nos relacionamentos consigo mesmo, com o outro e com o divino. A religiosidade também se faz presente no viver com HIV/Aids principalmente para explicar a origem da Aids no mundo. Quanto à estrutura representacional da Aids, foram analisadas, comparativamente, as evocações do grupo geral, e as relacionadas ao sexo e à religião dos participantes. O possível núcleo central do grupo geral é composto pelas palavras medo, morte, tristeza e vida, elementos afetivos que também foram identificados nas entrevistas. A estrutura representacional do sexo feminino se sobrepõe a do grupo geral, diferindo-se da dos homens, que assume um caráter mais racional. Conclui-se que o sofrimento relacionado ao impacto do diagnóstico pode levar à dificuldade de encontrar sentido para a vida e, portanto, de vivenciar a espiritualidade. Ainda assim, esta dificuldade passa a ser substituída, com o tempo, por um encontro de sentido para se viver, levando a uma ressignificação da vida. A estrutura representacional permitiu a visualização de como os elementos relacionados à espiritualidade se organizam. Observa-se um processo de transformação das representações sociais da síndrome, que coincide com a presença da espiritualidade. Destaca-se o papel do enfermeiro na promoção do cuidado espiritual à pessoa com HIV/Aids. / This study has as its theme the spirituality of people living with HIV/Aids and its general aim is to analyze the expressions of spirituality of people living with HIV/Aids in the context of representational constructions on the syndrome, aiming to generate the proposal of a reflection on the nursing care as a technology which can stimulate this human dimension. This is a qualitative, descriptive, and exploratory research based on the processual and structural approaches from the Social Representations Theory. With regard to methodology, it has two stages: in the first, thirty people with HIV/Aids undergoing ambulatory treatment at a municipal hospital in Rio de Janeiro city, Brazil, participated. The data were collected through semi-structured interviews and analyzed through Bardin's content analysis. In the second, one hundred people treated in the hospital concerned participated. The data were collected through the free evocations technique and analyzed using the software EVOC. All data were collected on 2009. From analyzing the interviews, five categories emerged, which were named as: from suffering to the difficulty to make sense of the diagnosis; getting over it: making senses; from the difficulty in treatment adherence to the hope of cure; the relationships as a spirituality expression; and the presence of religiosity in the living with HIV/Aids. One realizes that the diagnostic finding is marked by an intense and inevitable suffering, mainly related to the social representation of aids, which is linked to death and discrimination. In the other hand, after the impact of the positive diagnosis, the participants find a sense to life, beginning to re-signify it. The difficulty of adherence is seen as a compromised experience of spirituality. The hope for cure is highlighted, divine or non-divine, and there are expressions of spirituality in the relationships with oneself, the other, and the divine. Religiosity is present in the living with HIV/Aids, especially for explaining the origin of aids in the world. With regard to the representational structure of aids, the evocations from the general group and those related to the participants' gender and religion underwent a comparative analysis. The possible central nucleus of the general group consists of the words fear, death, sadness, and life, affective elements which were identified in the interviews. The representational structure of the female gender overlaps that of the general group and differs from that of men, which assumes a more rational character. One concludes that the suffering to the impact of the diagnosis can lead to the difficulty to find a sense to life and, therefore, to experience spirituality. Even so, as time passes by, this difficulty begins to be replaced by another sense to life, leading to its re-signifying. The representational structure allowed the visualization of how the spirituality elements are organized. One observes a process of transformation of the representations of the syndrome, which coincides with the presence of spirituality. The role of the nurse for the promotion of spiritual is also stressed.

Esta pesquisa tomou como objeto de estudo as necessidades de aperfeiçoamento de enfermeiros que trabalham em Unidades de Saúde do Programa Saúde da Família PSF, tendo como enfoque o preparo destes profissionais para a execução da sua prática junto às famílias atendidas nessas unidades. Objetiva identificar o perfil sócio-demográfico das enfermeiras de Unidades de Saúde onde estava implantado o PSF, da Direção Regional de Saúde DIR XXIV, na região de Taubaté /SP, caracterizar suas práticas e identificar e analisar as necessidades de aperfeiçoamento destas no atendimento á estas famílias.Trata-se de um estudo descritivo, desenvolvido no município de Pindamonhangaba/SP, que utilizou um instrumento semi estruturado para a coleta das informações que, posteriormente, foram submetidas ao procedimento de análise de conteúdo de Bardin. A análise dos resultados aponta para duas categorias centrais: o saber e o fazer, observando-se a presença de uma rede complexa entre essas categorias, resultante do trabalho desenvolvido por estas enfermeiras. As considerações, ao final da pesquisa, indicam a insuficiência na formação acadêmica do enfermeiro em subsidiar o atendimento ás famílias, e que os cursos de aperfeiçoamento realizados não estão, muitas vezes, em sintonia com a práxis do enfermeiro na abordagem ás famílias. Reconhecem a importância da intervenção da enfermeira enquanto uma prática social na saúde e, evidenciam necessidades de aperfeiçoamento da enfermeira para atenderem a essa prática. / This research had as study object the necessity of improvement the nurses/male nurses who work in the Family Health Program (FHP) had; and its focus was on the training these professionals received to work with the families registered at these units. Characterizing the nurses - socio-demographic profile at the Health Units where the Family Health Program had been implemented, at the Regional Health Management - DIR XXIV, Taubaté region - SP, and identifying as well as analyzing their need for improvement in attending these families were the objectives of this study. It is a descriptive study developed in Pindamonhangaba town - SP, which used a semi-structured instrument to collect the information that was, later, submitted to Bardin’s content analysis procedure. The analysis of the results points out two main categories: the knowing and the doing, and between the two of them, a complex net was observed, resulting from the work developed by these nurses. The considerations, at the end of the research, reveal an insufficiency in the nurse/male nurse’s academic studies in subsidizing their caring for families; and in many cases, the improvement courses attended by the nurses/male nurses don’t correspond to their praxis in dealing with families. The considerations acknowledge the importance of the nurses intervention as a social practice concerning health, and make the nurses need for improvement evident in order to attend to that practice.

Este estudo tomou como objeto as práticas e os saberes que operam nas ações de saúde dos trabalhadores de dois centros de referência em hanseníase de um determinado território do Município de São Paulo. Trata-se de um estudo descritivo, cujo objetivo geral foi caracterizar as ações de saúde que operam na assistência dos agentes em saúde, em serviços de referência à hanseníase. O material empírico foi obtido por um formulário semi-estruturado, no período de agosto a novembro de 2006 e foram entrevistados 11 profissionais, após permitirem sua participação na pesquisa. Para a análise, foram utilizados os procedimentos, segundo a análise de conteúdo de Bardin, que possibilitaram a visualização das seguintes categorias empíricas: práticas de saúde; processo de trabalho em saúde e processo saúde-doença. A análise mostrou que os processos de trabalho, de interação dos trabalhadores nas equipes e o de qualificação dos trabalhadores na área da hanseníase expressam-se de forma homogênea e deficitária entre os estudados. Permitiu também, evidenciar que as práticas de saúde dos trabalhadores dos serviços estudados estão fortemente vinculadas à assistência respaldada no modelo biológico, pois realizam práticas de saúde centradas na atenção individualizada e pautados na multicausalidade do processo saúde-doença. Neste estudo, evidencia-se a necessidade de que as práticas de saúde na área da hanseníase sejam incorporadas a um saber ampliado à intervenção do coletivo que possibilite trazer contribuições para a meta de eliminação da doença e que sejam redefinidos os processos de trabalho, baseados no âmbito da determinação e não só nos resultados do processo saúde-doença / This study has taken as object the practice and knowledge that are performed in the health action of workers in two reference centers of leprosy in a specific area in São Paulo. It’s a descriptive study which has had as main objective the characterization of health action that has been performed in the agent’s assistance in health, in a reference center of leprosy. The empiric material was obtained through the semi-structured form, from August to November 2006 and eleven professionals were interviewed after taking part on this study. To the analysis, the procedures were used according to Bardin content analysis which enabled the visualization of the following empiric categories: health practice; work process in health and health-disease processes. The analysis showed that the work process, the way of worker’s interaction in the groups and their qualification in the leprosy area express a homogenous and deficient way among the people studied. Through the analysis it was evident that the health practice of workers in the studied service are closely related to the repaired assistance in the biological model which perform health practice focused on the individualized attention and centered on the multi-causes of the health-disease process. It is clear in this study, the necessity of these health practices of leprosy to be incorporated an enlarged knowledge into the group intervention in order to bring contributions to the disease removal target and to re-define the work processes based on the ambit of determination and not only on the results of the health-disease process

A enfermagem foi construindo suas práticas entrelaçadas aos modelos de atenção à saúde, aos modos de organização dos serviços e ao processo de trabalho em saúde, este vinculado aos contextos histórico, político, social e de gênero. Na atenção básica de saúde, as enfermeiras construíram e modificaram seu trabalho, ampliando e diversificando suas atividades, de acordo com as transformações exigidas pelos modelos de atenção à saúde. Com a implantação do PSF, em Campinas, mudanças ocorreram no trabalho das enfermeiras nos serviços municipais. Este estudo qualitativo objetivou apreender o trabalho das enfermeiras na rede básica de saúde de Campinas/SP. Os referenciais teóricos foram Gênero e Trabalho, sendo a enfermagem compreendida como um trabalho feminino, subordinado ao trabalho médico, masculino, que mantém e perpetua a divisão social e sexual do trabalho, entre homens e mulheres, refletindo a dicotomia entre o cuidar das enfermeiras e o tratar dos médicos, bem como suas respectivas relações de gênero. Os dados foram as respostas sobre as atividades típicas de um dia de trabalho de 133 enfermeiras assistenciais e as falas transcritas de uma oficina de trabalho realizada com seis enfermeiras, selecionadas entre as enfermeiras assistenciais. Na análise temática, emergiram dois temas: apreendendo o trabalho da enfermagem na atenção básica (com as categorias, a dimensão do cuidado e entendendo o processo de trabalho) e entendendo a enfermagem como um trabalho feminino (com as categorias, a enfermagem como trabalho feminino e as relações de gênero). Os resultados e discussão indicaram o trabalho das enfermeiras na atenção básica como: - cuidador, pelo cuidado direto e a gerência deste cuidado, realizado com predomínio de atividades assistenciais sobre as gerenciais, com destaque para as atividades assistenciais individuais, indicando mudança do enfoque no trabalho das enfermeiras com a manutenção da finalidade do trabalho - cuidar do corpo biológico doente; - diferente, porém semelhante, pelos modos diversos de organização dos serviços; - complexo, pelo objeto de trabalho, os sujeitos sociais em várias fases do ciclo de vida, e pelo trabalho em si, para o qual as enfermeiras percebem-se despreparadas e vivenciam adoecimentos; - específico, pelo uso amplo de tecnologias leves, que potencializam as relações singulares de cuidar, e pelo saber generalista, necessário para exercer esse trabalho; - feminino, pelas marcas femininas do trabalho das enfermeiras, pela subjetividade do trabalho como um saber e um fazer em relações, com afetividade e emoção, e pelas formas de dominação e resistência às relações desiguais de gênero. Consideramos que o trabalho das enfermeiras na atenção básica é rico, diverso, complexo e marcado pelo feminino, permeado por relações sociais, afetivas e subjetivas. Assim, estratégias que dêem visibilidade e potencializem o trabalho feminino da enfermagem devem ser estimuladas, possibilitando novas construções sociais e políticas, visando a um projeto mais específico para a enfermagem brasileira / Nursing practices have been built associated with health care policies, related to the way services were organized and to health work processes which have been connected to historical, political, social and gender associated contexts. In the case of primary health, nurses have planned and altered their tasks, enhancing and diversifying activities, according to changes and demands from public health care policies. With the implementation of PSF (Family Health Program), in Campinas, there were changes in the city nurses\' work. This is a qualitative research which aimed to grasp the way the city nurses perceive their jobs in the primary health system in Campinas. Theoretical references were Gender and Work, and nursing has been understood as a feminine career, subordinated to the masculine work of doctors, and it maintains and perpetuates the social and gender related division of the work system, as well as the dichotomy between the caring of nurses and the healing of doctors, and all the gender related consequences of these. The analyzed data included the responses of 133 nurses about their activities on a typical day at work and the transcribed material of a workshop attended by six nurses, volunteers from the nurse group. Two broader themes have emerged from the thematic analysis of the data: grasping the work of a nurse in primary health (with the categories, the caring dimension, and understanding the process of work) and understanding nursing as a feminine career (with the categories, nursing as a feminine career, and gender relations). The results and the considerations have indicated the following characteristics of the work of nurses in primary health: - caring, because of direct taking care and the management of this procedure, it includes the predominance of assisting activities over the managing role, with emphasis on individual assistance, which also shows a shift of focus at work with the maintenance of their professional goal - caring for the biological sick body; - different, but similar, due to the several ways the services have been organized; - complex, because of the object of the work, social subjects in several phases of their lives, and because of the work itself, which the nurses feel they have not been prepared for, and it has led to diseases; - specific, due to broad use of light technologies, which have empowered singular caring relations, and because of the general knowledge that is necessary to do the job; - feminine, because of the feminine traces of the nurses\' job, due to the subjectivity of the work as knowing and doing in relationship, with affection and emotion, and as a result of the way they suffer and resist gender related control. We have considered the work of nurses in primary health as rich, diverse, complex, feminine, and marked by social, caring and subjective relations. Therefore, strategies which may give focus and empowerment to the feminine work of the nurses must be stimulated, allowing new social and political relations, directed towards a more specific project for the Brazilian nurses