O estudo teve como foco a análise do envolvimento de gestores (secretários) municipais e equipes de saúde da atenção básica com as ações de controle da tuberculose (TB) em nove municípios prioritários do Estado de São Paulo, a partir da percepção dos coordenadores do Programa de Controle da TB. Utilizou-se como referencial teórico o modelo proposto pela Organização Mundial de Saúde (2003) baseado na integração dos componentes estruturais (Macro, Meso e Micro) do sistema de saúde para a organização da atenção às condições crônicas, dentre elas a TB. Trata-se de uma pesquisa que utilizou a abordagem qualitativa, cujos dados foram coletados por meio de entrevista semi-estruturada e analisados através da técnica de análise de conteúdo-modalidade temática. A codificação dos depoimentos resultou em duas Unidades Temáticas Centrais: \"O controle da Tuberculose na agenda municipal de saúde: uma prioridade política?\" e \"A incorporação das ações de controle da TB na Atenção Básica à Saúde\". A primeira Unidade Temática apontou o desinteresse pelas políticas e estratégias de controle da TB, a discordância com a prática do Tratamento Supervisionado, a presença de outras prioridades de saúde com caráter emergencial e o enfoque na implantação e expansão de equipes de saúde da família pela gestão municipal como elementos que dificultam a valorização da TB na agenda de saúde e a disponibilização de recursos essenciais para seu controle. Na segunda Unidade Temática identificou-se que a falta de recursos humanos, a inadequada qualificação dos profissionais e a visão centralizada e fragmentada da organização das ações de controle da doença no sistema de saúde representam as principais barreiras para a incorporação da TB no âmbito da atenção básica. Considera-se que a construção de um sistema municipal de saúde mais responsável e com ampla participação da atenção básica no efetivo controle da TB exige um padrão de gestão comprometido com a doença e com as estratégias difundidas para seu controle como o DOTS; a organização de uma rede de serviços integrada, resolutiva e humanizada e a elaboração/implementação de uma política de recursos humanos capaz de garantir formação e capacitação contínua das equipes de saúde. / The aim of this study was to explore the involvement of municipal health managers (Health Secretaries) and basic health attention teams with actions for tuberculosis (TB) control in nine priority cities in São Paulo, from the viewpoint of the TB Control Program coordinators. Theoretical references were based on the model proposed by the World Health Organization (2003), which consists of the integration of health system structural elements (Macro, Meso, and Micro) for the organization of services targeting chronic conditions, among which is TB. This study involves the use of a qualitative approach and data were collected through semi-structured interviews and analyzed by means of theme unit content analysis techniques. Two major theme units stood out after testimonials were encoded: \"Tuberculosis control in the municipal health agenda: Is it a priority?\" and \"The incorporation of TB control actions into basic Health services\". The first theme unit identified the following, as elements that hinder the inclusion of TB in the health agenda and allocation of essential financial resources for its control: 1) a lack of interest in strategies and policies for TB control; 2) disagreement on Supervised Treatment practice; 3) other existing health priorities, and 4) the Health Secretary\'s focus on implementing and expanding the Family Health Program actions and teams. The second theme unit showed that the lack of human resources, inadequate professional capacity building, and a centralized and fragmented understanding about organizing the disease control actions within the health system represent barriers that need to be overcome in order to include TB into the Basic Health Services. The conclusion is that setting up a more responsible municipal health system and making basic health attention providers more participatory in an effective control of TB requires a kind of management that is concerned with the disease and the strategies proposed for its control, such as DOTS. Furthermore, it is mandatory to organize an integrated, problem-solving, and human service network as well as design and implement a human resources policy that will ensure continuing education and capacity building targeting health teams.

A mola propulsora desta investigação foi a baixa cobertura da Saúde da Família no município de Ribeirão Preto, assim como no estado de São Paulo, aliada à escassa produção sobre a análise do impacto da Estratégia em municípios de grande porte. A avaliação de serviços de saúde, e em específico, a auto-avaliação de uma equipe de Saúde da Família sobre o trabalho que realizam, oferecendo subsídios para incrementar a qualidade da assistência prestada à população adscrita, se constituem no foco desta investigação. Na busca de instrumentos para essa proposta de avaliação, conhecemos a Avaliação para a Melhoria da Qualidade (AMQ), proposta do Ministério da Saúde, de autoavaliação em diferentes níveis decisórios da Saúde da Família (gestores, coordenadores e equipes), com instrumentos de fácil compreensão e de respostas positivas ou negativas que levam ao processo de reflexão e auto-avaliação. A AMQ foi criada por experts em atenção primária e em avaliação de qualidade de serviços de saúde e validada posteriormente. Assim, o objetivo desta pesquisa foi analisar o processo de auto-avaliação desencadeado por uma equipe de Saúde da Família vinculada à Universidade de São Paulo, em Ribeirão Preto - SP, mediante a utilização da metodologia da AMQ. Tomando como opção a abordagem qualitativa para a realização da investigação pela natureza do objeto, foi selecionada uma das equipes de Saúde da Família dos Núcleos de Saúde da Família ligados à Universidade de São Paulo, tendo por critérios de inclusão: a anuência da equipe, sua disponibilidade de participação, a equipe encontrar-se completa e atendesse ao critério de antiguidade. A coleta de dados foi realizada de dezembro de 2009 a março de 2010, por meio de grupo focal, tendo como eixo temático a utilização da AMQ. Por meio da análise temática foram identificados os temas: construção e fortalecimento da Atenção Básica; a equipe na Saúde da Família - construção de possibilidades?; reflexões sobre o trabalho na unidade de Saúde da Família e a AMQ - possibilidades e críticas ao instrumento. A reflexão trouxe à tona os princípios da Atenção Básica possibilitando que a equipe repensasse as atividades que não são realizadas e aquelas que são, e que podem ser implementadas e qualificadas. Portanto, os princípios da Atenção Básica presentes no dia-a-dia do trabalho foram sendo identificados, apontados, compreendidos e valorizados pelos próprios trabalhadores permitindo repensar uma melhoria das condições de trabalho e conseqüentemente a qualificação do atendimento à população sob responsabilidade desta equipe. A análise também apontou as dificuldades e potencialidades que a equipe tem de ver a necessidade de articulação dos diversos fazeres e saberes e da troca de conhecimentos, proporcionando a oportunidade de olhar para o próprio trabalho e empreender um movimento de análise das atividades realizadas e como elas são realizadas, trazendo à tona vários aspectos do cotidiano do trabalho que, muitas vezes, não tinham sequer sido notados pela equipe. Olhar para o trabalho, para a rotina diária, para as divergências e convergências em relação ao trabalho desenvolvido, para os problemas enfrentados, para os sucessos alcançados, para o resgate do que deu certo em determinado momento do passado, para as intervenções propostas pela equipe, enfim, esta teve a possibilidade de retomar estes movimentos, e de alguma forma indicar elementos para o planejamento do trabalho na unidade visando à qualificação da atenção que prestam. / What motivated this study was the low coverage of the Family Health Strategy (FHS) in the city of Ribeirão Preto and in the state of São Paulo, Brazil coupled with the scarcity of studies addressing the impact of the FHS in large cities. This study evaluates health care services. Specifically it proposes a self-evaluation of a FHS team concerning their work, aiming to support improvements in the quality of care delivered to the ascribed population. Searching for instruments to be used in this evaluation, we found the Evaluation for Quality Improvement (AMQ) proposed by the Ministry of Health, a self-evaluating instrument for different levels of decision-making in the FHS (managers, coordinators and teams), easy to understand with positive or negative answers that lead to a process of reflection and selfevaluation. The AMQ was developed by experts in primary health care and in evaluating quality of health services and was later validated. Thus this study analyzes a self-evaluation process triggered by the FHS team linked to the University of São Paulo at Ribeirão Preto, SP through the AMQ methodology. Given the nature of the object of study, a qualitative approach was chosen. One of the FHS teams linked to the University of São Paulo was selected according to the following inclusion criteria: team\'s consent, its availability to participate, team was complete and met the seniority criterion. Data collection was carried out from December 2009 to March 2010 through focus group, whose thematic axis was the use of AMQ. The following themes were identified in the thematic analysis: constructing and strengthening Primary Care; the Family Health team - construction of possibilities?; reflections concerning the work in the FHS unit and the AMQ - possibilities and critiques to the instrument. The reflection revealed principles of Primary Care, which enabled the team to rethink activities that are not performed and those that are performed and which can be implemented and qualified. Hence, the Primary Care principles, present in daily practice, were identified, listed, understood, and valued by the workers themselves, which enable them to rethink the possibility of improving working conditions and consequently qualifying care delivered to the population under the responsibility of this team. The analysis also revealed difficulties and strengths and that the team needs to articulate several tasks and different types of knowledge and also exchange knowledge, enabling an opportunity to look at their own work and promote a movement to analyze activities performed and how they are performed, revealing several aspects of the work routine, which oftentimes are not even noticed by the team. Looking at the work, the daily routine, to divergences and convergences in relation to the work performed, to problems faced, achieved successes, to recover what have worked in a given point in the past, to interventions proposed by the team, and finally, it enabled the possibility to review these movements and somehow indicate elements for planning the work in the unit with a view to qualify care delivery.

Introdução: Anemia é um importante problema de saúde pública no Brasil, ainda muito associado às condições sociais. A fortificação de alimentos com ferro é uma alternativa de grande alcance no combate à deficiência de ferro e controle da anemia, pois representa uma fonte complementar que contribui para a formação de reservas do mineral para os períodos de maior vulnerabilidade. As gestantes compõem um dos grupos mais vulneráveis à anemia, com consequências deletérias à sua saúde e do feto. Considerando que a fortificação compulsória das farinhas de trigo e milho com ferro foi efetivamente implantada em junho de 2004, supõe-se que mulheres em idade reprodutiva tenham aumentado suas reservas, tornando as gestações de menor risco. Justifica-se, assim, avaliar o efeito da fortificação das farinhas no controle da anemia em gestantes. Objetivo: Avaliar o efeito da fortificação das farinhas de trigo e milho com ferro, no controle da anemia em gestantes atendidas em serviços públicos de pré-natal, localizados em municípios das cinco regiões do Brasil. Métodos: Estudo de avaliação de intervenção por meio de painéis repetidos, com amostras transversais independentes, realizado em serviços públicos de saúde localizados em municípios das cinco regiões do Brasil. Foram coletados dados retrospectivos de 12.119 prontuários de gestantes distribuídas em dois grupos: Antes-fortificação (parto antes de Jun/2004) e Após-fortificação (última menstruação após Jun/2005). Anemia foi definida como Hb<11g/dL. Níveis de hemoglobina-Hb por idade gestacional foram avaliados segundo critérios do Center for Disease Control-CDC (1989) e Szarfarc et al. (1983). Utilizou-se teste qui-quadrado, t de Student e regressão logística, com nível de significância de 5%. Resultados: Na amostra total, a anemia diminuiu de 25% para 20% após a fortificação (p<0,001), com aumento das médias de Hb (p<0,001). Verificaram-se, entretanto, diferenças regionais importantes. Nas regiões Nordeste e Norte, onde as prevalências eram elevadas, houve queda significativa Após-fortificação: de 37% para 29% e de 32% para 25%, respectivamente. Nas regiões Sudeste e Sul, cujas prevalências eram baixas mesmo antes da fortificação, também houve redução: de 18% para 15% e de 7% para 6%, respectivamente. Nas regiões Sudeste e Sul, as gestantes tinham, respectivamente, razão de chance 30% e 75% menor de serem anêmicas, em relação às da região Nordeste. Em comparação com os parâmetros do CDC (1989), os níveis de Hb segundo idade gestacional de ambos os grupos se mostraram discretamente mais elevados nos primeiros meses, porém bem mais baixos após o 4º mês. O mesmo se verificou em relação à curva de Szarfarc et al (1983), porém após o 3º mês, as médias de Hb das gestantes estudadas acompanharam essa curva. Mesmo após o controle das variáveis que se mostraram diferentes entre os grupos (p<0,20), o grupo Após-fortificação apresentou menor razão de chance de ter anemia. Análise de regressão logística mostrou que grupo, região geográfica, situação conjugal, trimestre gestacional, estado nutricional inicial e gestação anterior associaram-se com anemia (p<0,05). Conclusões: Apesar de a prevalência da anemia em gestantes continuar elevada nas regiões Nordeste, Norte e Centro-Oeste, a diminuição no total da amostra e aumento das médias de Hb sugerem efeito positivo da fortificação das farinhas no controle da deficiência do mineral, embora outras variáveis não estudadas possam ter contribuído para tal resultado. A distribuição desigual da anemia nas diferentes regiões geográficas do Brasil, entretanto, reitera sua determinação social. Considerando as dificuldades na obtenção dos dados de Hb a partir de prontuários, sugere-se a implantação de um sistema de monitoramento permanente que possibilite acompanhar a evolução da anemia gestacional em resposta às estratégias implementadas. / Introduction: Anemia is an important public health problem in Brazil, and it has been quite associated to social conditions. Food fortification with iron is a far-reaching alternative to combat iron deficiency and anemia control, as it represents an additional source that contributes to the formation of the mineral stores for the periods of greatest vulnerability. Pregnant women are one of the most vulnerable to anemia, with deleterious consequences to their health and the fetus. Whereas the mandatory fortification of flour and corn flour with iron was effectively implemented in June 2004, it is assumed that women of reproductive age have increased their reserves, making lower-risk pregnancies. Therefore, it justified to evaluate the effect of flour fortification in the control of anemia in pregnant women. Objective: To evaluate the effect of fortification of wheat and corn flours with iron in the control of anemia in pregnant women attending public prenatal care, located in cities of the five regions of Brazil. Methods: A repeated cross-sectional panel evaluation study of intervention was carried out in public health care services located in cities of the five Brazilian regions. We collected backward data in 12.119 medical records. Pregnant women were divided into two groups: Before-fortification (delivery before Jun/2004) and After-fortification (last menstrual period after Jun/2005). Anemia was defined as Hb<11g/dL. Hb level by gestational age was evaluated according to criteria of Centers for Disease Control-CDC(1989) and Szarfarc et al(1983). We used chi-square, Students t test and logistic regression, with significance level of 5%. Results: In the total sample, anemia was dropped from 25% to 20% after fortification (p<0.001). Hb level also was significantly higher after fortification (p <0.001). However, the findings showed great differences among the regions. In the Northeast and North, where the prevalence of anemia were high, significant drop After-fortification was found: from 37% to 29% and 32% to 25%, respectively. In the Southeast and South, whose prevalences were low Before-fortification, also decreased: from 18% to 15% and 7% to 6%, respectively. In the Southeast and South, the women had, respectively, odds ratio 30% and 75% less to be anemic compared to the Northeast. Hb levels according to gestational age, comparing to CDC parameters, were better in the first trimester but worse from the 4th month in both groups. The same was verified comparing to curve of Szarfarc et al, but Hb levels of pregnant women studied followed this curve after 3rd month. Even after controlling for variables that were different between groups (p <0.20), the group After-fortification had lower odds ratio of having anemia. Logistic regression showed that group, geographic region, marital status, gestational trimester, initial nutritional status and previous pregnancy were associated with anemia (p<0.05). Conclusions: Despite the prevalence of anemia in pregnant women is still high in the Northeast, North and Midwest, the decrease in the total sample and increase in Hb levels suggest positive effect of fortification of flour to the control of iron deficiency, although other variables not studied may have contributed to this result. The unequal distribution of anemia in different geographical regions of Brazil, however, reiterates its social determination. Considering the difficulties in obtaining data of Hb from medical records suggest the establishment of a permanent monitoring system allows monitoring the evolution of pregnancy anemia in response to the strategies implemented.

O trabalho da enfermeira pressupõe a compreensão da enfermagem enquanto prática social realizada a partir de necessidades de saúde em determinada época e espaço. No atual momento de reorientação do modelo assistencial, a Estratégia Saúde da Família (ESF) consiste em um campo de atuação para a enfermeira, de modo que a identificação dos desempenhos realizados por essa trabalhadora para o desenvolvimento das ações, com uma aproximação a seus determinantes, possibilita entender como o trabalho vem ocorrendo no cotidiano, assim como as potencialidades e dificuldades de sua transformação. Seguindo os referenciais teóricos do processo de trabalho em saúde e competência dialógica, este estudo qualitativo objetivou analisar e validar os desempenhos presentes nas ações das enfermeiras na Atenção Básica (AB) com foco na ESF, em relação ao cuidado individual, cuidado coletivo e organização e gestão para o cuidado. A metodologia foi construída a partir da compreensão de validação como o processo de confirmação dos desempenhos observados, pelas enfermeiras que atuam no espaço específico da rede de AB do município de Ribeirão Preto - São Paulo - Brasil. Os sujeitos foram enfermeiras da ESF e da rede de AB do município estudado, as quais assumiram a função de juízes neste processo de validação. Para o desenvolvimento da pesquisa, foi utilizada a técnica da observação participante para identificar e analisar os desempenhos apresentados nas ações das enfermeiras nas situações do cotidiano. Posteriormente, entrevistas semiestruturadas e Oficina de Trabalho foram realizadas a fim buscar a validação dos desempenhos e uma aproximação aos determinantes dos mesmos. A análise do material empírico, mediante análise de conteúdo, usando a técnica de análise temática, construiu-se em processo, de modo que, ao final de cada etapa, o material analisado foi apresentado às enfermeiras para apreciação. Em relação à gestão, os resultados mostraram a identificação e validação dos desempenhos para as ações de: supervisão, trabalho em equipe, controle social, organização do trabalho, coordenação e planejamento. Para o cuidado individual e para cuidado coletivo, foi possível identificar e validar os desempenhos para as ações em: consulta de enfermagem, visita domiciliar, avaliação com classificação de risco, monitoramento e avaliação de vacina/reação adversa à vacina, atendimento para grupos educativos com indivíduos vulneráveis, vigilância epidemiológica. Os desempenhos descritos e validados evidenciaram que as enfermeiras utilizam diferentes estratégias de cuidado e mobilizam um conjunto amplo de atributos (conhecimentos, habilidades e atitudes) articulados de acordo com as finalidades das ações. Mostraram também que a gestão do trabalho é centralizada nas enfermeiras. A falta de formação em algumas áreas, a dinâmica do trabalho em equipe desenvolvida na ESF, as definições de trabalho realizadas pela secretaria municipal de saúde, a cultura dos usuários e a infraestrutura foram citadas e/ou discutidas como possíveis determinantes dos desempenhos das enfermeiras captados Concluímos que o trabalho da enfermeira na ESF tem potência para contribuir na reorganização da assistência a partir da atenção básica. / The nurse\'s work requires the understanding of nursing as a social practice conducted in view of health needs at a given time and space. At the current moment of reorienting the care model, the Family Health Strategy consists of a field for the nurse, so that the identification of the performance conducted by that professional for the development of actions, with an approach to its determinants, makes it possible to understand how the work is occurring in everyday life as well as the potentialities and difficulties of its transformation. Following the theoretical of the work process in health and dialogical competence, this study aimed to analyze and validate the performance present in the actions of nurses in Primary Care focused on the Family Health Strategy, in relation to individual care, collective care, organization and management of care. The methodology was built upon the understanding of validation as the process of confirming the observed performance of nurses who work in the specific space of the Primary Care Network in the city of Ribeirao Preto, state of Sao Paulo, Brazil. Subjects were nurses from the Family Health Strategy and Primary Care Network who assumed the role of judges in this validation process. For the development of research, it was used the technique of participant observation to identify and analyze the performance showed in the actions of nurses in daily situations. Subsequently, semi-structured interviews and workshops were carried out to seek the validation of performance and an approach to examine the determinants of performance. The empirical data analysis through content analysis, using the technique of thematic analysis, was constructed in process, and at the end of each stage, the analyzed material was submitted for the appreciation of nurses. Regarding management, results showed the identification and validation of performance for actions of supervision, teamwork, social control, work organization, coordination, and planning. Related to the individual and collective care, it was possible to identify and validate the performance for actions of nursing visits, home visits, evaluation with risk classification, monitoring, and evaluation of vaccine/adverse reaction to the vaccine, attendance for educational groups with vulnerable individuals, and epidemiological surveillance. The described and validated performances evidenced that nurses use different care strategies and mobilize a broad set of attributes (knowledge, skills and attitudes) articulated in accordance with the purposes of action. They also showed that work management is centralized in nurses. Lack of training in some areas, dynamics of teamwork developed in the Family Health Strategy, definitions of work by the Municipal Health Secretariat, culture of the users, and infrastructure have been cited and/or discussed as possible determinants of the performance of nurses. It was concluded that the nurse\'s work in the Family Health Strategy has the potential to contribute to the reorganization of care from primary care.

Introdução: O excesso de peso destaca-se como importante problema de saúde na atualidade e sua prevenção desde a primeira infância é essencial para a promoção da saúde da população. O uso de material didático e instrucional, como o álbum seriado, contribui para a prática do processo educativo em saúde na rotina dos serviços. Objetivo: Construir e validar um Álbum Seriado sobre prevenção do excesso de peso infantil na atenção básica. Método: Estudo descritivo que foca o desenvolvimento e a validação de um instrumento para intervenção educativa. Integra investigação mais ampla desenvolvida no município de Itupeva, Estado de São Paulo, aprovada por Comitê de Ética em Pesquisa e autorizada pela Diretoria de Saúde do município. Foi desenvolvida em três etapas: 1) Oficinas de escuta com mães e profissionais de saúde da atenção básica; 2) Construção do álbum seriado; 3) Validação do álbum seriado. Com base no referencial teórico da educação crítica, três oficinas com duração de 90 minutos cada, foram realizadas no período de abril a junho de 2015: duas com 10 mães e uma com 14 profissionais da atenção básica. As oficinas foram gravadas, transcritas e submetidas à análise de conteúdo. Os temas extraídos das oficinas, documentos técnicos do Ministério da Saúde e figuras disponíveis no banco de imagens da web foram utilizados na construção do Álbum Seriado. O Álbum Seriado foi validado por oito juízes, profissionais vinculados à Diretoria de Saúde e Educação do município, que avaliaram conteúdo e aparência mediante preenchimento de uma ficha de validação, durante discussão em grupo. Analisou-se a porcentagem de concordância dos juízes. Resultados: A construção do Álbum Seriado teve como base os temas extraídos das oficinas realizadas com mães e profissionais de saúde, porém para uma sequência lógica de apresentação, o material foi organizado de acordo com os temas reconhecimento do excesso de peso/obesidade, consequências para a saúde da criança e estratégias para prevenção e promoção da saúde infantil. O Álbum Seriado foi constituído por 27 folhetos com frente (figura) e verso (ficha-roteiro). Houve 99% de concordância dos juízes quanto ao tema proposto, 96% com relação à clareza/compreensão dos folhetos, 94% quanto à importância de cada uma das figuras para o álbum seriado e 47% quanto à necessidade de ajustes ou exclusão de folhetos. Melhorias na resolução e substituição de algumas figuras foram as principais sugestões para o ajuste do material apresentado para validação. Conclusões: A construção e validação do álbum seriado, com base na educação crítica, envolve os participantes, facilita o uso dessa tecnologia pelos profissionais de saúde no processo educativo na atenção básica e favorece a compreensão e incorporação de passos importantes para a prevenção do excesso de peso infantil, contribuindo para a promoção da saúde da criança. / Introduction: Weight excess stands out as a major health problem today and its prevention since early childhood is essential for the population health. The use of instructional teaching materials such as flip chart in the educational process in health contributes to the effectiveness of this practice in the service routine. Objective: To develop and validate a flip chart on prevention of childhood weight excess in primary care. Methods: Descriptive study that focuses on the development and validation of an instrument for educational intervention. Honest and wide investigation was developed in the city of Itupeva, State of São Paulo, approved by the Research Ethics Committee and authorized by the city\'s Health Board. It was developed in three steps: 1) Listening workshops with mothers and health professionals in primary care; 2) Development of a flip chart; 3) Flip chart validation. Based on the theoretical framework of critical education, where three workshops which lasted 90 minutes each were held from April to June 2015: two with 10 mothers, and one with 14 primary care professionals. The workshops were recorded, transcribed and subjected to content analysis. To develop the flip chart, themes were drawn from workshops, technical documents were used from the Ministry of Health and pictures were taken from the internet. The flip chart was validated by eight judges, who were part of the city professional Board of Health and Education. They evaluated the flip charts content and appearance by filling out a form validation for group discussion. The percentage of the judges agreement was analyzed. Results: The analysis of the listening workshops gave origin to the topics, weight excess acknowledgement\", consequences for the childs health\" and \"strategies for prevention and childrens health promotion. The flip chart consists of 27 sheets: odds pages with figure and even pages with plug-Script. There was 99% of the judges agreement on the proposed theme, 96% regarding clarity and understanding, 94% regarding the importance of each picture, and 47% as for needs of adjustments or exclusion. Resolution improvements and picture replacements were the main suggestions for the material validation. Conclusions: The flip chart construction and validation based on critical education involves the participants, facilitates the use of this technology by health professionals in the educational process in primary care, and promotes understanding and incorporation of important steps to prevent child\'s weight overflow, contributing to the child\'s health promotion.

Objetivo: Avaliar os níveis de hemoglobina de gestantes brasileiras antes e após a fortificação das farinhas de trigo e milho com ferro e investigar as variáveis associadas. Método: Estudo transversal que integra um projeto matricial desenvolvido com dados retrospectivos obtidos de prontuários de 12.119 gestantes atendidas em serviços públicos de pré-natal localizados em 13 municípios das cinco regiões geográficas do Brasil, divididas em dois grupos: Antes-fortificação das farinhas com ferro (gestantes com parto realizado antes de junho de 2004); e Após-fortificação (gestantes com data da última menstruação posterior a junho de 2005). A coleta de dados ocorreu em 2006-2008 e incluiu apenas gestantes de baixo risco, cujos prontuários continham pelo menos a data da primeira consulta de pré-natal e da última menstruação e a dosagem de hemoglobina (Hb). A variável dependente foi o nível de Hb (g/dL) e as independentes foram: grupo de fortificação, região geográfica, características sociais e demográficas, antecedentes obstétricos e características do pré-natal. Realizou-se análise descritiva, univariada e múltipla do nível de Hb para o total das gestantes, por região geográfica e por trimestre de gestação, por meio de modelos de regressão linear. Contruíram-se modelos de regressão polinomial para o ajuste das curvas de Hb por mês de gestação, que foram comparadas com referências nacional e internacional. Curvas de níveis médios e críticos (-2 desvios-padrão) de Hb de gestantes não anêmicas do grupo Após-fortificação também foram comparados às referências. O nível de significância de todos os testes foi de 5%. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: Não houve aumento significativo do nível de Hb para o total da amostra (p=0,325) após a fortificação, exceto em gestantes da região nordeste (p<0,001; =0,214) e em gestantes no segundo trimestre de gestação (p=0,025; =0,093). O nível de Hb foi menor entre aquelas que tinham menor idade, viviam sem companheiro, tinham menor Índice de Massa Corporal-IMC, maior idade gestacional e/ou duas ou mais gestações anteriores. Apesar da curva Após-fortificação apresentar níveis superiores em todos os meses de gestação, a regressão polinomial não mostrou efeito significativo da fortificação de farinhas (p=0,316). As curvas de Hb de ambos os grupos de fortificação mostraram-se acima dos níveis críticos das referências nacional e internacional no primeiro trimestre, com queda a seguir e estabilização no final da gestação. A curva de níveis críticos, construída com dados de gestantes não anêmicas do grupo Após-fortificação, ficou abaixo da curva de níveis críticos da referência nacional e do ponto de corte da OMS, mas semelhante à referência internacional, exceto no final da gestação. Conclusões: A fortificação de farinhas com ferro aumentou significativamente o nível de Hb apenas em gestantes da região nordeste do Brasil e no segundo trimestre de gestação. Idade, situação conjugal, IMC, idade gestacional e número de gestações anteriores mantêm-se como características importantes que devem ser consideradas na avaliação da anemia na gestação. As curvas construídas seguem os padrões das referências nacional e internacional. Propõe-se uma curva de Hb de gestantes não anêmicas para ser utilizada na avaliação da anemia em gestantes brasileiras. / Objective: To evaluate the hemoglobin levels of Brazilian pregnant women before and after fortification of wheat and corn flours with iron and to investigate the associated variables. Methods: This collaborative cross-sectional study was developed with retrospective data obtained from medical records of 12,119 pregnant women who attended public prenatal care services in 13 municipalities of five Brazilians geographical regions. They were divided into two groups: Before-fortification (women who delivered before June/2004), and After-fortification (women with date of last period after June/2005). Data collection occurred between 2006-2008 and included only low risk pregnant women, whose medical records contained at least the date of the first prenatal visit, date of the last menstrual period and measurement of Hemoglobin (Hb). The dependent variable was the Hb level (g/dL) and the independent variables were: group of fortification, geography region, social and demographic characteristics, obstetric history and characteristics of prenatal care. We conducted descriptive analysis, univariate and multiple (linear regression) of the Hb level for the total of pregnant women, by geographic region and trimester of pregnancy. Polynomial regression models were used to fit the curves of Hb by month of pregnancy, which were compared with national and international references. Curve of Hb mean and critical levels (-2 standard deviations) constructed with data of non-anemic pregnant of After-fortification group were also compared to references. The significance level for all tests was 5%. This study was approved by the Research Ethics Committee. Results: There was no significant increase in Hb level for the total sample after the fortification (p=0.325), except pregnant women in the northeast region (p <0.001, =0.214) and pregnant women in the second trimester of pregnancy (p=0.025; =0.093). The Hb levels were lower on those who were younger, lived without partner, had lower body mass index-BMI, had higher gestational age and/or had two or more previous pregnancies. Although the curve of After-fortification group had presented higher levels in all months of pregnancy, the polynomial regression showed no significant effect of fortification of flour (p=0.316). The curves of Hb in both groups of fortification were higher than the national and international references critical levels in the first trimester, followed by a drop and stabilization in late pregnancy. The curve of critical levels constructed with data of non-anemic pregnant women of After-fortification group were below the curve of critical levels of national reference and the WHO cut-off point, but similar to the international reference, except in late pregnancy. Conclusions: Fortification of flour with iron significantly increased the Hb levels of pregnant women only in northeast region of Brazil and in the second trimester of pregnancy. Age, marital status, BMI, gestational age and number of previous pregnancies remain as important characteristics that should be considered in the evaluation of anemia in pregnancy. The constructed curves follow the national and international references. We propose a curve of Hb non-anemic pregnant women to be used in the evaluation of anemia in pregnant Brazilian women.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-10-31T11:54:08Z No. of bitstreams: 1 Michelle Ribeiro Cordeiro de Souza.pdf: 2530971 bytes, checksum: 7b3c6332d17071b5b0ff3c404cd4f273 (MD5) / Made available in DSpace on 2017-10-31T11:54:08Z (GMT). No. of bitstreams: 1 Michelle Ribeiro Cordeiro de Souza.pdf: 2530971 bytes, checksum: 7b3c6332d17071b5b0ff3c404cd4f273 (MD5) Previous issue date: 2017-09-18 / The formation of health’s profissionals aim for nowadays, to attend to Sistema Único de Saúde. The Supervised Curricular Stage in the process of nurse’s formation is considered a strategy of teaching that approach the student of reality, develops habilities and contract with new experiences helping the existence of the future profissional practic. The study propose chances in curriculares activities on Nursing Course of Faculdade de Ciências Sociais e Agrárias de Itapeva from identification of the learning opportunities this stage in basic care, your contribution on profissional exercise in this área of acting and of competences acquired considering the pedagogical Project, in viewpoint of egresses, Is described explored, of approach quali-quantity, The theory os Social Representations was used like theorical reference and, the Discurse of Coletive Subject, methodological reference in organization and analysis of testimonies. The egresses aprove the stage how much the teaching performance considered fragilities/difficulties: use of small health units, basic nursing procedures, no realization of nurse consultation, monitoring the role of nurse, leadership, management decision-making and technical-scientific development. It is considered essential to extend the experiences during the stage, from the teacher nurse of the planning of the learning opportunities, to contemplate the development of technical skills in the period that precede the stage, to seek innovative learning methods in the proposed activities / A formação dos profissionais de saúde visa, atualmente, atender ao Sistema Único de Saúde. O Estágio Curricular Supervisionado no processo de formação do enfermeiro é considerado uma estratégia de ensino que aproxima o estudante da realidade, desenvolve habilidades e contato com novas experiências, propiciando a vivência da prática profissional futura. O estudo propõe mudanças nas atividades curriculares no Curso de Enfermagem da Faculdade de Ciências Sociais e Agrárias de Itapeva a partir da identificação das oportunidades de aprendizagem desse estágio na atenção básica, sua contribuição no exercício profissional nessa área de atuação e, das competências adquiridas considerando o projeto pedagógico, na ótica dos egressos. É descritivo, exploratório, de abordagem quali - quantitativa. A Teoria das Representações Sociais foi utilizada como referencial teórico e, o Discurso do Sujeito Coletivo e a Análise de Conteúdo, como referencial metodológico na organização e análise dos depoimentos. Os egressos aprovaram o estágio quanto à atuação docente, realização de atividades voltadas à promoção da saúde e os estudos de caso. Consideraram fragilidades/dificuldades: uso de unidades de saúde pequenas, realização dos procedimentos básicos de enfermagem, não realização de consulta de enfermagem, acompanhamento do papel do enfermeiro, liderança, gerenciamento, tomada de decisão e desenvolvimento técnico-científico. Considera-se essencial ampliar as experiências durante o estágio, a partir da interação docente - enfermeiro da unidade no planejamento das oportunidades de aprendizagem, contemplar o desenvolvimento de habilidades técnicas nos períodos que precedem o estágio, buscar métodos inovadores de aprendizagem nas atividades propostas

Esta tese centra-se na problemática da violência contra as mulheres, nas trajetórias em serviços de acolhimento e em práticas sociais e profissionais de cuidado. Baseada em estudos anteriores da autora, parte das afirmações de que serviços e práticas são inadequados, desarticulados, medicalizados e desrespeitam as mulheres vitimadas. Nesse sentido, a partir de experiências de mulheres em situação de violência buscou refletir, compartilhadamente, sua relação com os serviços e suas concepções de cuidado. Trata-se de estudo misto, que descreve e analisa a violência contra mulheres à luz de diferentes enfoques teóricos entre as teorias principalistas do direito à vida em segurança, da saúde e do gênero. O local de realização foi o Centro de Referência e Atendimento à Mulher (CRAM) do município de Porto Alegre. As participantes foram mulheres atendidas no CRAM em decorrência de situações de violência. A geração de dados ocorreu por meio de pesquisa documental em 536 formulários de atendimento, observação sistemática realizada no serviço e entrevistas em profundidade com 14 mulheres. A análise dos dados ocorreu, primeiramente, pela análise quantitativa que sistematizou registros provenientes dos formulários de atendimento do CRAM que corresponderam ao perfil dos atendimentos e das informações sociodemográficas das mulheres atendidas, bem como dos agressores. A segunda etapa correspondeu à análise dos dados qualitativos, provenientes da pesquisa documental, da observação e das entrevistas, com utilização do método da Análise de Conteúdo. Descreveu-se a organização e os processos de trabalho do CRAM, as características dos atendimentos realizados e o perfil das mulheres atendidas e dos agressores. Na análise das trajetórias, constatou-se que na maioria delas estão presentes serviços e/ou profissionais de saúde, principalmente para atendimento relacionados à saúde mental. Identificou-se que as mulheres não são adequadamente acolhidas no setor Saúde. Nos setores Segurança e Justiça, foram observadas negligências institucionais que reproduzem e potencializam a violência. O CRAM foi unanimemente bem avaliado, sendo articulador da rede de atenção. Outros serviços da rede (conselho tutelar, escola, serviços de assistência social, casas abrigos), também se constituem em pontos de apoio importantes para as mulheres, evidenciando a relevância de estabelecer adequada articulação da rede intersetorial. Na linguagem das mulheres, as experiências de sofrimento e busca de acolhimento remetem aos principais elementos para um atendimento eficaz e satisfatório que são: orientação, apoio e proteção. Atribuem às experiências de violência, os sentidos de humilhação, de culpa e de medo, as quais são geradores de intenso sofrimento e têm impactado em sua saúde. As violências impossibilitam o pleno desenvolvimento de uma vida digna. Portanto, entende-se que o enfrentamento dessas situações é necessariamente intersetorial, implicando articulação e fundamentação na garantia dos Direitos Humanos das mulheres. Conclui-se que existe, predominantemente, inadequação das práticas para a construção de projetos de acolhimento e cuidado para as mulheres em situação de violência. Nesse sentido, pensa-se que é preciso assumir nova razão terapêutica, incorporando elementos do cuidado que incluam as tecnologias relacionais e que considerem os direitos humanos, os direitos de cidadania e os aspectos subjetivos nas experiências vividas por essas mulheres. / This dissertation approaches the problem of violence against women upon trajectories in support services and in social and professional care practices. Based on previous studies by the author, it starts from statements that services and practices are inadequate, not articulated, medicalized and that they disrespect victimized women. Thus, a reflection was made from the experiences of women under violence condition by sharing their relation with the services and their care conceptions. This mixed study describes and analyzes the violence against women by considering different theoretical approaches among the Principalism theories regarding the right to safe life, to health and to gender and it was carried out in the Woman Reference and Attendance Center (CRAM) in Porto Alegre. The participants were women attended within the CRAM due to violence situations. The data were collected by means of documentation survey in 536 attendance forms, systematic observation at the service and in-depth interviews with 14 women. At first, the data underwent quantitative analysis that systematized records from CRAM attendance forms which corresponded to the attendance profile and the social and demographic information of the attended women and the offenders as well. The second step corresponded to the analysis of the qualitative data from the documental survey, the observation and the interviews by applying the Content Analysis method. A description detailed CRAM organization and working processes, the characteristics of the performed attendances and the attended women and offenders´ profile. The trajectories analysis showed that in most of them, services and/or health professionals are offered for mental health attendance and that the women are not properly welcome in the Health sector. Regarding Safety and Justice sectors, there has been institutional negligence which reproduces and enhances violence. CRAM service was unanimously well assessed and considered an organizer of the care network. Other network services (guardianship council, school, social support services, shelters) also are important support locations for women that evidence the relevance of establishing adequate articulation of the inter-sectoral network. In the language of women, experiences of distress and search for support address to the main elements of effective and satisfactory service, i.e.: advice, support and protection. They attribute to violence experiences the feelings of humiliation, guilt and fear which generate intense distress and impact on their health. Violence hinder the full development of a dignified life. Therefore, it is understood that the confrontation of these situations is necessarily inter-sectoral, implying articulation and foundation to safeguard the Human Rights to women. The conclusion drawn is that there is predominance of inadequate practices for the construction of support and care projects for women undergoing violence situation. Thus, it is needed to undertake a new therapeutic reason that incorporates care elements which include relation technologies and that consider human rights, citizenship rights and subjective aspects from these women´s experiences. / Esta tese aborda la problemática de la violencia contra las mujeres, en las trayectorias en servicios de acogida y en prácticas sociales y profesionales de cuidado. Considerando estudios anteriores de la autora, parte de afirmaciones de que servicios y prácticas son inadecuados, desarticulados, medicalizados y no respetan las mujeres victimadas. Desde experiencias de mujeres en situación de violencia, se buscó reflexionar compartiendo su relación con los servicios y sus concepciones de cuidado. El estudio mixto describe y analiza la violencia contra mujeres considerando diferentes enfoques teóricos entre las teorías del Principalismo del derecho a la vida en seguridad, de la salud y del género, realizado en el Centro de Referencia y Atendimiento a la Mujer (CRAM) de Porto Alegre. Participaron mujeres atendidas en el CRAM debido a situaciones de violencia. Los datos resultaron de pesquisa documental en 536 formularios de atendimiento, observación sistemática en el servicio, y entrevistas en profundidad con 14 mujeres. Los datos pasaron, primeramente, por análisis cuantitativo que sistematizó registros de los formularios de atendimiento del CRAM que correspondieron al perfil de los atendimientos y de las informaciones sociodemográficas de las mujeres atendidas y de los agresores. La segunda etapa correspondió al análisis de los datos cualitativos, provenientes de la pesquisa documental, de la observación y de las entrevistas, utilizando el método de Análisis de Contenido. Se describió la organización y los procesos de trabajo del CRAM, las características de los atendimientos realizados y el perfil de las mujeres atendidas y de los agresores. El análisis de las trayectorias mostró que en su mayoría están presentes servicios y/o profesionales de salud, principalmente para atendimiento a la salud mental y que las mujeres no son adecuadamente acogidas en el sector Salud. En los sectores Seguridad y Justicia fueron observadas negligencias institucionales que reproducen y potencializan la violencia. El CRAM fue unánimemente bien evaluado, siendo articulador de la red de cuidado. Otros servicios de la red (consejo tutelar, escuela, servicios de asistencia social, hogares de abrigo), también se constituyen en puntos de apoyo importantes para las mujeres, evidenciando la relevancia de establecerse adecuada articulación de la red intersectorial. En el lenguaje de las mujeres, las experiencias de sufrimiento y búsqueda de acogida remeten a los principales elementos para atendimiento eficaz y satisfactorio: orientación, apoyo y protección. Se les atribuyen a las experiencias de violencia, los sentidos de humillación, culpa y miedo, que generan intenso sufrimiento e impacto en su salud. Las violencias imposibilitan el pleno desarrollo de una vida digna. Así, se entiende que el enfrentamiento de esas situaciones es necesariamente intersectorial implicando articulación y fundamentación en la garantía de los Derechos Humanos de las mujeres. Se concluye que existe predominantemente inadecuación de las prácticas para la construcción de proyectos de acogida y cuidado para las mujeres en situación de violencia. Aún, es preciso asumir nueva razón terapéutica, incorporando elementos del cuidado que incluyan las tecnologías relacionales y que consideren los derechos humanos, los derechos de ciudadanía y los aspectos subjetivos en las experiencias vividas por esas mujeres.

A temática deste estudo trata da prática de enfermagem de trabalhadores de nível superior que atuam em serviços da rede de Atenção Básica à Saúde, em especial, na Estratégia de Saúde da Família (ESF). Foi desenvolvido com o objetivo de analisar como os enfermeiros identificam e intervêm nas necessidades de saúde, apresentadas pelos usuários que demandam os serviços de saúde de três Unidades de Saúde da Família, localizadas no município de Marília, São Paulo, além de conhecer as dificuldades e facilidades dos enfermeiros, ao desenvolverem a prática de enfermagem, na perspectiva da produção do cuidado em saúde. Constitui-se em um estudo de natureza descritiva e de abordagem qualitativa. Na coleta de dados, optamos pela observação livre e entrevista semiestruturada. A observação livre se deu durante os atendimentos agendados e eventuais, ocorridos na unidade e também na visita domiciliária. Participaram deste estudo três enfermeiras pertencentes à ESF da zona norte do município citado. Para a análise dos dados obtidos, utilizou-se a Análise de Conteúdo Temático. No decorrer da análise, foi possível apreender uma unidade temática relacionada às identificações e intervenções realizadas pelas enfermeiras, sujeitos desta pesquisa, e duas subunidades: eventos episódicos e problemas anteriores e eventos episódicos e problemas atuais. Os resultados da pesquisa apontaram o predomínio da identificação de necessidades de saúde como sinônimo de queixas, e nas intervenções prevaleceu a fundamentação no conhecimento biológico. Quanto às facilidades apontadas pelas enfermeiras observadas, observaram-se o vínculo e a autonomia em relação a alguns procedimentos, já as dificuldades destacadas foram a falta de recursos humanos, a não adesão dos usuários em relação às atividades coletivas, dentre outras. Dessa forma, concluímos que são necessários investimentos na formação e na qualificação dos enfermeiros para modificarem a prática em saúde, hoje focada na doença, para uma prática fundamentada em um conceito ampliado do processo saúde-doença, para que a satisfação das necessidades, anseios e dúvidas dos usuários passem a se constituir em foco de atenção da prática dos enfermeiros. Consideramos necessário utilizar a Educação Permanente no cenário do trabalho em saúde na atenção básica e assim possibilitar uma escuta qualificada dos trabalhadores, em especial, dos enfermeiros que atuam nos serviços de saúde. / This study deals with the practice of graduated nursing professionals who work in services of Primary Health Care Network, especially in the Family Health Strategy (FHS). It aims to analyze how nurses identify and intervene in health needs presented by the users who demand the health services of three Family Health Units, located in the city of Marilia, state of São Paulo, besides to understand the difficulties and facilities of nurses to develop nursing practice, in view of the production of health care. It consists of a descriptive and qualitative study. For data collection, free observation and semi-structured interview were used. The free observation was during the scheduled and possible attendances occurred in the unit and also at the home visit. Participants were three nurses form the FHS in the north zone of the city. For data analysis, the Thematic Content Analysis was used. During the analysis it was possible to identify a thematic unit related to the identification and interventions performed by nurses, who were subjects of this research, and two subunits: episodic events and previous problems and episodic events and current problems. The results showed predominance of the identification of health needs as a synonym of complaints, and in the interventions, the reasoning in biological knowledge prevailed. Regarding the facilities mentioned by the nurses are the bond and autonomy for some procedures, and the difficulties highlighted were the lack of human resources, non-compliance of users in relation to collective activities, among others. Thus it is concluded that investments are needed in training and qualification of nurses to change their practice in health, nowadays focused on the disease, for a practice based on an expanded concept of health-disease process, so that the satisfaction of needs, desires and doubts of the users becomes the focus of nursing care. It is necessary to use the Continuing Education in the setting of health work in primary care and thus provide a qualified listening of workers, especially nurses, who work in health services.

背景: 公共健康護理在香港的演變可以追溯到二十世紀三十年代，但公共衛生護士的培訓卻自一九五四年才正式開始。由於在此領域工作的護士人數相對比醫院護士少，因而令公共衛生護士的貢獻較不明顯。本研究旨在揭示公共衛生護士於一九五四年至二零一零年期間經歷了文化，社會，經濟和政治的變化後在母嬰健康院的發展。研究目的: 檢視公共健康護理的特點，並對公共健康護理在母嬰健康院的工作和改變進行分析，以確定對公共健康護理在母嬰健康院的發展有重大影響的事件和原因。研究方法: 使用研究歷史的方法，重新審視公共衛生護士的經驗。主要研究數據來源是收集退休公共衛生護士和醫療及護理行政人員的口述歷史。輔助數據來源則包括政府文件，個人筆記，照片和剪報。共有37名受訪者同意接受訪問，其中包括六名行政人員和三十一名退休公共衛生護士，年齡由五十多歲到九十歲。研究員以面對面訪談方法收集口述歷史。並以內容分析法處理所得資料。研究結果: 研究結果描繪公共健康護理有六大特點，包括其分類，護理文化，服務重點，健康教育和健康促進的功能，以及展現出護理的藝術和科學。研究結果表明，文化，社會，經濟，政治因素和社會上的重大事件影響了公共健康護理。其中不明顯和被貶值的公共健康護理服務，醫療優勢和行政影響，公共衛生和公共健康護理的意識形態，作為政府人員和公共健康護士的培訓等專業問題影響了公共衛生護士在香港的地位和護理專業。在這項研究中收集的數據也揭露了香港公共健康護理的發展是密切跟隨公共健康的變化，其發展可分為三個階段:從一九五四年到一九七零年是公共健康護理的演化期一九七零年至一九八零年間是靜態期，而一九九零年至二零一零年則是變化期。研究結論和含義: 公共健康護士需要擴大知識和技能，促進專業自主，推行以實證為基礎的護理並記錄護理成果。歷史研究可以幫助解釋過去和加強理解現狀；而歷史對護理亦提供了重大貢獻。 / Background: The evolution of public health nursing in Hong Kong can be traced back to the 1930s but formal training of public health nurses only commenced in 1954. However, as the number of nurses working in this field was small in comparison with hospital nurses, their practice and contribution is largely unknown. Aim: This study aims to reveal the developments in public health nursing practice in Maternal and Child Health Centres (MCHC) from 1954 to 2010. Objectives of this study include examining the characteristics of public health nursing practice and analysing the changes in public health nursing practice in MCHC, as well as identifying the significant events and factors that influenced its development. Methods: The historical research method was adopted to examine the public health nurses’ experiences. The primary data source was derived from the collected oral histories of retired public health nurses and medical and nursing administrators. The secondary data source was obtained from a review of government documents, personal notes, photographs and newspaper cuttings. In total, thirty-seven informants, including six administrators and thirty-one retired public health nurses were interviewed, ranging in age from late 50s to early 90s. Oral histories were taken from face-to-face interviews with these informants. Content analysis was used to analyse the collected information. Results: The study findings depict six characteristics of public health nursing, including its category, nursing culture, focus of service, health education and health promotion function, and the presentation of art and science in practice. Findings also demonstrate the developments and practice of the public health nursing was influenced by cultural, social, economical and political factors and events. In addition, several important professional issues affect the status and professional identity of public health nurses, among them the invisibility of the service and its devalued status, medical dominance and administrative influence, the ideology of public health and public health nursing in Hong Kong, the impact of working for the government and the preparation of public health nurses. Data collected in this study also disclose how developments in public health nursing in Hong Kong closely followed the changes in public health in which the development can be divided in three phases: the evolution of public health nursing from 1954 to 1970s, the static period from 1970s to 1980s and the period of changes from 1990s to 2010. Implications and Conclusions: Public health nurses are suggested to expand their knowledge and skills to further their autonomy, promote evidence-based practice and document nursing outcomes. The study also demonstrates that historical study can help to interpret the past and enhance understanding of the present. History has much to contribute to nursing. / Detailed summary in vernacular field only. / Foong, Mary. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 293-310). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendix H in Chinese. / APPENDICES --- p.xiii / LIST OF TABLES --- p.xiv / LIST OF FIGURES --- p.xv / CHAPTER ONE / INTRODUCTION --- p.1 / Chapter 1.1 --- Aims and objectives of the study --- p.3 / Chapter 1.2 --- Significance of the study --- p.3 / Chapter 1.3 --- Overview of this thesis --- p.4 / CHAPTER TWO / LITERATURE REVIEW --- p.7 / Chapter 2.1 --- Literature search --- p.8 / Chapter 2.2 --- Public health and related terms --- p.9 / Chapter 2.2.1 --- Definition of public health --- p.9 / Chapter 2.2.1.1 --- Characteristics of public health --- p.10 / Chapter 2.2.2 --- Public health in Hong Kong --- p.11 / Chapter 2.2.3 --- Definition of community health --- p.11 / Chapter 2.3 --- Public health nursing and related terms --- p.12 / Chapter 2.3.1 --- Definition and characteristics of public health nursing --- p.12 / Chapter 2.3.2 --- Definition of community health nursing --- p.13 / Chapter 2.3.3 --- Public health nursing versus community health nursing --- p.13 / Chapter 2.3.3.1 --- Differentiation from setting of practice --- p.15 / Chapter 2.3.3.2 --- Differentiation from focus of practice --- p.15 / Chapter 2.3.3.3 --- Differentiation from context --- p.16 / Chapter 2.4 --- Public health nursing and community health nursing in different countries --- p.17 / Chapter 2.4.1 --- Public health nursing and community health nursing in the United States --- p.18 / Chapter 2.4.2 --- Public health nursing and community health nursing in Canada --- p.19 / Chapter 2.4.3 --- Public health nursing and community health nursing in the United Kingdom --- p.19 / Chapter 2.4.4 --- Public health nursing and community health nursing in Asia --- p.20 / Chapter 2.4.5 --- Public health nursing in Hong Kong --- p.23 / Chapter 2.4.6 --- Lesson learned from the differences of public health nursing practice around the world --- p.24 / Chapter 2.5 --- Nursing, history and the history of nursing --- p.25 / Chapter 2.5.1 --- The value of history and nursing history --- p.26 / Chapter 2.5.2 --- The general value of history --- p.26 / Chapter 2.5.3 --- The general value of nursing history --- p.27 / Chapter 2.5.4 --- The value of studying nursing history --- p.27 / Chapter 2.5.5 --- The value of nursing history as suggested by scholars --- p.28 / Chapter 2.5.6 --- The tools to study history --- p.29 / Chapter 2.5.6.1 --- The use of historical research to study history --- p.30 / Chapter 2.5.6.2 --- Standard of historical research --- p.31 / Chapter 2.6 --- Literature review and critique of the previous historical studies --- p.32 / Chapter 2.6.1 --- Summary of the review --- p.45 / Chapter 2.7 --- Conclusion of this chapter --- p.48 / CHAPTER THREE / METHODOLOGY --- p.50 / Chapter 3.1 --- Rationale of selecting a qualitative research method --- p.50 / Chapter 3.2 --- The choice of qualitative method historical research --- p.51 / Chapter 3.3 --- The importance of primary and secondary data sources --- p.52 / Chapter 3.4 --- The relevancy of adopting oral history as the main research strategy and its issues --- p.52 / Chapter 3.4.1 --- An overview of oral history --- p.53 / Chapter 3.4.2 --- Definitions on oral history --- p.53 / Chapter 3.4.3 --- Virtues of oral history --- p.54 / Chapter 3.4.4 --- Issues related to oral history --- p.55 / Chapter 3.4.5 --- Differences between oral history and other qualitative studies --- p.58 / Chapter 3.5 --- Secondary data sources --- p.59 / Chapter 3.6 --- Research procedures --- p.61 / Chapter 3.6.1 --- Ethical consideration and ethical review --- p.61 / Chapter 3.6.2 --- Informed consent --- p.61 / Chapter 3.6.3 --- Sampling method --- p.62 / Chapter 3.6.3.1 --- The use of purposive sampling in qualitative research --- p.63 / Chapter 3.6.3.2 --- The determination of sample size and sample units --- p.63 / Chapter 3.6.3.3 --- Selection of participants --- p.65 / Chapter 3.6.3.3.1 --- Consideration of choosing the retired participants. --- p.66 / Chapter 3.6.3.4 --- Recruitment of participants --- p.66 / Chapter 3.6.3.4.1 --- The sampling process --- p.67 / Chapter 3.6.4 --- Data collection method --- p.67 / Chapter 3.6.4.1 --- Collection of primary data --- p.67 / Chapter 3.6.4.1.1 --- Sequence of interview --- p.68 / Chapter 3.6.4.1.2 --- Setting for interview --- p.68 / Chapter 3.6.4.1.3 --- The process of collecting oral histories --- p.69 / Chapter 3.6.4.1.4 --- Strategies for avoiding personal bias --- p.72 / Chapter 3.6.4.2 --- Collection of secondary data --- p.72 / Chapter 3.6.4.3 --- Data handling and record keeping --- p.73 / Chapter 3.6.4.3.1 --- Handling of primary data --- p.74 / Chapter 3.6.4.3.2 --- Handling of secondary data --- p.74 / Chapter 3.6.5 --- Data analysis --- p.75 / Chapter 3.6.5.1 --- The adoption of content analysis --- p.75 / Chapter 3.6.5.2 --- Process of content analysis --- p.76 / Chapter 3.6.5.2.1 --- Analysis of the primary data --- p.76 / Chapter 3.6.5.2.2 --- Analysis of secondary data --- p.78 / Chapter 3.6.5.2.3 --- Linking the primary and secondary data --- p.79 / Chapter 3.7 --- Rigour of the study --- p.80 / Chapter 3.7.1 --- Quality issues related to qualitative research --- p.80 / Chapter 3.7.2 --- Strategies to enhance the rigour of the study --- p.81 / Chapter 3.7.2.1 --- Strategies applied to ensure credibility --- p.82 / Chapter 3.7.2.2 --- Strategies applied to ensure confirmability --- p.83 / Chapter 3.7.2.3 --- Strategies applied to ensure dependability --- p.84 / Chapter 3.7.2.4 --- Strategies applied to ensure transferability --- p.85 / Chapter 3.8 --- The pilot study --- p.85 / Chapter 3.9 --- Conclusion of this chapter --- p.87 / CHAPTER FOUR / FINDINGS --- p.89 / Chapter 4.1 --- Framework of data handling and presentation --- p.90 / Chapter 4.2 --- Characteristics of the participants --- p.93 / Chapter 4.3 --- The evolution of public health nurses - 1950s --- p.96 / Chapter 4.3.1 --- Data collected from secondary data source --- p.97 / Chapter 4.3.1.1 --- Significant events in the community --- p.97 / Chapter 4.3.1.2 --- The MCHC service --- p.97 / Chapter 4.3.1.3 --- The public health nurses --- p.98 / Chapter 4.3.2 --- Oral histories from the public health nurses --- p.102 / Chapter 4.3.2.1 --- Training of public health nurses --- p.103 / Chapter 4.3.2.1.1 --- Scope of training --- p.103 / Chapter 4.3.2.2 --- Selection of the public health field --- p.105 / Chapter 4.3.2.3 --- Perception of public health nursing duties --- p.106 / Chapter 4.3.2.4 --- Public health nursing practice in IWC --- p.108 / Chapter 4.3.2.5 --- Identifying factors which influenced public health nursing development --- p.112 / Chapter 4.3.2.6 --- Qualities of good public health nurses --- p.114 / Chapter 4.4 --- Challenges from socio-cultural and economical influences 1960 -1969 --- p.114 / Chapter 4.4.1 --- Data collected from secondary data source --- p.114 / Chapter 4.4.1.1 --- Significant events in the community --- p.116 / Chapter 4.4.1.2 --- The MCHC service --- p.117 / Chapter 4.4.1.3 --- The public health nurses --- p.118 / Chapter 4.4.2 --- Oral histories from the public health nurses --- p.119 / Chapter 4.4.2.1 --- Training of public health nurses --- p.119 / Chapter 4.4.2.1.1 --- Scope of training --- p.120 / Chapter 4.4.2.2 --- Selection of the public health field --- p.121 / Chapter 4.4.2.3 --- Perception of public health nursing duties --- p.121 / Chapter 4.4.2.4 --- Public health nursing practice in MCHC --- p.122 / Chapter 4.4.2.5 --- Identifying factors which influenced public health nursing development --- p.125 / Chapter 4.4.2.6 --- Qualities of good public health nurses --- p.129 / Chapter 4.5 --- The increasingly affluent period 1970 -1979 --- p.130 / Chapter 4.5.1 --- Data collected from secondary data source --- p.130 / Chapter 4.5.1.1 --- Significant events in the community --- p.132 / Chapter 4.5.1.2 --- The MCHC service --- p.133 / Chapter 4.5.1.3 --- The public health nurses --- p.134 / Chapter 4.5.2 --- Oral histories from the public health nurses --- p.134 / Chapter 4.5.2.1 --- Training of public health nurses --- p.135 / Chapter 4.5.2.1.1 --- Scope of training --- p.135 / Chapter 4.5.2.2 --- Selection of the public health field --- p.136 / Chapter 4.5.2.3 --- Perception of public health nursing duties --- p.136 / Chapter 4.5.2.4 --- Public health nursing practice in MCHC --- p.139 / Chapter 4.5.2.4.1 --- Health education activities --- p.139 / Chapter 4.5.2.4.2 --- Home visiting --- p.140 / Chapter 4.5.2.4.3 --- Serving clients with different backgrounds --- p.141 / Chapter 4.5.2.5 --- Identifying factors which influenced public health nursing development --- p.145 / Chapter 4.5.2.6 --- Qualities of good public health nurses --- p.145 / Chapter 4.6 --- The impact of the political scenes 1980 1989 --- p.147 / Chapter 4.6.1 --- Data collected from secondary data source --- p.147 / Chapter 4.6.1.1 --- Significant events in the community --- p.147 / Chapter 4.6.1.2 --- The MCHC service --- p.148 / Chapter 4.6.1.3 --- The public health nurses --- p.149 / Chapter 4.6.2 --- Oral histories from the public health nurses --- p.150 / Chapter 4.6.2.1 --- Training of public health nurses --- p.150 / Chapter 4.6.2.1.1 --- Scope of training --- p.151 / Chapter 4.6.2.2 --- Selection of the public health field --- p.152 / Chapter 4.6.2.3 --- Perception of public health nursing duties --- p.153 / Chapter 4.6.2.4 --- Public health nursing practice in MCHC --- p.154 / Chapter 4.6.2.5 --- Identifying factors which influenced public health nursing development --- p.156 / Chapter 4.6.2.5.1 --- Factors not influencing public health nursing --- p.156 / Chapter 4.6.2.5.2 --- Factors influencing public health nursing --- p.157 / Chapter 4.6.2.6 --- Qualities of good public health nurses --- p.161 / Chapter 4.7 --- 1990- 1999 Before and after the new era; the transition of political parties --- p.162 / Chapter 4.7.1 --- Data collected from secondary data source --- p.162 / Chapter 4.7.1.1 --- Significant events in the community --- p.162 / Chapter 4.7.1.2 --- The MCHC Service --- p.164 / Chapter 4.7.1.3 --- The public health nurses --- p.164 / Chapter 4.7.2 --- Oral histories from the public health nurses --- p.166 / Chapter 4.7.2.1 --- Training of public health nurses --- p.166 / Chapter 4.7.2.1.1 --- Scope of training --- p.167 / Chapter 4.7.2.2 --- Selection of the public health field --- p.168 / Chapter 4.7.2.3 --- Perception of public health nursing duties --- p.170 / Chapter 4.7.2.4 --- Public health nursing practice in MCHC --- p.172 / Chapter 4.7.2.4.1 --- Health education activities --- p.172 / Chapter 4.7.2.4.2 --- Home visiting --- p.173 / Chapter 4.7.2.4.3 --- Serving clients with different backgrounds --- p.175 / Chapter 4.7.2.4.4 --- Child developmental screening service --- p.176 / Chapter 4.7.2.4.5 --- Trail of various service delivery approaches --- p.177 / Chapter 4.7.2.5 --- Identifying factors which influenced public health nursing development --- p.178 / Chapter 4.7.2.5.1 --- Factors not influencing public health nursing --- p.178 / Chapter 4.7.2.5.2 --- Factors influencing public health nursing --- p.179 / Chapter 4.7.2.6 --- Qualities of good public health nurses --- p.184 / Chapter 4.8 --- Years of change after 2000 --- p.185 / Chapter 4.8.1 --- Data collected from secondary data source --- p.185 / Chapter 4.8.1.1 --- Significant events in the community --- p.185 / Chapter 4.8.1.2 --- The MCHC service --- p.188 / Chapter 4.8.1.3 --- The public health nurses --- p.190 / Chapter 4.8.2 --- Oral histories from the public health nurses --- p.193 / Chapter 4.8.2.1 --- Training of public health nurses --- p.193 / Chapter 4.8.2.1.1 --- Scope of training --- p.194 / Chapter 4.8.2.2 --- Selection of the public health field --- p.194 / Chapter 4.8.2.3 --- Perception of public health nursing duties --- p.195 / Chapter 4.8.2.4 --- Public health nursing practice in MCHC --- p.196 / Chapter 4.8.2.5 --- Identifying factors which influenced public health nursing development --- p.198 / Chapter 4.8.2.5.1 --- Factors not influencing public health nursing --- p.198 / Chapter 4.8.2.5.2 --- Factors influencing public health nursing --- p.199 / Chapter 4.8.2.6 --- Qualities of good public health nurses --- p.206 / Chapter 4.9 --- Oral histories from the administrators --- p.207 / Chapter 4.9.1 --- Training of public health nurses --- p.207 / Chapter 4.9.1.1 --- Scope of training --- p.209 / Chapter 4.9.1.2 --- Perception of public health nursing duties --- p.211 / Chapter 4.9.1.3 --- Public health nursing practice in MCHC --- p.213 / Chapter 4.9.1.4 --- Identifying factors which influenced public health nursing development --- p.216 / Chapter 4.9.1.5 --- Qualities of good public health nurses --- p.221 / Chapter 4.10 --- Conclusion of this chapter --- p.222 / CHAPTER FIVE / DISCUSSION --- p.225 / Chapter 5.1 --- A sketch of the working life of public health nurses --- p.225 / Chapter 5.2 --- The three research objectives --- p.227 / Chapter 5.2.1 --- Research objective one: The characteristics of public health nursing in Hong Kong --- p.229 / Chapter 5.2.1.1 --- Categories of public health nurses in Hong Kong --- p.229 / Chapter 5.2.1.1.1 --- Public health nurse title as defined by organisation --- p.229 / Chapter 5.2.1.1.2 --- Public health nurse title as defined from training --- p.231 / Chapter 5.2.1.1.3 --- Ranking of public health nurses --- p.232 / Chapter 5.2.1.2 --- Nursing culture --- p.233 / Chapter 5.2.1.3 --- Population-focused service in MCHC --- p.234 / Chapter 5.2.1.4 --- Nursing practice on health education, health promotion and direct care --- p.237 / Chapter 5.2.1.5 --- The invisible service --- p.238 / Chapter 5.2.1.6 --- The presentation of art and science in public health nursing --- p.239 / Chapter 5.2.2 --- Research objectives two: the changes of public health nursing practice during the study period --- p.241 / Chapter 5.2.2.1 --- The delineation of the development of public health nursing practice in MCHC from 1954 to 2010 --- p.241 / Chapter 5.2.2.1.1 --- The first phase of development: 1954 to the 1970s and the evolution of public health nurses --- p.242 / Chapter 5.2.2.1.2 --- The second phase of development: 1970s to 1980s a static period in the public health nursing service --- p.243 / Chapter 5.2.2.1.3 --- The third phase of development: 1990s to 2010s a period of changes --- p.244 / Chapter 5.2.2.2 --- Predominant features in the development --- p.246 / Chapter 5.2.2.2.1 --- Perceived decrease of autonomy --- p.246 / Chapter 5.2.2.2.2 --- Generational differences among nurses influence job satisfaction --- p.247 / Chapter 5.2.2.2.3 --- The cessation of home visits --- p.248 / Chapter 5.2.3 --- Research objective three: significant events and factors influencing public health nursing development --- p.250 / Chapter 5.2.3.1 --- The influence of significant events happened in the community --- p.251 / Chapter 5.2.3.2 --- Devaluation of the service and the invisibility of the practice --- p.254 / Chapter 5.2.3.3 --- Medical dominance, administrative influences and manpower factors --- p.257 / Chapter 5.2.3.4 --- Impact of working for a government organisation --- p.260 / Chapter 5.2.3.5 --- The ideology of public health and public health nurses in Hong Kong --- p.262 / Chapter 5.2.3.6 --- The good practice model initiated by the earlier public health nurses --- p.265 / Chapter 5.2.3.7 --- Training of public health nurses --- p.267 / Chapter 5.3 --- History, historical research and nursing --- p.271 / Chapter 5.4 --- Conclusion of this chapter --- p.276 / CHAPTER SIX / CONCLUSIONS --- p.278 / Chapter 6.1 --- Strengths of the study --- p.278 / Chapter 6.2 --- Limitations of the study --- p.279 / Chapter 6.2.1 --- Shortcomings of historical research --- p.280 / Chapter 6.2.2 --- Threats to internal and external criticism --- p.280 / Chapter 6.3 --- Implications for nursing research, practice and education --- p.282 / Chapter 6.3.1 --- Research --- p.282 / Chapter 6.3.1.1 --- Methodology --- p.282 / Chapter 6.3.1.2 --- Further research questions and new interpretations on history --- p.284 / Chapter 6.3.2 --- Education --- p.287 / Chapter 6.3.2.1 --- Content of nursing curricula related to nursing history --- p.287 / Chapter 6.3.2.2 --- Teaching historical research methodology --- p.288 / Chapter 6.3.2.3 --- Strengthen training on public health nursing --- p.288 / Chapter 6.3.3 --- Practice --- p.289 / Chapter 6.4 --- Conclusion of this chapter --- p.291 / REFERENCES --- p.293