Percepções de enfermeiros sobre a longitudinalidade em seu trabalho na estratégia saúde da família

Abstract

The longitudinality refers to lasting relationship established between health professional and user, and constitute an important and exclusive attribute of Primary Health Care (PHC). The literature on the subject is scarce, but points benefits such as: better recognition of the users' needs, more accurate diagnosis, reduce of costs and hospitalizations, better health promotion and prevention, and bigger user satisfaction. This study aimed to understand the perception of nurses that work in Family Health Strategy (FHS) in the scope of 10th Regional Health (RH) of Paraná about the longitudinality of care in nurse's work. This is a descriptive exploratory study with qualitative research, achieved with 20 nurses that work in FHS teams in seven municipalities in the scope of 10th RH. The data were collected in April 2010 through taped semi-structured interviews, that were transcribed and, later, submitted to the categorical content analysis (Bardin), having as a conceptual base for longitudinality the conceptual presuppositions of Starfield. The results showed that nurses understand the longitudinality as something lasting, seeing the individual in its entirety. Nurses emphasized that the team is participatory, being the Community Health Agent considered important element in population monitoring, and the doctor the less integrated professional in interdisciplinary actions. Nurses understand the link as important to have the longitudinality, they understand it as humanized relationships based in confidence, believing that its establishment happens because of competence and problem solving / quality of the professional actions, being also facilitated by the user's interest and constant contact with him, and limited before rotation of the population and when the care stay restricted to the unit. Nurses develop the longitudinality through activities for individuals (especially home visits) and for community (meetings, groups, lectures). In assistance provide to the different life cycles, the longitudinal care occurs more frequently between children and the elderly people, do not letting to exist for women and sick people, but with adolescents and adult men that care practically does not occur, unless when they have any chronic illness. To carry out the longitudinality, there are some factors that facilitate this care practice: proposals of the FHS, teamwork, resource availability, co participation of population and adscription population associated to the time working on the same unit. However, the nurse also meets some obstacles, that need to be modified, therefore, it was verified a need for bigger availability of human resources, materials and physical structure, change in the population view, achievement of multi-professional actions, profile to act in FHS , professional capacitation, professionals hiring, improvements in working conditions, public transport and road maintenance, execution of the FHS proposals, link between users and professionals, and improve the system of counter reference. It was concluded, through the nurses' perception that longitudinality is a reality in professionals' everyday, and is closely related to the FHS principles. It is emphasized that the occurrence of longitudinal care needs to occur beyond the illness episodes and to permeate the assistance at all stages of development, not only to priority age groups and with bigger demand.