O engenho por dentro: cartografia das práticas cotidianas de cuidado em saúde mental dos auxiliares e técnicos de enfermagem na perspectiva da integralidade / Cartography of everyday mental health care practices of the nursing staff within the integral care perspective

Discutem-se os processos de trabalho e de produção do cuidado dos auxiliares e técnicos de enfermagem do Núcleo de Atenção à Crise do Instituto Municipal de Assistência à Saúde Nise da Silveira, no contexto da desinstitucionalização, e seus efeitos na integralidade do cuidado. O foco de análise repousa sobre o cuidado cotidiano prestado por esses profissionais nas unidades de internação psiquiátrica. Buscou-se realizar uma reflexão sobre os aspectos contemporâneos do cotidiano da assistência psiquiátrica e o papel dos hospitais psiquiátricos no atendimento aos pacientes agudos. Para tal objetivou-se, especificamente: contextualizar o IMNS no cenário de saúde mental no município do Rio de Janeiro; descrever as práticas assistenciais de auxiliares e técnicos de enfermagem no cuidado aos pacientes agudos internados; e discutir as práticas de cuidado no contexto da reorientação do modelo hospitalar e suas repercussões na integralidade da assistência em saúde, buscando contradições e aproximações com o discurso da política de saúde mental vigente. Foram abordadas na fundamentação teórica: as questões da prática da equipe de saúde sob o eixo da integralidade, em especial da equipe de enfermagem, e a relação trabalho/saúde/cotidiano na construção dos processos de trabalho e de produção do cuidado da assistência prestada. Como abordagem teórico- metodológica que possibilitou alcançar o objetivo proposto, realizou-se estudo exploratório, de natureza qualitativa, na perspectiva da cartografia, tendo na observação participante seu principal elemento de coleta de dados. O mapeamento das práticas rotineiras de cuidado evidenciou que estas são predominantemente pautadas no modelo asilar, no qual auxiliares e técnicos desempenham suas atividades diárias de modo distanciado dos pacientes e de suas necessidades...

Development of the New Zealand nursing workforce: historical themes and current challenges.

Development of the New Zealand nursing workforce has been shaped by social, political, scientific and interprofessional forces. The unregulated, independent and often untrained nurses of the early colonial period were succeeded in the early 1900s by registered nurses, with hospital-based training, working in a subordinate role to medical practitioners. In the mid/late 1900s, greater specialisation within an expanding workforce, restructuring of nursing education, health sector reform, and changing social and political expectations again reshaped nursing practice. Nursing now has areas of increasing autonomy, expanding opportunities for postgraduate education and leadership roles, and a relationship with medicine, which is more collaborative than in the past. Three current challenges are identified for nursing in New Zealand's rapidly evolving health sector; development of a nursing-focused knowledge culture, strengthening of research capacity, and dissemination of new nursing knowledge.

Swedish child health care in a changing society.

BACKGROUND: Staff in Swedish child health care today feel a gap between policy and practice. By revealing the main lines in the development of child health care, we hoped to achieve a better understanding of the current trends and problems in today's Swedish child health care. METHODS: A selection of official documents about the development of child health care during the period 1930-2000 was studied with the aid of discourse analysis. RESULTS: Four discourses were identified, which serve as a foundation for a periodization of the development of child health care. In the first period the main task of child health care, alongside checking on the development of the child, was to inform and educate the mothers. During the second period health supervision became the crucial task, to identify risks and discover abnormalities and disabilities. The third period focused on the discussion concerning the identification of health-related and social 'risk groups', and the work of child health care was increasingly geared to supervision of the parents' care of their children. Parents were to be given support so that they could cope with their difficulties by themselves. During the current period child health care is increasingly expected to direct its work towards the child's surroundings and the family as a whole and is now explicitly defined as an institution that should strengthen parents' self-esteem and competence. The level of responsibility for the child's health changed gradually during the different periods, from public responsibility to parental responsibility. The focus of efforts in child health care was changed from being general in the first and second periods to general and selective in period three, and then gradually becoming selective again in period four. While control of the child's physical health was central during the first two periods, psychosocial health came into focus in the last two, along with the importance of supporting the parents to enable them to handle their difficulties by themselves. CONCLUDING REMARKS: We noted that it was difficult to translate policy recommendations into practice. One reason was the shifting focus in child health care from the child's physical health to psychosocial problems which in itself meant a shift from descriptions of concrete and well-defined duties to more abstract and general descriptions of tasks which are by definition open to interpretation. Another reason for the noted difficulty was the transition from unambiguously described measures in terms of paternalistic regulation to more participatory and at the same time more expansive definitions of roles and responsibilities.

O discurso da sexualidade como eixo de instrução da enfermagem moderna / The discourse of sexualism how axle of instruction of modern nursing

Estudo da formaçäo de identidade profissional da Enfermeira a partir da biografia do mito de origem da Enfermagem Moderna, Miss Florence Nightingale, e o contexto histórico anterior e contemporâneo à sua vida, na medida em que o sistema de formaçäo de enfermeiras dominante no Brasil, desde sua implantaçäo até nossos dias, é o sistema Nightingale. A chamada Enfermagem Moderna tem nascimento no séc. XIX, na Inglaterra Vitoriana, näo apenas ligada à pessoa de Florence Nightingale, mas absolutamente decorrente das suas idéias e das suas propostas de trabalho. Este mito de origem näo isento de contradiçöes, mantém seus princípios norteadores até nossos dias, mas näo sem dificuldades e está presente no ideário popular, oscilando um certo dualismo entre o sagrado e o profano