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[巴西圣保罗市初级保健服务中高危妊娠妇女的护理:医疗团队的视角]

[Care for women with high-risk pregnancies in primary care services in the city of São Paulo, Brazil: the healthcare team's perspective].

作者信息

Sanine Patricia Rodrigues, Venancio Sonia Isoyama, Silva Fernanda Luz Gonzaga da, Tanaka Oswaldo Yoshimi

机构信息

Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, Brasil.

Instituto de Saúde, Secretaria de Estado da Saúde Pública de São Paulo, São Paulo, Brasil.

出版信息

Cad Saude Publica. 2021 Nov 22;37(11):e00286120. doi: 10.1590/0102-311X00286120. eCollection 2021.

Abstract

The study aimed to evaluate care for women with high-risk pregnancies from the healthcare team's perspective in primary healthcare (PHC) services in the city of São Paulo, Brazil. This is an evaluative study with a qualitative approach that used the open interview technique for data collection from PHC personnel. The data were explored through thematic categories built from the content emerging spontaneously from the interviews, discussed according to Health Work Process Theory. The results evidenced three domains: a "normal work routine", organized from the perspective of exclusively biological practices and in which the management model sometimes fails to allow compliance with the recommended practices; a "referral and counter-referral" system, which sometimes allows more timely interventions, more unique to the pregnant women's needs, but still disconnected from the referral services; and "shared responsibility of the PHC team for the pregnant woman", characterized by flexibilization of the work routine that extends beyond application of clinical protocols, encouraging the building of a bond and favoring qualification of care. The study revealed the need for flexibilization of use of patient care protocols in the work process, which can promote the shared responsibility of PHC teams for care, to adjust it to each pregnant woman's unique needs, beyond the limits of services' organization based on the logic of exclusively biological practices.

摘要

该研究旨在从医疗团队的角度评估巴西圣保罗市初级卫生保健(PHC)服务中对高危妊娠妇女的护理情况。这是一项采用定性方法的评估研究,运用开放式访谈技术从初级卫生保健人员处收集数据。通过根据访谈中自然浮现的内容构建的主题类别对数据进行探究,并依据卫生工作流程理论进行讨论。结果表明存在三个领域:一个“正常工作流程”,从纯粹的生物学实践角度组织,其中管理模式有时无法确保遵循推荐的实践;一个“转诊和反向转诊”系统,有时能实现更及时的干预,更符合孕妇的需求,但仍与转诊服务脱节;以及“初级卫生保健团队对孕妇的共同责任”,其特点是工作流程灵活化,超越了临床方案的应用,鼓励建立联系并促进护理质量提升。该研究揭示了在工作过程中需要灵活运用患者护理方案,这可以促进初级卫生保健团队对护理的共同责任,根据每位孕妇的独特需求进行调整,超越基于纯粹生物学实践逻辑的服务组织限制。

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