Programa saúde da família: espaço instituinte de produção de qualidade de vida e de novas práticas de Enfermagem

Abstract

The objectives of the study were: analyze the implembntation of the Family Health Program in the context of the Public Policies of São Gonçalo cio Amarante town, Ceará, Northeast of Brasil, checking if these policies break with the centralizirig doctrines and tend to move forward with intersectorial actions, which are able to iníluence the factors and/or indicators of life quality of the population of the town mentíoned; analyze the nature of the nursing practices in this Program, while instítutors of new ways of promoting health, and, specifically, obtaining the indicators of life quality of São Gonçalo do Amarante; examine if these indicators are consídered by the Family Health Program as a basis for specific actions of collective impact, The qualitative and quantitative methods were used, bearing in mind the goal of correlating life conditions with implementation of public policies and the tendency of the nursing practices, The combination of these ways has an identification with the histórica! materialism, for which this researcher opted for admitting the possibility of emphasizing the simultaneity and complementarity of two kinds of phenomena: the subjective meaníng of human actions and the objective essence of society. The population of the First phase of the research was composed of the 3800 registered families in that moment, in the Family Health Program, in São Gonçalo do Amarante town, in Ceará. The sample is made up of 150 families. The data collection in the families was conducted from March to June 2001 and took píace in two stages: collection of the data for formation of the indicator of life conditions, in which the construction of the composite indicator was chosen; collection of the data related to the indicators of health and tendencies of the Family Health Program. The second moment of the research consisted of the identification of the nursing practice in the Family Health Program. I used questionnaires, serni-structured interview, participatory observation and field agenda. According to the results, it was possible to identify this: 37% of the town’ population has a very low instruction levei; 26% live in precarious dwellings; 82% of the family heads have low participation in labor market and 50% have an income between 0,00 and 100,00 $R. The indicator composed by those categories showed that almost the half (47%) of the population of São* Gonçalo do Amarante lives in a poverty State. The public policies that have been implemented in the town represent mosíly the^possibility of meeting the needs according to the concept of the social minima, what strengthens the understanding of the centralizing nature of the Family Health Program. Concerning the nursing practice, the study showed that the nurses identify the Program as transforming the assístantial model. However, most of the time the nurses lack an understanding of the reallíy through the praxis, in order to comprehend the historícal-social process of the health-disease as a basíc tool for transformatíon of a practice centered on the biological to care for health. This fact is evidenced by: the acceptance of ministerial norms which focus their actions on the consultation habit and prescription of medicines; the dissociation of the practice nucleus with the caretaker dimension of the individual and the collecíiviíy; the importance given to the more independent practice in the Program, disconstructing the theoretical grounding of the interdisciplinary work or presenting tendencies of changes operationalized by the reforms in the health legitimatization system related to mechanisms of interaction between the work process and the legitimatization of a new practice field. From those evidences, l could conclude that the Family Health Program can form a field that favors the appearance of a new practice of the profession. However, at the moment, I could already observe that the nurses have used the consultation as space for shelter and for education in health, what ís delineating a new kind of practice which is establishing links among the professionals/patients, and patients and Service.