889
NURSES’ PRACTI CES AT HEALTH BASI C UNI TS I N A CI TY I N THE SOUTH OF BRAZI L
Taís Mar ia Nauder er1 Maria Alice Dias da Silva Lim a2
Nauderer TM, Lim a MADS. Nurses’ pract ices at healt h basic unit s in a cit y in t he Sout h of Brazil. Rev Lat ino- am Enfer m agem 2 0 0 8 set em br o- out ubr o; 1 6 ( 5 ) : 8 8 9 - 9 4 .
On Public Healt h, nur ses can influence t he car e of t he healt h needs of t he populat ion. The obj ect iv e of t his paper is t o feat ur e and under st and t he pr act ices of nur ses w or k ing at Healt h Basic Unit s. I t is a qualit at iv e r esear ch w her eby sem i- st r uct ur ed int er v iew s w er e m ade w it h 15 nur ses w ho w or k at Por t o Alegr e- Br asil. The t r eat m en t of t h e dat a w as based on an aly sis of con t en t of t h e t h em at ic t y pe. Ou t com es in dicat e t h at t h e act iv it ies per for m ed by nur ses ar e influenced by t he Healt h Sy st em and it s lim it at ions, especially t he lack of nursing workers. Nurses are sought t o solve problem s t hat are not always relat ed wit h t heir work, dem onst rat ing t h e d iv er sit y of t h eir p r act ices. Th e con clu sion is t h at t h e p r esen ce of n u r ses in t h e d aily car e an d t h eir ar t iculat ing r ole cont r ibut es t o change t he r ealit ies of healt h.
DESCRI PTORS: com m unit y healt h nur sing; public healt h nur sing; nur se’s r ole; healt h cent er s
LAS PRÁCTI CAS DE ENFERMEROS EN UNI DADES BÁSI CAS DE SALUD EN UN
MUNI CI PI O DEL SUR DE BRASI L
En la Salu d Colect iv a los en fer m er os pu eden in flu ir efect iv am en t e en la at en ción de las n ecesidades de la salud de las poblaciones. El obj et ivo de est e est udio es caract erizar y com prender las práct icas de los enferm eros en Unidades Básicas de Salud. Se t rat a de una invest igación cualit at iva, en la cual fueron realizadas ent revist as sem i- est r uct ur adas con 15 enfer m er os act uant es en Puer t o Alegr e, Br asil. Los dat os fuer on t r at ados con base en el an álisis d e con t en id o d el t ip o t em át ico. Los r esu lt ad os in d ican q u e las accion es ej ecu t ad as p or los en f er m er os son in f lu en ciad as p or el sist em a d e la salu d y p or su s lim it acion es, esp ecialm en t e la f alt a d e t r abaj ador es. Los enfer m er os son solicit ados par a r esolv er pr oblem as que no siem pr e pr esent an una r elación con su t r abaj o, dem ost r ando la diver sidad de sus pr áct icas. Se concluye que la pr esencia del enfer m er o en lo cot idiano y su papel ar t iculador cont r ibuy en par a m odificar las r ealidades de la salud.
DESCRI PTORES: enfer m er ía en salud com unit ar ia; enfer m er ía en salud pública; r ol de la enfer m er a; cent r os de salud
PRÁTI CAS DE ENFERMEI ROS EM UNI DADES BÁSI CAS DE SAÚDE EM
MUNI CÍ PI O DO SUL DO BRASI L
Na Saúde Colet iva, os enfer m eir os podem influir efet ivam ent e no at endim ent o das necessidades de saúde das populações. O obj et iv o dest e est udo é car act er izar e com pr eender as pr át icas dos enfer m eir os em unidades básicas de saú de. Tr at a- se de pesqu isa qu alit at iv a, n a qu al f or am r ealizadas en t r ev ist as sem i- est r u t u r adas com 15 enfer m eir os at uant es em Por t o Alegr e, RS, Br asil. Os dados for am t r at ados com base na análise de cont eúdo do t ipo t em át ica. Os result ados indicam que as ações execut adas pelos enferm eiros são influenciadas pelo sist em a de saúde e suas lim it ações, especialm ent e a falt a de t rabalhadores. Os enferm eiros são procurados par a r esolv er pr oblem as que nem sem pr e apr esent am r elação com seu t r abalho, dem onst r ando a div er sidade de suas pr át icas. Con clui- se que a pr esença do enfer m eir o no cot idiano e seu papel ar t icu lador con t r ibuem par a m odificar as r ealidades de saúde.
DESCRI TORES: enfer m agem em saúde com unit ár ia; enfer m agem em saúde pública; papel do pr ofissional de en fer m agem ; cen t r os de saú de
1
M.Sc. in Nursing, Facult y, Cent ro Universit ário FEEVALE, Brazil, e- m ail: t nauderer@hot m ail.com ; 2 Ph.D. in Nursing, Associat e Professor, School of Nursing, Rio Grande do Sul Federal Universit y, Brazil, e- m ail: m alice@enf.ufrgs.br.
Art igo Original Rev Lat ino- am Enferm agem 2008 set em bro- out ubro; 16( 5) : 889- 94
w w w .eer p.usp.br / r lae
I NTRODUCTI ON
P
ublic Healt h is considered a privileged area f o r N u r s i n g a n d f o r t e a m w o r k , w h e r e e a c h p r o f e s s i o n a l k e e p s t h e i r s p a c e a n d a r e a o f com pet ence and r esponsibilit y( 1). I n t his field, nur ses h av e f ou n d a br oad space t o dev elop t h eir r ou t in e w or k( 2 ), decidin g on t h eir act ion s, est ablish in g h ow t hey do t heir work and keeping considerable aut onom y in t heir pract ices, since t he care m odel provide t hem g r e a t e r f r e e d o m t o u s e s p a c e s t o c h a n g e l o c a l r ealit ies.Healt h services and t heir st ruct ures influence t h e w or k of n u r ses; h ow ev er, t h ey can f in d escape lines in t his cont ext and look for alt ernat ives different fr om t hose t r adit ionally used for t he sit uat ions. This e s c a p e l i n e s c a n m a k e w o r k e r s c h a n g e c e r t a i n r ealit ies, u sin g t h e r esou r ces f ou n d in t h e ser v ices a n d e m p l o y i n g a s o c i a l v i e w , r a t h e r t h a n o n l y b i o l o g i c a l , o f t h e b o d y, t h u s d e m o n s t r a t i n g u n d er st a n d i n g o f t h e so ci a l d et er m i n a t i o n o f t h e healt h- disease pr ocess, pr oposed by Public Healt h( 1). Fr om t h is p er sp ect iv e, w e u n d er st an d t h at escape lines can also dem onst r at e how nur ses hav e act ed t o t r an sf or m t h eir w or k . Becau se Collect iv e Healt h is a field where professionals est ablish priorit ies of act ion, t he following quest ion is always posed: What are t he charact erist ics of nurses in prim ary care? What aspect s influence building up t hese pr act ices?
The per spect iv e of t his st udy m ak es nur sing pract ices, social pract ices t hat go beyond t he t echnical a n d p r o f e s s i o n a l d i m e n s i o n , a n d c o n s i d e r t h e d y n a m i c s t h a t i n c l u d e b u i l d i n g o f k n o w l e d g e , socioeconom ic and polit ical reproduct ion and insert ion of indiv iduals in t his cont ex t . Thus, nur sing w or k is underst ood as present ing a social end wit h a biological per spect iv e an d t h at also in clu des psy ch osocial an d cult ur al aspect s( 3).
The field of com pet ence and responsibilit y of nurses in healt h t eam is care. I n t he field of Collect ive Healt h, professionals develop several act ivit ies t o care for users of t hese services( 1). These act ivit ies are t he bases of t heir w or k and t he m eans t hey use t o look for changes in t he r ealit y.
This ar t icle, w r it t en fr om a m ast er ’s t hesis( 4) aim s at : f eat u r in g an d u n d er st an d in g p r act ices of nur ses in Basic Healt h Unit s.
METHOD
This is a qualit at iv e st udy( 5 ). Par t icipant s of t his sur v ey w er e 15 nur ses w or k ing at Basic Healt h
Un i t s ( UBS) i n t h e ci t y o f Po r t o Al eg r e. We h av e int ent ionally select ed t w o dist rict m anagem ent of t he
cit y t h at agr eed an d w er e av ailable t o t ak e par t in t h e s t u d y. B o t h m a n a g e m e n t s e n c o m p a s s e d
populat ion ar eas w it h poor socioeconom ic condit ions and dw eller s in r isk sit uat ions.
As a t echnique for dat a collect ion, w e hav e used sem i- st r uct ur ed indiv iduals int er v iew s( 5), based
on a script , and wit h quest ions m ade from findings of t h e l i t e r a t u r e a n d t h e o b j e c t i v e s o f t h e s t u d y.
I nt er v iew s w er e conduct ed in July and August 2006. We h a v e o b t a i n ed a u t h o r i za t i o n f r o m t h e
coordinat or of t he Prim ary Care Net of t he Cit y Healt h
Secr et ar i at an d t h e p r o j ect w as ap p r o v ed b y t h e Et h i cal Resear ch Co m m i t t ee acco r d i n g t o p r o cess
# 001.034383.03.9. Each int er v iew ed nur se r eceiv ed a w rit t en inform ed consent ensuring t he prerogat ives
based on t h e Resolu t ion # 1 9 6 / 9 6 , of t h e Nat ion al Healt h Cou n cil.
To t r e a t d a t a , w e h av e u se d t h e co n t e n t
analy sis t echnique and t hem at ic analy sis( 6).
RESULTS AND DI SCUSSI ON
I n t er v i ew s p er f o r m ed w i t h n u r ses sh o w ed
dif f er en t r ealit ies in each of t h e Basic Healt h Un it s r esear ch ed , w i t h co n t r ast s i n w o r k i n g co n d i t i o n s,
pr ofessional concept ions r egar ding t heir w or k, and in t he pr act ices per for m ed in t heir r out ine.
Act ivit ies of nur ses in t heir w or k r out ine
The act iv it ies of nur ses can be classified as: m anagem ent act ivit ies in t he Healt h Unit ; coordinat ion
act iv it ies, or g an izat ion , t r ain in g , con t r ol of n u r sin g w or k ; in d iv id u al car e act iv it ies, an d collect iv e car e
act iv it ies( 7 ).
Sev er al act iv it ies w er e m ent ioned by nur ses
as par t of t heir r out ine w or k . Descr ipt ion pr esent ed her e does not ent ail all act ivit ies per for m ed by t hem
at UBSs in Port o Alegre, but t hey are only represent ing t h o s e t h a t w e r e m o s t c o m m o n l y m e n t i o n e d b y
pr ofessionals dur ing dat a collect ion.
Ex am p les of m an ag em en t act iv it ies in t h e H e a l t h Un i t w e r e r e p o r t i n g d i se a se s, a sk i n g f o r
m at erials, scheduling appoint m ent s in t he healt h unit , scheduling appoint m ent s wit h specialist s in t he cent ral
of appoint m ent s, and writ ing several t ypes of report s. All n u r ses in t er v iew ed p oin t ed ou t as p ar t of t h eir
891
Heat h Unit and t he act ions of t he t eam w er e under
t heir r esponsibilit y.
Ex am ples of coor dinat ion, or ganizat ion, and
t r ain in g act iv it ies, an d con t r ol of t h e w or k of t h e
n u r si n g t e a m m e n t i o n e d w e r e : cl o ck i n r e co r d s,
r ecor d in g ab sen ces, or g an izin g sh if t s, d ay - of f an d
h oliday s, su per v isin g t eam s in t h e t ask s per f or m ed
in healt h unit ( wound dressings, welcom ing, vaccines) .
I ndividual care act ivit ies included: welcom ing,
h om e v isit s, n u r sin g ap p oin t m en t s in t h e f ollow in g
pr ogr am s ( pr á- nenê ( for babies) , hiper dia, w om en’s
h ealt h , an d p r en at al, p r á- v id a ( f or lif e) , sm ok in g ,
g u i d a n c e f o r c h i l d r e n w i t h a s t h m a ) , v a c c i n e
a p p l i c a t i o n , p e r f o r m a n c e o f Gu t h r i e t e s t ,
cyt opat hologic collect ion, screenings t o prevent breast
can cer, p lacin g u r in ar y p r ob es, p er f or m in g su r g ical
dr essing, check ing blood t ension, blood glucose t est ,
r e q u e s t i n g e x a m i n a t i o n s , a s s e s s i n g l a b o r a t o r y
ex am in at ion s r equ ir ed b y phy sician s ( X- Ray, scan s,
ECG) , a s s e s s m e n t i n t e r v i e w w i t h c o u p l e s f o r
vasect om y, on t he count er services. recept ion service,
and giv ing m edicat ions.
Ex a m p l e s o f c o l l e c t i v e a c t i v i t i e s w e r e :
educat ion groups for fam ily planning, sm oking groups,
diabet es groups, ast hm a groups and pediat ric groups.
We m ay underst and t hat nursing care is also
dir ect ed, in collect iv e h ealt h , at in div idu al car e an d
it s syst em at izat ion geared t o priorit y groups t hat are
c h a r a c t e r i z e d b y b i o l o g i c a l r i s k s , s u c h a s
h y p e r t e n si v e , a n d d i a b e t i c p a t i e n t s, ch i l d r e n i n
daycare cent ers, am ong ot hers. This idea is confirm ed
on t he st udy of t he nat ional survey of t he I nt ernat ional
Classificat ion of Nur sing Pr act ices in Public Healt h( 8 )
w hich st at es t hat ev en w hen dealing w it h gr oups or
c o l l e c t i v e o b j e c t s , t h e w o r k o f n u r s e s p r e s e n t
chr onological cut s, due t o diseases or places w her e
car e is p r ov id ed su ch as d ay car e cen t er s, sch ools,
am on g ot h er s.
We did not want t o invest igat e dist ribut ion of
t im e nur ses spent in each r out ine act iv it y ; how ever,
w e ident ified a gr eat er v ar iet y of indiv idual act iv it ies
t hat do not necessar ily cor r espond t o t he div ision of
t im e dedicat ed t o each act iv it y. A st u dy( 9 ) in dicat es
t hat act ivit ies perform ed in t he rout ine work of nurses
can be quant ified in t he following way: 28% individual
act ions, 23. 9% collect iv e act ions, 33% m anagem ent
act ions, and 13.8% refer t o coordinat ion, organizat ion,
t r aining, cont r ol and super v ision of nur sing w or k .
I nt er v iew ees m ent ioned per for m ing act iv it ies
ex clusiv ely t o nur ses, such as nur sing appoint m ent s
and super v ising assist ant and t echnicians. How ev er,
act ions m ent ioned include sev er al act iv it ies nor m ally
perform ed by assist ant s and nurse t echnicians. These
act iv it ies can be per for m ed by nur ses; how ev er, t his
s i t u a t i o n b e c o m e s a p r o b l e m w h e n t h e y s t o p
p e r f o r m i n g t h e i r a c t i v i t i e s s u c h a s n u r s i n g
appoint m ent s t o help t he nursing t eam wit h t echnical
pr ocedur es due t o shor t age of w or k er s.
Thus, from t he findings of t his st udy, we m ay
con sid er t h e st r on g in f lu en ce of local con d it ion s in
t he pract ice of nurses, especially short age of nursing
st a f f. Th i s l a ck o f p r o f e ssi o n a l s i s co n si d e r e d a
condit ion of all t he basic cent er s of t he cit y. Nur ses
st op perform ing act ions of t heir work t o cover up for
t he basic work of Nursing in Healt h Unit s t hat support s
all ot her w or k s of t he t eam . Hom e v isit s consider ed
as a st r at egic act iv it y in basic h ealt h is on e of t h e
a ct i o n s l i m i t ed b y t h e sh o r t a g e o f n u r si n g l a b o r.
Acco r d i n g t o t h e r e p o r t o f a n i n t e r v i e w e e , w h e n
leav in g t h e Un it for t h is act ion , n u r ses leav e a few
assist ant s alone, wit hout being able t o help in case of
need, and in t he occasional absence of ot her healt h
pr ofessionals r esponsible for t he UBS.
A st udy perform ed in a capit al in t he sout h of
Br azil( 10) , ident ified sim ilar aspect s t o t hose found in
Port o Alegre, explaining t he difficult ies found by nurses
when perform ing t heir act ivit ies due t o ot her dem ands.
Th e a u t h o r s r e p o r t e d a s i g n i f i c a n t d i f f i c u l t y i n
p er f o r m i n g n u r si n g a p p o i n t m en t s b eca u se n u r ses
w er e in gr eat dem and for ot her act iv it ies.
Th e p r a c t i c e o f n u r s e s c a n n o t b e
charact erized only by t he descript ion of t heir act ivit ies.
Analysis of t hese pract ices dem and assessing what is
consider ed in planning, t he feat ur es and specificit ies
of w or k .
Thr ough t he pr oposal of act ions, nur ses t r y
t o m eet t he needs ident ified by t hem or by t he healt h
t e a m . Pr o p o si n g a ct i o n s i s f o l l o w e d b y co u n t e r
-p r o -p o sa l s o f o t h e r -p r o f e ssi o n a l s co n ce r n i n g t h e
recognit ion of t he work perform ed. That is, as act ions
are proposed by nurses and lead t o posit ive out com es
for t he t eam and for t he populat ion, m or e ideas and
proposals are present ed t o nurses by t heir t eam peers.
Th i s s i t u a t i o n s h o w s a p r o c e s s o f c o n t i n u o u s
assessm ent and change in t he pract ice of professionals
t hat are defined by t echnical division bet ween t he t eam
m em b er s, o f f i el d s a n d a ct i v i t i es r el a t ed t o ea ch
indiv idual and, especially, based on t he dem ands of
t he local populat ion. A st udy perform ed in t he realit y
of UBSs in an ot h er cap it al( 1 0 ) sh ow s t h at r eg ar d in g
Rev Lat ino- am Enferm agem 2008 set em bro- out ubro; 16( 5) : 889- 94 w w w .eer p.usp.br / r lae
or ganizing t he w or k in t he Healt h Unit , som e nur ses
go t ow ards act ivit ies t hat are not direct care or t hey
“ s p e c i a l i z e t h e m s e l v e s ” i n s o m e k i n d s o f c a r e :
because of affinit y, t he dem and or t he w ork division.
Am ong t he com pet encies of nurses in prim ary
car e d escr ib ed in t h e lit er at u r e( 1 1 ), is t h e f act t h at
nurses are responsible for healt h care and cont ribut e
t o t h e or g an izat ion of t h is car e, as w ell as f ost er
com m it m ent wit h healt h as an individual and collect ive
r ight .
Th e pr esen ce of n u r ses at UBSs sh ou ld be
highlight ed. The feat ures of t he working hours of m ost
nurses enable t hem t o be recognized as a professional
w it h access t o t he populat ion since t hey st ay longer
at UBSs, t hey w or k w it hin sev er al fields in t he unit ,
and t hey per for m m or e out side act iv it ies.
Qualit ies such as nice, generous, and hum ane
h a v e a l r ea d y b een a t t r i b u t ed t o n u r ses o f Pu b l i c
Healt h( 1 2 ). Becau se of t h ese f eat u r es, r ein f or ced by
t he social idea t hat represent s nurses as angels, users
seek t hem , m any t im es, t o m eet needs t hat go beyond
t heir solv ing capacit y.
( I n) specificit ies of nur sing w or k
Sev er al in t er v iew ees said t h at “ ev er y t h in g”
is considered by users as a reason t o look for nurses.
This feat ur e r einfor ces t he ar t iculat ing r ole of t hese
professionals in t he rout ine of UBS. Nurses art iculat e
t he dem ands of users wit h t he st ruct ure of t he service
an d w it h ot h er pr of ession als, as w ell as w or k as a
r e f e r e n ce f o r o t h e r m e m b e r s o f t h e t e a m i n t h e
r ef er r al of p r ob lem s an d r eq u est s. Th e ar t icu lat in g
r o l e o f n u r s e s w a s c l a s s i f i e d a s p o s i t i v e i n t h e
int er v iew s, since it r einfor ces t he im por t ance of t he
t eam and dem onst rat es t he polyvalence of t heir work
ev en if it m ean s ov er load . Th e p oly v alen t f eat u r e,
i n co r p o r a t e d i n t o t h e p r o f e ssi o n a l p r a ct i ce a s a
st r at egy t o occupy spaces, m ay be char act er ized as
a specificit y of t he nursing w ork( 13).
A st udy per for m ed( 11) highlight s, am ong t he
c o m p e t e n c e s o f n u r s e s i n p r i m a r y c a r e t h e
con t r ibu t ion of n u r ses f or t h e con st r u ct ion of m or e
hum ane car e as t hey use t heir com pet ences such as
list ening t o users and dem onst rat ing welcom ing skills
and sensibilit y. The uses of t hese skills ar e elem ent s
t hat guide and or ganize pr act ices in pr im ar y car e.
Polyvalence of t he w ork of nurses refer bot h
t o act ions wit h users and t hose relat ed wit h t eam work,
b ecau se as t h ou g h t h ey ar e n ot in a coor d in at in g
posit ion at UBS, nurses are involved wit h t he problem s
of ot her m em ber s of t he t eam , out side t he scope of
n u r sin g. An ex am ple of t h at is t h e case of a n u r se
who was called t o solve a conflict bet ween t he cleaning
assist ant and t he doorm an of a healt h unit .
Ot h er car eer s su ch as psy ch ologist s, social
w o r k e r s , p h y s i c i a n s , a n d e v e n l a w y e r s w e r e
m ent ioned in t he int erviews t o exem plify t he reasons
user s look ed for nur ses and t hey consider ed nur ses
can solv e or r efer suit ably t o all k inds of pr oblem s.
Thus, it is not t he figur e of ot her pr ofessionals t hat
nurses get close t o in t his analogy, but rat her t o t he
w or k per for m ed by t h ese pr ofession als.
Dissat isfact ion w it h t he sit uat ions pr esent ed
w as clear ; h ow ev er, n u r ses accep t ed t h is sit u at ion
becau se t h ey accept t h e sev er al pr oblem s t h at ar e
pr esen t ed t o t h em , ev en t h ou gh t h ey say t h ey ar e
n ot par t of t h eir j ob. Wh en t h ey accept t h e r ole of
solv in g t h ese sit u at ion s, n u r ses t ak e u p w or k t h at
can n ot be m easu r ed, is n ot def in ed an d can n ot be
classified. Th u s, it is in v isible w or k , t h at can n ot be
con sid er ed lig h t or less im p or t an t b ecau se of t h is
feat ur e, but w hich is closer t o fem ale and dom est ic
w o r k t h a t h a s f o l l o w e d t h e p r o f e ssi o n si n ce i t s
begin n in g.
A s s o c i a t i o n o f t h e i r w o r k w i t h t h a t o f
f ir ef ig h t er s, d on e b y an in t er v iew ee, in d icat es t h e
e x t e n t o f n u r s e a c t i o n s i n f a c e o f t h e d e m a n d
present ed, not only due t o t he need for healt h of t he
populat ion, but for all kinds of problem . Som e nurses
pr esent fix ed, pr e- det er m ined act iv it ies, such as t he
schedule of nursing appoint m ent s and groups. But all
of t hem said t hat in addit ion t o t hese act ions, t hey
t a k e u p a l l t h e r e s t , i n d i c a t i n g t h a t t h e r e i s a
consider able am ount of t im e consum ed by t his
non-def in ed w or k .
Nu r se s h a v e b e e n u si n g t h e i r sp a ce i n a
confusing way, becom ing over w helm ed w it h act ivit ies
i n t h e d a i l y w o r k b u t w i t h o u t t h e co r r e sp o n d i n g
polit ical power of t hese spaces. This feat ure is reflect ed
in t he underst anding of all issues im port ant t o nurses,
and t her efor e, m ust be solve by t hem( 12).
W h e n t h e y a b s o r b e v e r y t h i n g a s t h e i r s ,
workers in t his field run t he risk of becom ing invisible
t o t he inst it ut ion, t o t he healt h t eam , and t o societ y.
Th u s, p r o f e ssi o n a l s b e co m e i n v i si b l e d u e t o t h e
invisible j ob t hey perform . When t hey t ell users when
t h ey can g et t h eir w or k in g p ap er s, w h en t h ey g et
inv olv ed in t he pr oblem s pat ient s had because t heir
893
f aci l i t y w as i n co m p l et e, w h en t h ey ad v i se a u ser r egar ding her m ar it al pr oblem s ( t hese ar e ex am ples
m en t ion ed in t h e in t er v iew ) , n u r ses ar e per for m in g im por t ant act ions for t hese user s t hat cor r espond t o
t he need t hey have at t he t im e, however, it cannot be consider ed as car e w it hin t he act iv it ies pr edict ed in
t he sy st em .
An ot h er elem en t t h at sh ou ld be con sider ed
in t his issue m ay be relat ed wit h t he way som e healt h ser v i ces ar e o r g an i zed , m ak i n g u ser s ad ap t t h ei r
needs t o t he care supply. Report s from nurses enabled us t o infer t hat int erviewees are list ening t o t heir users
an d , in a w ay, in d icat e a solu t ion f or t h eir sev er al
needs. I n t hat , t he problem of m aking supply suit able is left t o nurses t hat spend a considerable am ount of
t im e in act ions t hat cannot be recorded or quant ified, and are not valued by ot her professionals and by t he
sy st em an d t h at con t r ibu t e t o t h e in v isibilit y of t h e p r of ession al.
Th ese act ion s, n or m ally t ak en as gu idan ce,
are usually perform ed in t he hallways or wait ing room of t he UBSs. I n t hese places user s can st op nur ses
and ask for help t hat occur usually v er bally, w it h no possibilit y for for m al r ecor d on u ser s’ ch ar t s or t h e
out pat ient product ion report . Thus, t he act ion cannot be checked lat er, or seen by ot her pr ofessionals t hat
can ad d t o t h e r ecor d of b eh av ior s, b ecau se it is considered t hat t he “ record of nursing act ions on t he
chart is a significant inst rum ent in nursing care and it is essent ial t o proper pat ient car e”( 14).
Pr a c t i c e s a n d s p a c e s o f n u r s e s w e r e
hist or ically m ade w it h t he obj ect iv es of ensur ing t he work of inst it ut ions and follow m edical orders, as well
as t o m eet t he dem ands of pat ient s, developing wit h t hat t he skills and t radit ion for viewing t he whole, which
is v er y oft en m ent ioned t o char act er ize t he w or k of nurses. Thus, t he act ions t hat help t his invisibilit y are
t h o s e t h a t g u a r a n t e e t h e f u n c t i o n i n g o f h e a l t h inst it ut ions.
Visibilit y of t he physicians’ work and invisibilit y of t h e n u r ses’ w or k is com par ed in a st u dy( 1 5 ) t h at
in dicat es t h at t h e f ir st is m ade u p of con cr et e an d quant ifiable act ions, wit h a higher wage and paym ent
f or each act ion m ad e, w h er eas t h e secon d f ollow s
t h e o r d e r s o f t h e f i r st e v e n w i t h t h e i r co n cr e t e , cont inuous and essent ial ex ist ence.
W h e n p o i n t s r e f e r r i n g t o t h i s i ssu e w e r e discussed, t her e is a st udy quest ioning t he need for
nurses t o define a role when perform ing care, because w hen t hey dev elop sev er al w ay s of car e, t hey car r y
w i t h t h e m a n a r r a y o f s p e c i f i c k n o w l e d g e a n d
pract ices, t hat t hey use t o est ablish a relat ionship wit h u s e r s , t a k i n g u p a r o l e a t e a c h e s t a b l i s h e d
r elat ionship( 16). The st at em ent s of int er v iew ees show an im port ant sense of t heir work is t o m eet t he several
dem ands from users, and t hat t he problem s t hat are t ot ally out of r each for t hem lead t o fr ust r at ion and
f at igu e.
Un d e r st a n d i n g t h e r o l e o f n u r se s r e q u i r e
underst anding Nursing as a social pract ice, hist orically in f lu en ced. Nu r sin g pr esen t s in t er n al con t r adict ion s
in it s knowledge/ m aking, such as nursing care t hat is not perform ed only by nurses, t he difficult y t o m easure
it s w or k f or ce in t er m s of m ar k et , an d t h e sev er al
act iv it ies dev eloped t hat ar e not alw ay s r elat ed w it h nursing or wit h t he client , sit uat ions t hat are present ed
as a b ases f or a con f lict in g r ou t in e an d , at t im es, fr ust r at ing for pr ofessionals( 12).
Th e sev er al r epor t s on t h e ar t icu lat in g r ole of nurses t o solve several problem s enable t o consider
t he assum pt ion t hat t his j ob is especially for nur ses,
in addit ion, of cour se, t o t he ot her act iv it ies alr eady descr ibed. To fix or cor r ect w hat becam e a pr oblem ,
m e e t i n g d i f f e r e n t r e q u e s t s a n d d e m a n d s i s a sophist icat ed w or k of ar t iculat ion. Thus, t his feat ur e
could be int erpret ed not as a difficult y t o define roles of nur ses but as a specificit y of t heir w or k of gr eat
v a l u e t o t h e d e v e l o p m e n t o f t e a m w o r k a n d , especially, t o t he car e of user s’ need.
FI NAL CONSI DERATI ONS
The pract ices of nurses present , at t he sam e
t i m e , f e a t u r e s o f H e a l t h Un i t s , w i t h t h e i r l o c a l sp ecif icit ies, an d f eat u r es r elat ed w it h t h e n u r sin g
pr ofession and t heir w or k . The cur r ent hist or ical and p o l i t i cal co n t ex t i n f l u en ce t h e r el at i o n sh i p t h at i s
est ab lish ed w it h in t h e ser v ice am on g p r of ession als and t he com m unit y.
K n o w i n g a n d u n d e r st a n d i n g p r a ct i ce s o f n u r s e s n e e d t o c o n t e m p l a t e a r t i c u l a t i n g t h e s e
pr act ices w it h t hose of all healt h w or ker s involved in
t h e w o r k p r o c e s s . Th u s , n o t c o n s i d e r i n g t h e p er sp ect i v es o f o t h er p r o f essi o n a l s i s o n e o f t h e
lim it at ions of t his st udy, which deals wit h one side of t h e issu e: t h e speech of n u r ses. Fr om t h e poin t of
view of nurses on t heir pract ices, w e have privileged t he dim ension of subj ect as t he m odifier of t he realit y
t hat builds t he possibilit ies of change and innov at ion
w it hin t he st r uct ur al or ganizat ion alr eady est ablished in t he act ivit ies.
Rev Lat ino- am Enferm agem 2008 set em bro- out ubro; 16( 5) : 889- 94 w w w .eer p.usp.br / r lae
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