RESUmo
Pesquisa de abordagem qualitaiva aricu -lada com o referencial metodológico de Paulo Freire, consisindo de três momen -tos: invesigação temáica; codiicação e descodiicação; desvelamento críico. Objeivou compreender se a Consulta de Enfermagem promove a autonomia das mulheres em um Centro de Saúde. Cons -ituíram-se seis Círculos de Cultura com duas horas de duração e média de nove paricipantes, ocorridos entre maio e julho de 2011. A invesigação revelou oito temas, que foram desvelados em dois, necessida -de -de escuta e diálogo sobre violência do -mésica, relação do enfermeiro e parícipes na Consulta de Enfermagem. Os resultados indicam que a Consulta pode consituir-se como espaço para o desenvolvimento de ações de Promoção, que ocorrem ainda imidamente no Centro de Saúde. Como possibilidades e limitações destacam-se a necessidade de capacitações muliprois -sionais para compreender questões con -ceituais e estratégias de Promoção, intensi -icando suas práicas em todos os espaços do Sistema Único de Saúde.
dEScRiToRES
Mulheres
Cuidados de enfermagem Promoção da saúde Autonomia pessoal Atenção Primaria à Saúde
The promotion of women’s autonomy during
family health nursing consultations
O
riginal
a
r
ticle
AbSTRAcT
We adopted a qualitaive approach com -bined with the methodological framework of Paulo Freire, consising of themaic invesigaion, coding and decoding, and criical unveiling, to understand whether nursing consultaion promotes women’s autonomy in a health center. Six Culture Circles that were each two hours long were conducted, with an average of nine parici -pants each, between May and July 2011. The invesigaion revealed eight topics of importance, although two were paricu -larly important: the need for dialogue on domesic violence and the relaionship be -tween nurses and paricipants during con -sultaions. The results indicate that consul -taions may present a space for women to take acions that they may otherwise be fearful to take. Our results highlight the need for mulidisciplinary training of nurs -es with regard to strategi-es for promoion and intensiicaion of their pracices in the Uniied Health System.
dEScRiPToRS
Women Nursing care Health promoion Personal autonomy Primary Health Care
RESUmEn
Invesigación cualitaiva ariculada con referencial metodológico de Paulo Freire, consistente en tres momentos: invesiga -ción temáica, codiica-ción y decodiica -ción, y revelación críica. Se objeivó com -prender si la consulta de enfermería pro -mueve la autonomía de las mujeres en un centro de salud. Se consituyeron seis cír -culos de cultura, de dos horas de duración, con nueve paricipantes promedio, entre mayo y julio 2011. La invesigación deter -minó ocho temas, revelados en dos, nece -sidad de ser escuchado y diálogo sobre vio -lencia domésica, relación del enfermero y paricipantes en la consulta de enfermería. Los resultados indican que la consulta pue -de consituirse en espacio para -desarrollo de acciones de promoción, que suceden, aún ímidamente, en los centros de sa -lud. Como posibilidades y limitaciones se destacan la necesidad de capacitaciones muliprofesionales para entender asuntos conceptuales y estrategias de promoción, intensiicando sus prácicas en todos los espacios del Sistema Único de Salud.
dEScRiPToRES
Mujeres
Atención de enfermería Promoción de la salud Autonomía personal Atención Primaria de Salud
michelle Kuntz durand1, ivonete Teresinha Schülter buss Heidemann2
Promoção da autonomia da mulher na consulta de enfermagem em saúde da família
Promoción de la autonomía de la mujer en la consulta de enfermería en salud de la familia
1rn. family health specialist. m.sc. in nursing, graduate nursing Program, universidade federal de santa catarina. member of the research and
community service group in nursing and health Promotion – nePePs. florianópolis, sc, Brazil. michakd@hotmail.com 2rn. Ph.d. in Public health
inTRodUcTion
Commitment to care and the ability to strengthen people’s autonomy are skills that nursing professionals are introduced to at the beginning of their educaion. Respect for the autonomy and dignity of each person is an ethical imperaive, and not a favor one can or cannot grant one another(1). This noion is reinforced by the fun -damental premise that those who pracice the educaive process from a criical perspecive should have the goal of enhancing the personal strength of the people with whom they interact(2). It is necessary to help human beings help themselves, allowing them to become agents of their re
-covery, with a criical and relexive aitude towards their problems.
Autonomy can be relected as a condiion of health and ciizenship, and therefore, it is a fundamental value, but one that is not, and cannot be, absolute.
Autonomy should be constructed in a pro
-cess of suc-cessive producion in a network of malleable dependence, and it is necessar
-ily reduced in the case of illness. Autonomy should be built coninuously in its interrela
-ion with dependence in daily life. It is dii
-cult to consider autonomy in the health care ield without considering autonomy in the general ield of poliics and life. The relaion
-ship between autonomy and dependence is present throughout one’s lifeime, both at the individual level and at the society level(3).
The intent of this research was to under
-stand whether nursing consultaions pro
-mote women’s autonomy at a health center that operates in the framework of the Fam
-ily Health Strategy (FHS). We invesigated the acions of nursing professionals aimed at the promoion of women’s health, with an emphasis on features such as autonomy and dialogue, as well as the improvement
of spaces for communicaion and listening. These char
-acterisics were highlighted when emphasizing the health professional’s role as an instrument of support for the au
-tonomy of the paricipants; such support can be achieved by strengthening their skills for coping with stress and cri
-ses and improving paient aitudes regarding their lives and health(2).
The decision to work with women is jusiied by ex
-periences as a member of a Family Health Strategy team. The experience of disinct social realiies allows for novel perspecives. In the delivery of care to women who atend nursing consultaions, there is a need for comprehensive recepion, including qualiied listening.
This approach to health is one of the main strategies for the reorganizaion of services and the redirecion of professional pracices at this level of care. The First In
-ternaional Conference on Health Promoion was held in 1986 in Otawa, Canada, and the Charter to achieve health for all by the year 2000 was presented. Health Promoion was deined as a process that enables individuals and communiies to improve their quality of life and health, al
-lowing people to have greater control over their health so that they can idenify and achieve their aspiraions, saisfy their needs and change or cope with the environment(4).
In Brazil, the Naional Health Promoion Policy, which was put into pracice in 2006, addresses the importance of subjects’ autonomy in health services. Therefore, it is important to improve professionals’ perspecives with the goal of encouraging the health potenial of individuals and groups. Rather than remain restricted to the treatment of manifest diseases and situaions, we must expand thera
-peuic projects that acknowledge quality of life as a health
target(5).
The FHS is a rich and outstanding ield in which Health Promoion has gradually gained ground. Professionals and commu
-niies have begun to perceive Health Pro
-moion as a strategy for improving health and quality of life, assuming that the tasks in their daily work are a key point of their acions. Nursing has become increas
-ingly important, and the nursing consulta
-ion has acquired more value and profes
-sional visibility.
Based on past experiences, the nursing consultaion is understood not only as a clin
-ical and pre-established space associated with speciic standards and rouines but also as a space to approach and welcome parici
-pants who visit the service to seek further contact with the area of women’s health. The nursing consultaion represents a space for dialogue, relecion and empowerment for women to take control of their health, to establish healthy habits, to claim their rights and control over the determinants of their own health and that of their families and to strengthen their autonomy.
In the same context, some health centers establish Health Promoion pracices to provide a welcoming space for dialogue for paients. When considering the diferent experiences in family health, however, there is a need to simulate the autonomy and empowerment of health system paricipants. In the dialogic and paricipatory model, all stakeholders, professionals and paricipants act as equals, despite playing disinct roles. The author also emphasizes that in the paricipatory process, the perspec
-ives and prioriies of both professionals and communiies are legiimate and valued(6).
Based on the issues described above, the intent of this study is to invesigate whether nurses’ Health Promo
-ion ac-ions during FHS consulta-ions simulate women’s
autonomy can
be relected as a
condition of health and citizenship, and therefore, it is a fundamental value, but
one that is not, and cannot be, absolute.
autonomy should be constructed in a process of successive
production in a network of malleable dependence, and it is necessarily reduced in
autonomy as subjects and authors of their own lives and thus improve women’s percepion of the relaionship be
-tween health and quality of life. In paricular, our intent is to relect on how women’s autonomy is simulated during nursing consultaions as part of the Family Health Strategy.
Based on this context, the objecive of this study is to understand whether the nursing consultaion is focused on Health Promoion acions that enhance women’s au
-tonomy in the realm of Family Health.
mETHod
A qualitaive and paricipatory study was developed based on the theoreical reference framework of Health Promoion and the method described by Paulo Freire. Freire’s Iinerary was used, which comprises the following steps: themaic invesigaion, coding and decoding and criical discovery.
The research was undertaken in Florianópolis, in the state of Santa Catarina, Brazil. In that city, the Primary Health Care Network is based on the Family Health Strat
-egy – FHS, which is divided into ive health districts des
-ignated as the Central, Coninental, Eastern, Northern and Southern Health Districts(7). The health center (HC) that was chosen for the study is located in the Coninental Health District and was founded in 2005.
The paricipants were women who paricipated in nursing consultaions (prenatal visits, pap smear collec
-ion, child care, family planning, elder care, adult health, hypertensive and diabeic treatment, mental health, and Health Promoion) and were invited during a teaching traineeship.
Twelve women paricipated in the study. The par
-icipants were married or single and between 18 and 79 years of age. The decision to conduct the study at only one health center was due to the limited ime available to develop the four phases proposed in Paulo Freire’s Re
-search Iinerary using Culture Circles and due to the dii
-culty of recruiing women to paricipate in these meeings. Freire’s Research Iinerary outlines that Culture Circles can take place with a limited and irregular number of par
-icipants, as they provide a dynamic and lexible method that permits approximaion between the researchers and the research subjects, turning the researcher’s theme of interest into a possibility of collecive interest. Epistemo
-logical rigor is ensured by profound and comprehensive relecion on reality, which helps develop the subject’s autonomy. To guarantee anonymity in accordance with ethical research principles, the paricipants’ names have been replaced with codenames extracted from the educa
-tor Paulo Freire’s work Pedagogy of Autonomy, published in 2009.
The themes were invesigated between May and July 2011. During this three-month period, the themaic re
-search, coding and criical discovery phases were under
-taken during six Culture Circles that were held at iteen-day intervals.
The mean duraion of the Culture Circles was two hours. Each session was held in the health center’s audi
-torium at 2 p.m. on scheduled Wednesdays. The research objecives were displayed, and the Informed Consent Terms (ICT) were presented and explained to each re
-search paricipant. The Culture Circle environment was arranged to enhance dialogue between the subjects, the research aids and the mediator.
The generated themes were coded and decoded through dynamics and dialogic circles. The irst themes raised were reduced to eight main themes, which were discussed during the Circles, coded and decoded, and then discovered during the ith and sixth Culture Circles, giving the paricipants a new perspecive on the nurses’ role in FHS, allowing recovery of the paricipants’ autono
-my in the Uniied Health System (SUS), and simulaing a coninuous process of acion and relecion regarding the paricipants’ life histories and social roles.
The research themes were discovered with the help of all subjects involved in the study, as suggested by Freire’s method. The theoreical framework of Health Promoion, in combinaion with Freire’s concepts, contributed to the criical discovery process of the themes that emerged from the Culture Circles. This phase was focused on the research subjects’ autonomy and co-accountability, their potenial for empowerment and their quality of life.
To register the themes, a ield notebook was used to record important observaions for the subsequent phases of the Culture Circle study. In addiion, an audio recorder was used, with the paricipants’ permission, to record the enire meeings.
To improve the quality of the records, two research aids and a volunteer psychology student collaborated.
Ater each Culture Circle, complementary meeings were held between the research advisor and research aids to relect on the themes that had emerged and to deter
-mine how proceed to the next Circle. These meeings per
-mited relecion on the themes invesigated during the previous meeing and thus allowed for dialogue about how to conduct the subsequent session of collecive relecion.
The research was approved by the Florianópolis Mu
-nicipal Health Secretary and the Research Ethics Commit
-tee at Universidade Federal de Santa Catarina CEP/UFSC under opinion1133/11, FR 385731, on November 29, 2010.
RESULTS
Themaic invesigaion
The irst Culture Circle was held in the health center auditorium with nine paricipants. Iniially, a dynamic and relaxing acivity was proposed to allow all paricipants to introduce themselves. The paricipants were asked to menion three qualiies that they admire in themselves and three aitudes they would like to change. This intro
-ducion enhanced inclusion in the group’s dialogic process and permited the presentaion of the research and iniial invesigaion of the main generaing themes as they re
-lated to the paricipants’ reality.
In this phase, 45 themes were surveyed that relected the paricipants’ reality, allowing for dialogue and for the coding and discovery of themes. A dynamic acivity was conducted that used labels to list the generated themes on a panel for collecive visibility and further coding. As a result of the relecion, this irst phase culminated in the reducion of the 45 iniial themes to 23 themes that were of interest to the paricipants in the Culture Circle. During the inal relexive process in this irst phase, seven themes related to the needs of the women who paricipated in the study were highlighted: Conlicing family relaions; Losses/social isolaion; Adopion: Diferent concepions of generaions; Need for listening and dialogue; Domesic violence; and Nursing consultaion. These themes were further considered during the coding and decoding phase.
It is important to emphasize that the themes raised relect the reality of the paricipants’ lives, including their emoions, their family conlicts and their concepions of the process of health and disease. In the course of this process, the research quesion was introduced in relaion to the research subjects’ desires and their need to express the daily feelings that interfere with their way of life.
Coding and decoding
Dialogue in the Culture Circles took place in a hori
-zontal and cordial manner, respecing each paricipant’s needs and interests. As themes emerged, they were dis
-covered according to the subjects’ degree of interest. The themes generated during the irst Culture Circle did not explicitly relate to the research quesion about women’s autonomy during nursing consultaions. Dialogue with the paricipants revealed the immediate problems that inter
-fered with their daily lives.
In the coding and decoding phase of the themes high
-lighted during the Culture Circles, adopion was prioriized due to the paricipants’ desire to relect on this issue. To support and moivate debate in the Circle, the movie Ma-ternal Love (Mother Bufalo rescues her young caught by lions) was presented, correlaing it with situaions related to adopion. This short movie permited problemaizaion of the paricipants’ feelings about being a mother and
implicaions in the case of adopion. The movie depicts a story of animals ighing to survive, and emoional state
-ments such as the following ones arose: How beauiful... Everyone working, helping a single one... (Curiosity); That is what humans do... How sad when they don’t... When they do not take care of the young... (Sensiivity).
Dialogue about the theme of adopion reinforced the paricipants’ sensiivity and afecion and allowed them to express their feelings and anxieies related to family conlicts. The union between peers and the importance of mutual co
-operaion were discussed. Relecions about the movie mo
-ivated a debate about family and human relaions, as well as dialogue and qualiied listening regarding the theme of conlicing relaions and domesic violence. The depth of the comments about issues related to these themes was noted, as was the lack of space to further address and experience this. Among the statements that arose related to the theme of domesic violence, several are highlighted below:
so, he hit me… and everyone heard! i yelled... when he
slapped me I did not react… I could have iled a complaint,
but i didn’t ...i don’t want to ruin his image! so what am i going to do? i’m going to separate and that’s it! that’s the best i can do... (criticality).
With regard to this theme, the researchers atempted to relect with the paricipants about the importance of women gaining strength in all aspects of their lives, seek
-ing to be valued as holisic be-ings, and highligh-ing their strengths in the group to overcome their weaknesses.
When coding and decoding the theme of domesic violence, represented by humiliaion, inidelity and separa
-ion, we noted the paricipants’ low self-esteem. Domesic violence prevents vicims from expressing their feelings of constant oppression. The opportunity to paricipate in the Circles allowed the women to construct new possibiliies to transform and improve their quality of life. The theme of domesic violence is relected in the following statement:
i no longer complain to my husband... that is why, when you invited me to come here, i made sure to come… she knows, we go to the gym together, right, so we’re like a family... But there’s none, right… they aren’t strange peo-ple we can’t blow off steam with, talk... i really like to par-ticipate because i can tell, i have someone to be able to blow off steam with... (commitment).
Furthermore, many comments were made about the objeciicaion of women and their social role with regard to domesic violence. In their statements, the women expressed their inability to expose themselves and exercise their rights as the true authors of their lives. Paricipants indicated that the Circle permited them to discuss their opinions and report histories, as demonstrated in the following comments:
The theme of Nursing Consultaion was problemaized with the paricipants; they discussed their relaionship with the nurse and their ideniicaion and atribuions at the health center. These topics guided the debate in this phase of the Research Iinerary, encouraging collecive re
-lecion. One theme that emerged was the paricipants’ diiculty in idenifying the nursing professionals among other mulidisciplinary team members. Another issue that was highlighted relates to nursing care. The paricipants revealed their knowledge about the main services ofered at the unit: Denist, general clinician, there’s a gynecolo -gist, but also the girls who measure the pressure... (Listen -ing). The Health Center also ofers pap smear collecion services, as coordinated by the nurse. Most paricipants were aware of this service, but they did not idenify this acivity as being part of the nursing consultaions. They described the nursing consultaion like other rouine health acions at the unit: I have already been through a consult with E1... She always gives room for me to talk… It’s very good for me… (Commitment)... I have never been through any consult with any of the nurses... (Listening).
The subjects who paricipated in the Culture Circles re
-vealed that the theme of domesic violence was a priority in the debate. The nursing consultaion was sill not ac
-knowledged by the paricipants as an element that could help them overcome their problems; rather, the nursing consultaion was only understood as a technical and rou
-ine acivity in the health center.
Criical discovery
The Criical Discovery phase was accomplished during two Culture Circles in which, on average, six women par
-icipated. It was observed that among the eight themes that were coded and decoded, the themes that were the most predominant were the need for listening and dia
-logue about domesic violence and the nurse’s relaion
-ship with the users during the nursing consultaion. Hence, during this phase of the Iinerary, and through the approximaion of the themes, the generated themes of need for listening and dialogue about domesic violence
and the nursing consultaion were ideniied simultane
-ously. In the discovery phase, the women’s paricipaion as subjects and as the authors of their lives was simulated, empowering them in their daily realiies. At this retrospec
-ive moment, the themes that had been coded/decoded previously were raised in the Circle again for debate so that paricipants could relect on, problemaize and become criically aware of the themes and their limitaions.
To enrich relecion about the highlighted themes, par
-icipants were encouraged to debate the importance of expressing their feelings in the Culture Circles. Paricipants shared opinions related to domesic violence, dialogue with the nurses at the Unit, the meaning and importance of the nursing consultaion as a space to overcome con
-licts and receive care, and the integraion of other Family
Health team professionals. There was also addiional, re
-laxed dialogue about the paricipants’ life histories, which allowed paricipants to strengthen their experiences in a space where they could relieve anguish and gather to
-gether, as revealed in the following statement:
We have nothing to hide… it’s a cry (listening).
The fact that the paricipants were able to express their hidden feelings towards domesic violence contrib
-uted to their ability to overcome these limiing situaions and facilitated paricipant empowerment.
One group suggested that the Culture Circle debates could contribute to increased dialogue with nurses dur
-ing consultaions. The paricipants referred to the limited ime and duraion of the consultaions, as well as the need for room for dialogue to discuss their true needs and feelings, which are oten overlooked. This situaion reveals limitaions in the professional educaion model, as well as a health system that depends on quanitaive pro
-ducivity. It also reveals the challenges that exist in work processes that aim to promote bonding and qualiied lis
-tening, such as the welcoming of paricipants into the sys
-tem. Addiionally, the paricipants perceived limitaions to interdisciplinary pracice with regard to the ability of the Family Health teams to develop their acions. Accord
-ing to the relecions collected from the Culture Circles, it is apparent that diiculies exist with regard to disin
-guishing among muliprofessional team acions, as well understanding and implemening mulidisciplinary team acions. These diiculies inluence the paricipants’ per
-cepions and understanding of the disincions between diferent health consultaions; someimes, the parici
-pants confused mental health nursing consultaions with psychologist and physician consultaions:
it depends on the doctor… because right now, without knowing, you asked me that… did the same doctor, per-haps unknowingly, ask the same question? that’s what makes me... (curiosity)... there’s a huge difference… ah, just by talking we already know people who are attentive and people who are not... (listening)
By compleing Freire’s Iinerary, the researchers en
-couraged dialogue as a method for developing personal autonomy, addressing exising gaps and strengthening the tools used to pracice Health Promoion.
In the inal Culture Circle, each paricipant received a lower of a diferent color, emphasizing her unique quali
-ies and potenial and highlighing the importance of women’s autonomy in a social context. The Circle was ended in a relaxed manner that acknowledged the group paricipants and emphasized their potenials, limits and strengths, as favored by this research context and meth
-od. The paricipants’ increased understanding regarding the relaionship between health and illness was observed, and the relaionship between Health Promoion, qual
commitment, cooperaion, co-responsibility and solidarity was emphasized. These structural values are essenial for dialogue and reciprocity.
diScUSSion
Throughout the process of discovery of the generated themes, the Culture Circles enhanced the paricipants’ ap
-proximaion and autonomy with regard to the diferent aspects of the health ield, paricularly the nursing consul
-taion in the FHS. Although the SUS has invested in care-humanizaion policies through the implementaion of welcoming aciviies for users, this study reveals the need to improve collecive relecions and qualiied listening in health services to achieve genuine Health Promoion and enhanced quality of life for paients.
The humanizaion policy proposed by the Ministry of Health values the diferent subjects involved in the health producion process, including users, workers and manag
-ers. The values guiding this policy are subject autonomy and the protagonist role, the co-accountability of sub
-jects, the establishment of bonds of solidarity, and col
-lecive paricipaion in the management process(8) as key tools for this research.
Autonomy is considered to be the ability to make independent decisions regarding issues related to the individual. An autonomous individual is capable of mak
-ing his or her own personal choices and demands to be treated with respect for his or her self-determinaion and co-responsibility(9).
Our study results allow for relecion and a broader understanding of the nursing consultaion with regard to women at a Family Health Center. Through the adopion of Freire’s Iinerary, the researchers were able to promote a dialogic interacion between paricipants in the Culture Circles and to achieve true, comprehensive, in-depth data collecion. It is important to reinforce that the ambiions, moives and goals implicit in the themes presented by the Culture Circles are human aspiraions, goals and moives. Therefore, these themes are not staic concepts; instead, they are dynamic topics that require further exploraion(10).
The data reveal that there is a lack of space at the Fam
-ily Health Center for dialogue with and the welcoming of its users. Throughout this study, limiing situaions such as domesic violence were overcome, and awareness was gained that helped paricipants cope with the circum
-stances of the health and disease process and achieve a beter quality of life. These achievements were facilitated by the creaion of solidarity among the paricipants. The philosopher Paulo Romualdo Hernandes emphasizes the importance of human relecion on the challenges and problems that emerge in the course of life. He also high
-lights that human beings need to be aware that they are part of a larger context and that they should achieve har
-mony and balance within that context.
The nursing consultaion is perceived as an acivity that is speciic to nurses, conquered in the history of the category’s struggle. It is conceptualized as a methodologi-cal process of knowledge systemizaion, which takes form in a method applied within an educaional and care per -specive, capable of responding to the complexity of the care subject(11). Nevertheless, a problem was observed with regard to the users’ understanding of the disincion between medical and nursing consultaions. A hidden un
-derstanding was revealed about this professional’s tasks and visibility, which may be related to the lack of idenii
-caion and clear delimitaion of each professional’s acivi
-ies and competenc-ies in the FHS.
A nurses’ valuaion is highlighted not only in his or her area of acivity, but in all ields that he or she may take part in, especially in Health Promoion and its strategies. It is relevant to simulate poliical aspects of knowledge, which feeds nurses’ autonomous aciviies, in view of the manipulaions by diferent professional groups, manag
-ers and rule-mak-ers who operate in the background of health services(12). To provide comprehensive, systemized, humanized care, nurses must promote individual and col
-lecive changes with regard to disease prevenion as well as health promoion and recovery. Many of these changes involve women and their families and are related epide
-miological issues(13).
The understanding of the nursing consultaion was im
-proved, and this acivity was clearly ideniied as a nursing responsibility. However, to change current mispercepions about the nursing consultaion, it is essenial for nursing professionals to take responsibility for their acions, step outside of their comfort zone and face challenges by using their competencies and intervening proacively according to diferent social demands(14).
The nursing consultaion is highlighted as a space that supports women’s empowerment and their ability to overcome domesic violence situaions. According to
Freire,
autonomy is a gradual process of maturing, which hap-pens across the lifetime, enabling individuals to make de-cisions and, at the same time, bear the consequences of this decision, thus taking responsibilities(15).
From this perspecive, the empowerment of the re
-search paricipants not only corresponds to a psychologi-cal, individual act, but a social and poliical act(16). Indi -vidual empowerment allows indi-viduals to beter perceive their own lives, to be capable of inluencing and adapt
-ing to their environment and to enhance mechanisms of self-help and solidarity(17-18). The concept of social or com -munity empowerment highlights the idea of health as a process that results from a collecive ight of individuals for their rights. This concept does not ignore psychologi
-tant to understand that macrostructural condiions deter
-mine an individual’s daily reality and that these condiions inluence and signify the macro-social level in an interde
-pendent manner(18).
It is important to keep in mind that dialogue does not annul how the act of teaching is considered at imes. By contrast, dialogue supports this act, which is completed through the act of learning and gaining autonomy. Hori
-zontal dialogue only becomes truly possible when the educator’s criical, restless thinking does not constrain the students’ ability to think criically or start thinking. When the educator’s thinking hampers the development of the students’ thinking, imid, inauthenic or some
-imes purely rebellious thinking tends to be aroused in the students(19).
The Culture Circle, as a collecive space for dialogue, made it possible to decode the nursing consultaion, its aciviies (both private and public) and its atribuions in the Family Health Strategy. Further relecion was simu
-lated with regard to the nurses’ role, and awareness was raised regarding the paricipants’ previous knowledge and experience of reality. The results will certainly engender new care opportuniies and a new approach to life. The paricipants demonstrated their ability to relect on their concepion of their own acts and background, perceiving soluions that were not understood previously and relect
-ing on their own prejudices.
concLUSion
This study describes the experience of paricipants in Culture Circles, highlighing the relevance of dialogue as a research tool, regardless of where that dialogue takes place. In this case, paricipants and professionals from a Family Health Center contributed to the development of the study within an innovaive framework of criical-re
-lexive methods. Paulo Freire’s Research Iinerary permits acts of acion-relecion and acion, turning researchers
into not only interviewers and data collectors but also fa
-cilitators and study paricipants.
According to the study paricipants, the nursing con
-sultaion serves as a fundamental space for nurse acions. Nurses are understood as subjects capable of signiicantly contribuing to overcoming the limiing situaions that in
-terfere with women’s lives. The themes presented, includ
-ing domesic violence and the need for listen-ing, dialogue and understanding of the FHS professionals’ diferent roles, can also be overcome through dialogue during the nursing consultaion. The study revealed that the nursing consultaion can serve as a space for the development of Health Promoion acions, which are sill limited in the coverage area of the Health Center that was selected. Therefore, muliprofessional training is needed to help nurses understand the conceptual and strategic issues re
-lated to Health Promoion.
The ability to complete a study in a short ime period is one of the advantages of Paulo Freire’s Method. This method permits the ideniicaion of themes in short Cul
-ture Circles, and it has lexible methodological steps. In this case, six Culture Circles were held over a two-month period. The relecion that took place in the Circles was not interrupted ater the research themes were revealed, leading to acions that could contribute to overcoming and transforming the realiies under invesigaion. The paricipants’ capacity and willingness to develop acions were perceived, but the study deadlines created a limita
-ion for the group.
In view of the possibiliies and limitaions that were ideniied by the women who paricipated in the Culture Circles, it can be concluded that Health Promoion prac
-ices in primary health care need to be improved, guaran
-teeing space for dialogue not only in nursing consultaions but in all acions undertaken at the Health Unit. Coninu
-ing educaion and train-ing, focus-ing not only on Health Promoion but also on the humanizaion of care and on more welcoming nursing consultaions, are recommend
-ed for health professionals.
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