Migrant nurses in Brazil: demographic characteristics, migration flow and relationship with the training process.

OBJECTIVE: to analyze the migration of nurses in Brazil, describe the demographic characteristics of migrant nurses, the main migration flows, and establish relationships with the training process. METHOD: a descriptive, exploratory study, based on 2010 Census data. The data were analyzed using descriptive statistics. RESULT: there were 355,383 nurses in Brazil in 2010. Of these, 36,479 (10.3%) reported having moved compared to the year 2005: 18,073 (5.1%) for intrastate migration, 17,525 (4.8%) interstate migration, and 871 (0.2%) international migration. Females (86.3%), Caucasians (65.2%), and unmarried (48.3%) nurses prevailed in the population, without considerable variation between groups according to migration situation. The findings indicate that the migration flows are driven by the training process for states that concentrate a greater number of courses and positions in undergraduate and graduate studies, and the motivation of employment opportunity in regions of economic expansion in the country. CONCLUSION: it is necessary to deepen the discussion on the movement of nurses in Brazil, their motivations, and international migration.

[Supply and demand in home health care]. / Oferta e demanda na atenção domiciliar em saúde.

The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil to consider Home Care (HC) as a care strategy. However, there is a gap between the supply of HC services, the demand for care and the health needs manifested by the population. Thus, this article analyzes scientific output regarding the status of the relation between supply, demand and the needs related to home health care. This work is based on an integrative review of the literature in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health and Science (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science. Despite the fact that few articles refer to the issue in question, there is evidence indicating that health demands and needs are seldom taken into account either in a quantitative or qualitative approach when developing the organization of HC services. The analysis would indicate that there is a national and international deficit in the supply of HC services considering the demand for health care and needs currently prevailing.

[Expansion of undergraduate courses in nursing: dilemmas and contradictions facing the labor market]. / Expansão dos cursos de graduação em enfermagem: dilemas e contradições frente ao mercado de trabalho.

We sought to analyze, from the perspective of professors and students, the reasons and consequences of the expansion of undergraduate courses in nursing, discussing the dilemmas and the contradictions confronting the labor market. It was a qualitative study with data obtained from focus groups, conducted in 18 undergraduate nursing courses in the state of Minas Gerais, during the period of February to October of 2011. The narratives were submitted to critical discourse analysis. The results indicated that the education of the nurse was permeated by insecurity as to the future integration into the labor market. The insecurity translates into dilemmas that referred to employability and the precariousness of the working conditions. In this context, employment in the family health strategy emerges as a mirage. One glimpses the need for a political agenda with the purpose of discussion about education, the labor market and the determinants of these processes.

[Expansion of undergraduate nursing and the labor market: reproducing inequalities?]. / Expansão dos cursos de Graduação em Enfermagem e mercado de trabalho: reproduzindo desigualdades?

This study aimed to analyze the relationship between the increase in the number of degree courses in nursing and the nursing job market. It is a descriptive exploratory study with a quantitative approach, which used data on Undergraduate Nursing courses, supply of nurses, connection with health facilities, and formal jobs in nursing in the state of Minas Gerais. The evolution of Undergraduate Nursing courses reveals a supply and demand decline in recent years. Such context is determined by the nurse's labor market being influenced by the contradiction of a professional quantitative surplus, particularly in the state's less developed areas, as opposed to a low percentage of nurses to care for the population's health. These characteristics of the nursing labor market reproduce inequalities furthermore aspects such as the regulation of nursing education and the creation of new jobs need to be discussed further.

Cuidado materno ao recém- nascido na unidade de terapia intensiva neonatal: possibilidades e desafios / Cuidado materno del recién nacido en la unidad de terapia intensiva neonatal: posibilidades y desafíos / The mother when caring for her newborn baby at the neonatal intensive care unit: possibilities and challenges

Apresenta o resultado de um estudo qualitativo que teve como objetivo apreender os limites e as possibilidades do cuidado materno ao recém-nascido internado na Unidade de Terapia Intensiva Neonatal (UTIN). O estudo foi realizado em um hospital filantrópico em Belo Horizonte-MG e teve como participantes 11 mães de recém-nascidos internados na UTIN e 11 profissionais de saúde que prestam cuidado a esses recém-nascidos. Para a coleta de dados, utilizaram-se a entrevista e a observação participante. Os dados obtidos na entrevista e os registros da observação participante foram analisados por meio da análise de discurso. Evidenciaram-se as formas de participação das mães no cuidado com os filhos e as relações e tensionamentos com os profissionais no desenvolvimento desse cuidado. Foi demonstrado que o fazer da mãe determina seu lugar no cuidado do filho e redefine suas possibilidades de ação dentro da UTIN num processo contínuo e dinâmico. Conclui-se que a participação da mãe no cuidado do filho na UTIN não é explorada em sua potencialidade, sinalizando a necessidade de ampliar os estudos a fim de solidificar as práticas já existentes e construir novas alternativas para a participação das mães.

This paper presents the results of a qualitative study aimed to understand the limits and possibilities of maternal care to the newborn in the Intensive Neonatal Therapy Unit (NICU). The study was held at a philanthropic hospital in Belo Horizonte, M.G, and had 11 mothers of newborns hospitalized at the NICU and 11 health professionals who take care of these newborns as participants. For data collection, interviews and participant observation were used. Data analysis was made through Discourse Analysis. The data evidences the forms of participation of the mothers in the care given to their children and their relationships and tensions with the professionals in the development of the care. It was demonstrated that the attitude of the mother towards the child determines her role in the care of this child and redefines her possibilities of action inside the NICU in a continuous and dynamic process. It was concluded that the participation of the mother in the care process at the NICU is not explored in its potentiality, pointing out the need to amplify the studies in order to solidify the practices already existent and build up new alternatives for the participation of the mothers.

Se presenta el resultado de un estudio cualitativo que tuvo como objetivo comprender los límites y las posibilidades del cuidado materno al recién nacido en la Unidad de Terapia Intensiva Neonatal (UTIN). El estudio se realizó en un hospital filantrópico en Belo Horizonte, M.G. y tuvo como participantes 11 madres de recién nacidos ingresados en la UTIN y 11 profesionales sanitarios que cuidan de estos recién nacidos. Para la recolección de datos se utilizó entrevistas y la observación participante. El análisis de los datos se llevó a cabo a través del Análisis del Discurso. Los datos dejan claro las formas de participación de las madres en el cuidado de los hijos y las relaciones y tensiones con los profesionales en el desarrollo de este cuidado. Fue demostrado que las formas de participación de la madre determina su lugar en el cuidado del hijo y redefine sus posibilidades de acción dentro de la UTIN en un proceso continuo y dinámico. Se concluyó que la participación de la madre en el cuidado del hijo en la UTIN no se explora en su potencialidad, apuntando la necesidad de ampliar los estudios a fin de solidificar las prácticas ya existentes y construir nuevas alternativas para la participación de las madres.

[Epidemiological profile of the elderly population in Belo Horizonte, MG, Brazil]. / Perfil epidemiológico da população idosa de Belo Horizonte, MG, Brasil.

This is a descriptive study using the data side of the municipal secretariat for coordination of social policy in Belo Horizonte, whose purpose was to describe the epidemiological profile of elderly population of this city. The elderly in Belo Horizonte in 2000 represent 9.1% of total population residing therein. Population of elderly, 60.5% are women and 39.4% are men, 2.9% of the elderly had some type of physical disability, 16.4% have hearing loss, 23.5% find it hard to see, 24.1% have difficulty walking or climbing stairs, and that 3.8% had mental problems. It was concluded that the share of elderly people, weakened in Belo Horizonte was represented by less than one with good health. Aging is not synonymous with disability.

Home care as change of the technical-assistance model.

OBJECTIVE: To analyze home care practices of outpatient and hospital services and their constitution as a substitute healthcare network. METHODOLOGICAL PROCEDURES: A qualitative study was carried out using tracer methodology to analyze four outpatient home care services from the Municipal Health Department and one service from a philanthropic hospital in the municipality of Belo Horizonte, Southeastern Brazil, between 2005 and 2007. The following procedures were carried out: interviews with the home care services' managers and teams, analysis of documents and follow-up of cases, holding interviews with patients and caregivers. The analysis was guided by the analytical categories home care integration into the healthcare network and technical-assistance model. RESULTS: Home care implementation was preceded by a political-institutional decision, both with a rationalizing orientation, intending to promote cost reduction, and also with the aim of carrying out the technical-assistance rearrangement of the healthcare networks. These two types of orientation were found to be in conflict, which implies difficulties for conciliating interests of the different players involved in the network, and also the creation of shared management spaces. It was possible to identify technological innovation and families' autonomy in the implementation of the healthcare projects. The teams proved to be cohesive, constructing, in the daily routine, new forms of integrating different perspectives so as to transform the healthcare practices. Challenges were observed in the proposal of integrating the different substitutive healthcare services, as the home care services' capacity to change the technical-assistance model is limited. CONCLUSIONS: Home care has potential for constituting a substitutive network by producing new care modalities that cross the projects of users, family members, social network, and home care professionals. Home care as a substitute healthcare modality requires political, conceptual and operational sustainability, as well as recognition of the new arrangements and articulation of ongoing proposals.

[Work process in the neonatal intensive care unit: building a holistic-oriented care]. / Processo de trabalho na Unidade de Terapia Intensiva Neonatal: construção de uma atenção orientada pela integralidade.

This is a qualitative study aimed at analyzing the performance of healthcare professionals, as well as their contribution to a holistic-oriented care towards newborn babies in a Neonatal Intensive Care Unit (NICU). The study was carried out in the Sofia Feldman Hospital, in Belo Horizonte, State of Minas Gerais, Brazil. The study's subjects were ten healthcare professionals who cared for newborns in the NICU, and seven parents of admitted newborns. Data was collected by means of workshops and participant observation processes. Data were treated and analyzed by means of discourse analysis concepts. The resulting data highlighted the following aspects: the potential and holistic-oriented practices of healthcare professionals; the presence or absence of healthcare actions that materialized the holistic care; the different perceptions of the participants about the work carried out by the team; and in what sense the rationale of the work organization encompassed the workers' collective performance.

[Disease-related absenteeism among nursing team members in a teaching hospital]. / Absenteísmo relacionado à doenças entre membros da equipe de enfermagem de um hospital escola.

The article presents results of the research that identified to causes of disease-related absenteeism, justified by medical license, among nursing employees of a public hospital in Montes Claros, MG, Brazil. This is a descriptive-exploratory study. Results indicate that the main reasons for absenteeism are related to musculoskeletal problems and to respiratory diseases; mainly between married female nurse aides, with age between 25 and 45 years, that works in day shift and with more than one employment. It was concluded that there is a necessity to develop prevention actions for controlling the absenteeism as a strategy for the quality of life of nursing workers.

[Comprehensive health care: indications from the training of nurses]. / Integralidade do cuidado na saúde: indicações a partir da formação do enfermeiro.

This study has the objective of understanding the training of nurses for comprehensive health care. It used data from interviews with teachers, students and service nurses submitted to discourse analysis. There is an understanding of comprehensive care in the training of nurses from the perspective of establishing a healthcare model in which care is directed to the patient. There are reflections regarding the technologies and the form of organization of the work, expressed in a permanent tension: Clinical versus Collective Health as a challenge for comprehensive care. It was identified that building completeness in the formation implies assuming acting in health as an educative principle in a new form of learning-teaching in health, which breaks up with pre-formed, out-of-context knowledge. The conclusion is that comprehensive health care is taken as an object of reflection in the movement for change in the pedagogical practices, and that it is reflected in health attention.

Brazilian nursing and professionalization at technical level: a retrospective analysis.

This article presents a retrospective analysis of the Brazilian Nursing concerning the professionalization of workers at technical level. It also provides some indication about the trends of professional education. There is a clear indication of increased intellectual and conceptual accumulation in the four decades the professional education in nursing at technical level has been part of the public policy agenda. This experience serves as reference for the formulation of new actions directed to other professionals of technical level who deliver direct care to the population. The study shows that there was reformulation of the nursing professional qualification issue, including in the discussion the need to improve the quality of educational processes and extensive supply of continuous education to workers already inserted in the process, in order to keep the constant changes in the Brazilian Health system.

[Health policies and practices toward equity]. / Políticas e práticas de saúde rumo a eqüidade.

The text approaches the inequalities and the social exclusion in health establishing its social, historical, cultural and economic inter-relations and determinations. It points to the iniquities as consequence of the inequalities in the production and distribution of the wealth expressed by access to services and material goods. It discusses the practices of management, in the field of the health, as supporters of the equity, indicating the shared management as a tool that promotes the values of citizenship and respect to the diversity. It approaches the participation and the social control as practices that promote equity in the health services. It comments the experience of the Department of Social Politics and Health of Belo Horizonte with the work in geopolitical and social territories with practices of management, assistance and social control that contribute for equity. It concludes that, beyond the analyses and macro interventions, it is basic to take the spaces micro of the work for reflection and performance in the construction of equity.

[Health promotion as a political decision in nursing education]. / Promoção da saúde como decisão política para a formação do enfermeiro.

It is a descriptive-exploratory study with a qualitative approach that has the objective of analyzing the health promotion in training nurses. The setting of the research was two nursing undergraduate courses in the State of Minas Gerais, Brazil. The results show that both schools used settings favorable to a health promotion approach in this training. They anchor this approach in the need to provide students experiences of learning from an immersion in the reality of professional life. It is prevalent on formation a tension between good educational pratices for health promotion were revealed those become into the daily of the service and practices that arrest the subjects on their ways of thinking. It is concluded that health promotion is recognized as a political decision in nursing education, although this is yet incipient and has a mixed theoretical formulation, indicating the need to increase opportunities for conceptual and operational discussion.

Nursing education: seeking critical-reflexive education and professional competencies.

The study describes changes that are noted in students during training and which contribute to define a professional profile. We carried out a descriptive-exploratory study with a qualitative approach, based on dialectics as a theoretical-methodological framework. The data was obtained from documented analysis and through focal groups with teachers, students and service nurses. The results show the student's position as an active subject in the teaching-learning process, through a movement of transformation of academic structures. A correlation was found between the movement that seeks students' greater political, active and critical participation as a way of determining and guiding the profile of the generalist nurse and greater social insertion. We conclude that, despite efforts, training guidelines and the definition of the professional profile in the study settings is directed at the demands of the labor market, and that competency-based training is still incipient.

[Nursing education: building up the integrality of care]. / A formação do enfermeiro: construindo a integralidade do cuidado.

In this study it was aimed to understand the nursing teaching towards the integrality of healthcare. A qualitative approach study with data obtained from interviews with members of the teaching staff, student nurses and nurses of services. The transcribed interviews were submitted to discourse analysis. Intentionalities shown by the research participants regarding the professional training from the perspective of the integrality of healthcare in a movement of overcoming the flexnerian paradigm towards a possibility of critical and reflective education were seen. It was concluded that the nursing training points at reflections on the changing movement on the pedagogical practices and healthcare as fundamental strategy in order to build the integrality of healthcare.

Permanent education: a tool to think and act in nursing work.

This research is important to the extent that it contributes to reflections on educational actions directed at nursing workers, focusing on the purpose, instruments and subjects responsible for care. The general aim was to analyze the effects of permanent education actions on nursing care quality at a large private hospital in Belo Horizonte, Minas Gerais, Brazil. We carried out a qualitative study in the framework of dialectics. Data were collected from two nurses and seventeen nursing auxiliaries and technicians who worked on the eighth and ninth floor and from the nurse manager. The results showed that education is not articulated with the work process and that professionals need management improvement, permitting teaching through problem-raising. The role of nursing professionals needs to be reviewed in the context of the work process, together with training based on the permanent education strategy.

Educación en Enfermería en América Latina: necesidades, tendencias y desafíos / Nursing education in Latin America: needs, trends and challenges

El presente trabajo se expuso en la VII Conferencia Iberoaméricana de Educación en Enfermería, realizada en Medellín en Octubre del 2003. Su objetivo fue analizar las necesidades, tendencias y dasafíos de la educaión de enfermería en América Latina frente a las reformas sectoriales de salud y educación, de los cambios en la organización tecnológica del trabajo y de los patrones epidemiológicos y demográficos de la población de la región. Para su elaboración se revisaron autores que están trabajando el tema con una visión crítica y reflexiva sobre los efectos de las políticas neoliberales y sus repercusiones en la expansión de la educación superior con fuerte énfasis en la privatización de la educación. Considera la educación como un patrimonio cultural de la región marcado por una enorme diversidad y una estrategia para la inclusión social, cultural y económica de sectores de la población historicamente excluidos del consumo de los bienes y servicios producidos en nuestros paises. Presenta los resultados de la Conferencia Mundial de la UNESCO, realizada en París en 2003, donde se presentaron los desafíos para la educación en general y que precisan ser considerados en la educación en enfermería. El artículo aborda la temática del cuidado como categoría central para la organización de la educación de enfermería en la región con la preparación y responsabilidad de las enfermeras en la calidad de salud como un derecho humano de toda la población de la región. En conclusión, destaca la defensa de la salud como un imperativo ético y político de enfermería como tendencia de un pensar y hacer de la disciplina que se aplica en todos los ámbitos de la práctica profesional.

[The changing process in nursing education at the uni settings: potentials and challenges]. / O processo de mudança na educação de enfermagem nos cenários uni: potencialidades e desafios.

This study analyzes changes occurred in the nursing teaching and learning process from Brazilian Schools which pursue the UNI Project, by describing a movement toward change, besides resistance, conflicts, and current challenges involved. It is a qualitative study whose data were gathered by using Focal Groups and documents available in these institutions. Its results show there is a gradual, dynamic and continuous movement toward change, through the search for teaching models that might replace technical rationality with a critical-reflexive proposal. In spite of challenges related to evaluation and individual competencies to overcome resistance and conflicts, we have found that the change process was supported by the creation of participative spaces and horizontal relationships, allowing for a renewed valorization of nursing education.

[A new look at the nursing care provided in basic health units in Juiz de Fora-MG]. / Um novo olhar sobre o cuidado no trabalho da enfermeira em unidades básicas de saúde em Juiz de Fora-MG.

The purpose of this study is to analyze the current "praxis" regarding the nursing care provided in Basic Health Units. The reasons for developing this study are the evidence of a care based on healing actions and the importance of changing this model and redefining nursing care. This is a qualitative, descriptive and analytical study. The results revealed that the nursing care in the Basic Health Units changes according to its specificity and the subjectivity of the nurses who provide it. In sum, authors emphasize the importance of this professional as a member of the health team at the Basic Health Units in the city of Juiz de Fora, MG.