Representações sociais da tuberculose por enfermeiros

Abstract

Objective: to describe the social representation of nurses on tuberculosis and identify the implications on nursing care. Method: qualitative research with the participation of 52 nurses from 23 Basic Health Units of Belém, Pará. A semi-structured interview was conducted with subsequent analysis of the thematic content according to the Theory of Social Representations. Results: the social representations of tuberculosis were organized into two categories: infection, evidencing the clinical-epidemiological aspects of the disease, and stigma and prejudice, representing the social aspect. Care is affected by fear -a fact that explains the distance adopted by some nurses when handling ill people. Conclusion: the social representations of nurses on tuberculosis remain grounded in fear, leading professionals to keep a certain distance from patients and generating stigma and prejudice, which may affect adherence to treatment. Descriptors: Tuberculosis; Nursing; Social Psychology; Nursing Care; Social Stigma. RESUMO Objetivo: descrever as representações sociais de enfermeiros sobre a tuberculose e identifi car as implicações para o atendimento de enfermagem. Método: pesquisa qualitativa, com participação de 52 enfermeiros de 23 Unidades Básicas de Saúde de Belém, Pará. Realizou-se entrevista semiestruturada com posterior análise de conteúdo temática segundo o referencial da Teoria das Representações Sociais. Resultados: as representações sociais da tuberculose se organizaram em duas categorias: o contágio, evidenciando a vertente clínico-epidemiológica da doença, e o estigma e preconceito, a vertente social. O atendimento é infl uenciado pelo medo, fato que explica o distanciamento de alguns enfermeiros ao lidar com os doentes. Conclusão: as representações sociais de enfermeiros sobre a tuberculose perduram pautadas no medo que provoca o afastamento do doente, gerando estigma e preconceito, o que pode infl uenciar na sua adesão ao tratamento. Descritores: Tuberculose; Enfermagem; Psicologia Social; Cuidados de Enfermagem; Estigma Social. RESUMEN Objetivo: describir las representaciones sociales de enfermeros sobre la tuberculosis e identifi car las implicaciones en la atención de enfermería. Método: Investigación cualitativa, con participación de 52 enfermeros de 23 Unidades Básicas de Salud de Belém, Pará. Se realizó entrevista semi estructurada, con posterior análisis de contenido temático, según el referencial de la Teoría de Representaciones Sociales. Resultados: las representaciones sociales de la tuberculosis se organizaron en dos categorías: el contagio, evidenciando la vertiente clínico-epidemiológica de la enfermedad, y el estigma y prejuicio, la vertiente social. La atención se ve infl uida por el miedo, hecho que explica el distanciamiento de algunos enfermeros al tratar con los enfermos. Conclusión: Las representaciones sociales de enfermeros sobre la tuberculosis continúan pautadas en el miedo que provoca el aislamiento del enfermo, generando estigma y prejuicio, lo que puede infl uir en su adhesió...

Nursing in adherence to treatment of tuberculosis and health technologies in the context of primary care

“…The nurse, in general, maintains contact with the person with TB throughout the treatment, so the way in which he or she receives and approaches these people has the potential to be the differential for adherence or not to treatment, since the social representations (SR) act in the motivation of the people, interfering in their choices, in this case, in the decision to care for patients with TB. 3,6 These factors are limiting in the nurses' performance: absence of a computerized system and periodicity in the accomplishment of the DOT; difficulty in articulating team actions and work overload, 6,20 distancing from welfare practices, intensifying bureaucratic/administrative activities, 21 centralized verticalization of control actions under the PHC; professional training and articulation between health care points and strategies for monitoring fragile TB control actions. 22 Other negative aspects that contribute to the non-adherence of the user identified by PHC nurses are: unpreparedness and lack of interest of other staff members, limited time for drug supervision and insufficient number of employees; determinants for quality care and for interaction between professional and person with TB, which has repercussions on the establishment of a link.…”

“…6,12,13,17,21 In this scenario, there is also occupational insecurity under the conditions offered by the work environment, it is pointed out that work permeated by situations different from any kind of violence (physical, psychological) demonstrates that the individual vulnerability of the professional in his occupational locus can produce different reactions in the worker, which assumes meaning and endorses the behaviors that will be adopted in the relationship with the patient. 3 As for the disease being socially determined, financial difficulty is defining the absence of minimum conditions of confrontation, since often there are no good living conditions, such as adequate food, work, safe housing, education, leisure, and healthy habits, such as physical exercise and non-use of licit or illicit drugs. 14…”

“…26 With regard to the social representations of TB by nurses, negative representations have been perceived that bring fear Nursing in adherence to treatment of tuberculosis Temoteo RCA, Carvalho JBL, Lira ALBC, Lima MA, Sousa YG and shame to the patients; according to the nurses, a person affected by the disease will feel constrained by their condition, because it is a marked event in their individual history and for continuing to permeate their social life. 3 Understanding patients' experiences with TB can help improve adherence to treatment. Lack of awareness or knowledge about the disease may lead the person with TB to misconceived attitudes, therefore, health education is essential to eliminate a negative attitude towards the disease.…”

“…2 In this perspective, access to TB treatment is assured by public policies and is available in Primary Health Care (PHC), however, it is often based on technical procedures, and does not prioritize the relationships established between people with TB and the professionals responsible for their care. 2,3 Promoting adherence to TB treatment involves encouraging self-care and empowering the user in an active way for their health, understanding the risks to which they are exposed so that they can at eliminate them. 4 The incompleteness of TB treatment may have repercussions on unfavorable outcomes such as drug resistance and maintenance of the chain of transmission.…”

“…5 Therefore, it is important to consider the context of the user for the success of the treatment, and also to consider the strengthening of humanized care and integration with a multiprofessional team, carried out by nursing historically and nowadays, favoring adherence to TB treatment, a disease that is configured as a relevant social phenomenon. 3,6,7 Nursing has been gaining prominence in the application and development of technologies, when it is possible to use them in care and educational contexts. Its use has shown greater professional growth and benefits of the relationship between professional and customer.…”