O trabalho do enfermeiro na atenção primária à saúde rural no Brasil

Abstract

he general objective of this study was to analyze the work of primary health care nurses in rural areas by focusing on the meanings of work, rural health policies and working conditions. A qualitative case study was conducted with 11 nurses from Family Health Strategy teams from rural areas of the city of Campina Grande, state of Paraíba. The data collection period was between January and March 2017 through semi-structured interviews and documentary analysis. The documents and interviews underwent Content Analysis. In the analysis of documents, were organized two categories, namely: International health policies for rural areas and National health policies for rural areas. Four categories emerged from the interviews: Life and health context of populations served by the Family Health Strategy of rural areas: a place of underserved population; Working conditions of Family Health Strategy nurses of rural areas; Daily practices of nurses in rural areas; Work meanings for the Family Health Strategy nurses of rural areas. Although policies have been created for reducing health inequalities in rural population groups in Brazil, they have not been fully implemented. The first category revealed the precarious living and health conditions of the rural population, which is mostly consisted of farmers, retirees and a large number of unemployed persons. The Family Health Unit is the only alternative for health access and this population is isolated in relation to the use of communication and information technologies. The second category describes the difficulties inherent in nurses working conditions. The main difficulties were the following: long distances travelled by nurses to rural health units through asphalted highways and dirt roads; differentiated work schedule according to the existing peculiarities of the rural environment that influences the access to service. The third category shows that nurses daily practices are focused on groups already known by ministerial protocols, such as children, hypertensive and diabetic patients, and through programmatic actions and individual care to spontaneous demand. These practices are influenced by working conditions, such as poor transport on the way to rural areas and lack of water in the units, which is essential for performing procedures and assistance. The fourth category describes the meanings of work for nurses based on the dimensions of the meanings of work defined by Morin; Tonelli and Pliopas (2007), which are the individual, organizational and social. Nurses identify that work brings positive meaning when feeling personal satisfaction at work, growth and learning, identification with work, usefulness of the activity they perform, bond with the population and the insertion and social contribution of work. On the other hand, the lack of fullness at work, especially due to difficult conditions and the organization of services, and the distant relationship between management and professionals, were the main aspects identified by professionals as a loss of meaning for development of work. The conclusion is that work of Family Health Strategy nurses of the rural areas studied has a differentiated dynamic with particularities of the rural area and by infrastructure, organization and operational difficulties of services affecting the performance of compatible nursing work with Primary Health Care. Such aspects influence these professionals attribution of different meanings to work. Health policies, especially of 10 the Brazilian SUS (Health Care System) are needed to overcome the health care model and combat health inequities in order to include rural population groups. Nursing; Primary Health Care; Family Health Strategy; Rural areas.