Care for women in domestic violence situation : representations of hospital nurses *

Our study aimed to analyze the structure and contents of nurses’ social representations about the care provided to the victim of domestic violence. Nurses from two medium size public hospitals at Rio Grande/RS participated in the study. We collected data through free evocations of the inductor term “care for the victim” and analyzed them by software. The nurses had representations centered in the psychosocial care demonstrated by the terms present in the central nucleus. We inferred the presence of a subgroup in the contrast zone that acknowledges the importance of the physical care, without limiting to the actions of technicians. In the periphery, we inferred the work is evident when facing terms of assistance and orientation. The professionalism reveals the need to address the object, based on the reified knowledge. Because this is a theme with a considered emotional load, added to the hospitalization and the fragility of the victim, the psychosocial focus is more significant in the care context. Descriptors: Domestic Violence; Nursing Care; Women's Health; Hospital Care. INTRODUCTION Access to routine prenatal care is given primarily in Primary Health Care, whose multiprofessional care contributes to more favorable maternal and perinatal outcomes, since it allows the early detection and treatment of pathologies, as well as the control of vulnerability factors related to the pregnant woman and the fetus from the monitoring of health conditions. In order to ensure quality prenatal access, a number of strategies were instituted in Brazil, such as the * Extracted from the Doctoral Thesis in Nursing “Social representations of hospital nurses about domestic violence against women and their relationship with care”, Nursing Graduate Program, Universidade Federal do Rio Grande, 2015. 1 Nurse, Ph.D. in Nursing. Adjunct Professor at Universidade Federal do Rio Grande. Rio Grande, RS, Brazil. E-mail: nieleacosta@gmail.com. 2 Nurse, Ph.D. in Nursing. Full Professor at Universidade Federal do Rio Grande. Rio Grande, RS, Brazil. E-mail: vlog1952@gmail.com. 3 Nurse, Ph.D. in Public Health. Full Professor at Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. E-mail: dcuerj@gmail.com. 4 Nurse, Ph.D. in Nursing. Adjunct Professor at Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. E-mail: sergiocmarques@uol.com. br. 5 Nurse, Ph.D. in Nursing. Adjunct Professor at Universidade Federal do Rio Grande. Rio Grande, RS, Brazil. E-mail: giovanacalcagno@furg.br. Received: 07/22/2016. Accepted: 02/07/2017. Published: 09/18/2017. Suggest citation: Acosta DF, Gomes VLO, Oliveira DC, Marques SC, Gomes GC. Care for women in domestic violence situation: representations of hospital nurses. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a21. Available from: http://dx.doi. org/10.5216/ree.v19. 42471. Acosta DF, Gomes VLO, Oliveira DC, Marques SC, Gomes GC. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a21. Available from: http://dx.doi. org/10.5216/ree.v19. 42471. 2 Family Health Strategy (FHS), the Prenatal and Birth Humanization Program (PHPN) and, more recently, the Stork Network, which aim to reduce the rates of maternal, perinatal, and neonatal morbidity and mortality . In this sense, the Ministry of Health (MH) advocates several criteria for the care of the pregnant woman during her follow-up, which must be followed by all the professionals who treat pregnant women, aiming to guarantee integral and quality care, thus reducing risks to the mother and child. However, even with improvements in access to prenatal care, data show that maternal and infant mortality rates are still worrying, especially those related to obstetric causes. This reality shows an alarming problem and therefore requires immediate and effective intervention. Based on the need to evaluate the quality of the health services offered to the population, the Quality Assistance Program (PROQUALI) was developed, which is a tool for the evaluation, monitoring, and training of FHS teams consisting of Performance Improvement Instruments (IMD), which are protocols of the service structure and actions provided by the teams, allowing the improvement of the care provided by several professionals. Among the prenatal care professionals, we can mention the nurse, who performs his or her duties according to Law 7,498/86, in a multiprofessional team and meets the assumptions of the Ministry of Health, considered as essential for qualified prenatal care. Thus, these professionals need to be constantly evaluated in relation to their work actions and stimulated to carry out safe health interventions and actions to promote the health of their population. Based on the assumption that routine prenatal care appointment is part of the professional competence of the nurse in FHS and that the early diagnosis of health problems and their adequate treatment can reduce maternal and neonatal mortality, the objective of this study was to evaluate the quality of nursing appointments in routine prenatal care. METHODS This is an evaluative-descriptive research with a quantitative approach, conducted between January 2014 and March 2015, with five FHS nurses of a municipality in the countryside of the State of Ceará, Brazil, which has approximately 26,415 inhabitants and 11 Basic Health Units (BHU), located in the urban and rural areas of the city of Redenção, Ceará, Brazil. To carry out this study, we investigated five BHU (four located in the urban area and one in the rural area). The remainder was excluded because of the refusal of two nurses to participate in the study, three could not be reached by the researchers because of difficulties in the access, and one nurse responsible for the unit could not be reached. Data collection was carried out by three researchers who, during two meetings, participated in a training, in which the discussion of the instrument was carried out and each activity that would be evaluated was commented. Data collection was carried out with the nurse on the days of prenatal appointments, which occur Acosta DF, Gomes VLO, Oliveira DC, Marques SC, Gomes GC. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a21. Available from: http://dx.doi. org/10.5216/ree.v19. 42471. 3 three times a month in each BHU on average, depending on the demand of pregnant women, from the nonparticipant observation of the procedures performed by nurses during care related to the quality criteria recommended by the MH. To support the study, a structured instrument developed by PROQUALI was used, which encompasses the basic activities that nurses must perform during the appointment, based on the guidelines of the MH. The data were recorded on the instrument obeying a classification consisting of YES (Y), when the activity was performed, NO (N) when it was not performed, and NOT APPLICABLE (NA) for procedures and conducts that should be performed only in different gestational periods. In order to obtain reliable results, and avoid false evaluations, we observed three appointments for each nurse. The records of the observations were grouped according to the topics: characterization of the reception, anamnesis, physical examination, and guidance provided to the pregnant woman. The data obtained were entered in the Excel software. Each item was evaluated individually and classified according to the performance index of the required item. The simple percentage of each item was calculated and when an item was performed in up to 49.9% of the observations it was considered as unsatisfactory (U), when it was performed from 50.0 to 69.9% of the time, it was partially satisfactory (PS), and when it was performed more than 70% of the time, it was satisfactory (S). In general, the activities present in the quality prenatal care were evaluated according to the procedures recommended by PROQUALI, and then a general calculation of all the activities performed by the nurse was carried out. The items classified as NA were taken from the table because there would be no way to characterize whether the activities were carried out satisfactorily or unsatisfactorily, when necessary. This study was carried out according to resolution No. 466 of December 12, 2012, approved by the Research Ethics Committee of the Universidade da Integração internacional da Lusofonia Afro-Brasileira (UNILAB) under CAAE protocol number: 32387314.7. 000. All participating nurses signed the Informed Consent (IC).