Family Health Strategy : nursing care management

This study aimed to understand the knowledge of nurses working in Family Health Strategy about the concept, difficulties and strategies used to develop care management. This is a qualitative, descriptive and exploratory research, carried out in Pelotas/RS/Brazil, involving 20 nurses. Data collection occurred with semi-structured interviews, analyzed based on the Thematic Analysis. Nurses understand care management as the articulation between management and care. As for the difficulties, there is a lack of physical structure and material, resistance to dealing with co-workers, lack of autonomy and the position of district manager assigned to the person with no knowledge in the health area. The suggested strategies were approaching the municipal management with the health service, permanent education investments and increase in the number of human resources. Nurses understand that care and management are interconnected to ensure care for the population in their territories. Descriptors: Nursing; Family Health Strategy; Nursing Care; Health Services Administration. INTRODUCTION Care management consists of nurse attribution directly related to the search for quality care and better working conditions for professionals, in a perspective that articulates management and care, focusing on the health service user and care in an approach that goes beyond technicality towards the integrality of attention. It encompasses a dialectical relationship between knowing how to manage and knowing how to take care of, in its theoretical origin. Therefore, nursing care management expertise bases in scientific, ethical, 1 Nurse. Pelotas, RS, Brazil. E-mail: verifermino@yahoo.com. br. 2 Nurse, Doctorate degree in Nursing. associate professor of Federal University of Bahia. Salvador, BA, Brazil. E-mail: simoneamestoy@hotmail.com. 3 Nurse, Master's Degree in Nursing. Doctoral Student of the Postgraduate Program at Federal University of Pelotas. Nurse of the Municipality of Pelotas. Pelotas, RS, Brazil. E-mail: bi.santos@bol.com. br. 4 Nurse, Master's Degree in Nursing. Doctoral Student of the Postgraduate Program at Federal University of Pelotas. Assistant Professor at Federal University of Pelotas. Pelotas, RS, Brazil. E-mail: stcasarin@gmail.com. Received: 08/18/2016. Accepted: 12/08/2016. Published: 04/18/2017. Suggest citation: Fermino V, Amestoy SC, Santos BP, Casarin ST. Family Health Strategy: nursing care management. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a05. Available from: http://dx.doi. org/10.5216/ree.v19. 42691. Fermino V, Amestoy SC, Santos BP, Casarin ST. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a05. Available from: http://dx.doi. org/10.5216/ree.v19. 42691. 2 aesthetic and personal knowledge, in the face of the complexity of the human being in terms of their singularity, multiplicity and individuality as well as their relation and insertion in the various everyday life scenarios. The nurse primarily does care management, while the nurse is responsible for the collective work organization of nursing so that care can be developed. The proactivity of this professional can bring important repercussions in their work. In view of the practical scenario, care management is important as a professional actions focus, since administrative processes should be used, such as technologies for their effectiveness, through direct actions with users or through delegation and articulation with the other health team professionals. Health care within the Unified Health System (UHS), despite the progress made towards consolidating the Family Health Strategy (FHS), as a model for reorienting primary care, has gaps influenced by the traditional model, characterized by fragmented, hierarchical, individualistic activities with a positivist vision of the health-disease process. Since UHS creation, there have been advances in its implementation. The aforementioned system has considerably increased access to health care for a large part of the population, reaching universal coverage for vaccination and prenatal care; it broadened the population's awareness of the right to health linked to citizenship; it promoted the development of human resources and technology in health. However, the UHS consists of a health system that continuously strives, through its political, economic, scientific and technological sustainability, to ensure universal and equitable coverage. For this reason, it lacks professionals engaged in the pursuit of the health actions development. Among the nurses' management actions in the FHS context, stand out participation in the elaboration, coordination and articulation of the Basic Health Unit (BHU) planning; promotion of integration and good relationship of the health teams under their responsibility; investment in interpersonal relationships (valuing professionals performance); identification of physical resources and demographic and epidemiological profile of the population ascribed. The study is relevant, considering that the literature indicates that most investigations related to nursing care management are related to hospital care. Moreover, in the FHS there are limitations of activities carried out by nurses, among them, the lack of autonomy in many municipalities, because there is no implementation of protocols that support their activities, which consequently implies the performance of functions, interfering directly in the care management. Based on the above, the objective was to understand the knowledge of nurses working in the Family Health Strategy about the concept, difficulties and strategies used to develop care management METHODS This is a qualitative, descriptive and exploratory research carried out in the basic health services of Pelotas/RS/Brazil. The municipality has 50 BHUs; 37 have FHS teams, corresponding in total, 66 FHS teams. Fermino V, Amestoy SC, Santos BP, Casarin ST. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a05. Available from: http://dx.doi. org/10.5216/ree.v19. 42691. 3 Within these values, 26 BHUs with FHS teams are in the urban area. Twenty nurses participated in the study. The inclusion criteria we adopted were nurses who worked in BHU with FHS in the urban area and were on the same team for at least six months. The exclusion criteria of the study were nurses not found in the place in more than two scheduled visits or not working due to sick/maternity leave. Saturation criterion delimited the number of participants, that is, when the information, explanations and meanings attributed by the participants started appearing regularly. We previously scheduled the interviews via telephone contact, and a nurse from every BHU was selected drawn by lot when there was more than one family health team. Data collection took place in September 2015 through a semi-structured interview with a script to identify the participants profile and open questions, in order to investigate nurses' knowledge, application and opinion about the subject. To preserve anonymity, we identified the statements with the letter E and the ordinal number corresponding to the sequence of interviews (E1, E2 ., E20). Participants were asked about the understanding and how to perform the management in practice as well as the difficulties, facilities and strategies to implement it in the FHS. We used thematic analysis, structuring and organizing the content in two moments. The first refers to the exploratory research phase, constituting the fundamental theoretical framework for the analysis. The second is the interpretative, in which the informants' reports were used to give meaning, logic and projection, seeking comprehension and aggregation of responses. Firstly, we put the data in order, which involved the transcription of the material obtained through the interviews and re-reading of the material. Afterwards, we proceed to data classification, by means of the horizontal and exhaustive reading, apprehending the structures of relevance and the central ideas. In the cross-sectional reading, we separated the data by direction units. In the rating process, we identified the categories, joined the similar parts, trying to perceive the connections between them, and keeping them in codes. In the final analysis, the data were compared with the literature. From the analysis, three categories emerged, the FHS nurses understanding on nursing care management; Difficulties faced during the nursing care management implementation; and Strategies to improve care management. In relation to ethical principles, we considered in all stages of the research the determinations of Resolution 466/12 of the National Health Council on Human Research. The Research Ethics Committee of the Nursing School of Federal University of Pelotas approved the research, protocol number 1,208,951. RESULTS AND DISCUSSION Regarding the profile of the 20 nurses participating in the study, the age ranged from 29 to 58 years and two were male. The training time was from seven to 28 years and only one was not from public university. None of them underwent an auxiliary or nursing technician course. Only one had no graduate studies; 18 had Fermino V, Amestoy SC, Santos BP, Casarin ST. Rev. Eletr. Enf. [Internet]. 2017 [cited __/__/__];19:a05. Available from: http://dx.doi. org/10.5216/ree.v19. 42691. 4 specialization, and of these, 14 were from public health or family health; two completed master's degree. The working time in the FHS team comprised between eight months and 15 years, nine of which were the coordinators of the multidisciplinary team. Regarding employment contract, all were civil servants, with a workload of 40 hours per week, but six also worked in another place, which can directly reflect on the assistance, considering the weekly work overload. The understanding of FHS nurses on nursing care management In order to understand the knowledge about the nursing care management in the view of the nurses working in FHS, there was a need t