Práticas de enfermagem direcionadas a gestão do cuidado à pessoa com tuberculose na perspectiva da integralidade.

Abstract

The political trajectory of actions to control tuberculosis presents a satisfactory path, although, studies indicate weaknesses in the way to manage, organize and make available resources that facilitate the early diagnosis and production of care for people with TB in the scenario of Primary Care, mainly under the focus of integrality. The National Tuberculosis Control Program has been articulated and structured to promote strategies aimed at the decentralization and horizontalization of tuberculosis prevention, surveillance, and control actions in Primary Health Care with a partnership among other health sectors, strengthening the model of hegemonic care of the Unified Health System. To describe, from the integrality perspective, how the nursing practices directed to the management of care of the person with tuberculosis in Primary Care are effective.This is a descriptive research, with a qualitative approach, developed in the Family Health Units of a municipality in the Sertão Paraibano, a priority in the development of tuberculosis control actions. Fifteen nurses working in the Family Health Strategy teams of this municipality participated, in which they have or have followed cases of the disease in the area. Data collection was performed from November 2017 to February 2018 by means of a structured questionnaire. The empirical material was analyzed and based on the technique of Content Analysis, thematic modality. The study was approved by the Research Ethics Committee of Faculdade Santa Maria (nº 1,502,733) in compliance with Resolution 466/2012. Nurses conceptualize and recognize the importance of integrality in the nurses daily practice to satisfy the needs of the user. They present difficulties in contextualizing the current situation of tuberculosis in the municipality, alleging lack of information and / or even underreporting of cases, after centralization of the disease control actions to the municipal polyclinic, secondary referral service. The nursing actions directed to the management of integral care for tuberculosis, developed through yeast technologies, are summarized in the active search of the suspected respiratory symptoms in an isolated and discontinued way, depicting a line of coordination and vertical management that induce the fragmentation of care and the work process in health; registration and notification of cases; home visits and general guidelines on the disease. The absence of a referral / reference service and of care management tools / devices were pointed out as the cause and consequence of a unstructured model of care that does not provide for a Basic Health Care structured as a first level of attention and a preferential entrance door of the system. It is necessary to (re) think the current model of care in the municipality from the decentralization and planning of tuberculosis control actions to the Family Health teams, concomitant, to the implementation of a Health Care Network that allows the structural organization of the system and a horizontal, continuous and integrated relationship between the levels of care, aiming to produce a shared management of integral care.