Análise da efetividade dos serviços de enfermagem das unidades de APS/ABS do distrito sanitário leste de Natal/RN e proposição de melhorias

Abstract

Primary Health Care (PHC) is the initial level of access for the population to the Brazilian Unified Health System, focusing on preventive health and accessibility. PHC units are distributed across the country, with a trend toward expanding services, evidenced by an increase of 36.8 million registered citizens between 2018 and 2023. In Natal/RN, where this study was conducted, 54.16% of the population, approximately 485,701 citizens, were registered in Basic Health Units (BHU) or Family Health Units (FHU) by December 2023. Nurses play a vital role in these units, being essential for the proper functioning of services. Their duties range from supervising other healthcare professionals to performing exams, dressing wounds, conducting consultations, administering vaccines, and other procedures. The methodology used included bibliographic, documental, and field research, the latter based on Participatory Ergonomics through the application of interactional and observational methods during the study. The primary objective of this work was to propose improvement measures to enhance the full provision of nursing services in the PHC units of the East Health District in Natal/RN through exploratory research. Questionnaires were applied to managers, the eight nurses from the three studied units, and a sample of 27 patients. The results showed that, according to the attendance records over the 12 months analyzed, BHU A effectively met the recommended indicators for the volume of nursing care in 11 months, BHU B met the target in only six months, and BHU C in just one month. The study identified that only BHU B had planned services that were not executed due to a lack of staff training, despite evidence of periodic training for existing services. Possible causes for interruptions in service provision and procedures included: lack of training; absenteeism; professional inaptitude due to lack of supervised practice or personal limitations even after training; risk of cross-contamination; shortage of supplies; and management decisions to prioritize certain services at other BHU. When asked about the services received, 92.3% of patients reported improvements in their health condition after beginning treatment at the unit, and 37% had previously attempted care unsuccessfully. Of these, 80% expressed satisfaction with the unit's operating hours, 16% were somewhat satisfied, and 4% were dissatisfied, suggesting that services start earlier. All patients stated they would return to the health service, and both patients and professionals said they would recommend the service to friends and family. Based on the findings, 17 improvement proposals were developed, divided into three categories to support the full implementation of nursing services in the BHU: Organizational Strategic Planning, Infrastructure, and Work Organization.