Análise da atuação do(a) enfermeiro(a) nos três níveis de atenção à saúde sob a ótica da Linha de Cuidado para atenção integral a crianças e adolescentes em situação de violência

Abstract

The objective of this study was to analyze the nurse's approach to children and adolescents in situations of violence in the three levels of health care based on the line of care for children and adolescents in situations of violence. Analytical study with qualitative approach, conducted in the city of Campina Grande, Paraíba, in primary, secondary and tertiary health care services that assist children and adolescents in situations of violence. Participated in the study 76 nurses distributed: in primary care, working in the Family Health Strategy; in secondary care, in a municipal child and adolescent care hospital in the reception, red room and pediatric ward sectors; in tertiary care, the nurses of the reception, red room, pediatric observation, pediatric ward and pediatric intensive care unit of a referral trauma hospital. Data were collected from January to March 2018 using a sociodemographic form and semistructured interviews recorded and transcribed. The collected data were analyzed by the IRAMUTEQ software through Descending Hierarchical Classification, Similitude Analysis and Word Cloud. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte with opinion no. 2,456,493. In Primary Care, from the lexicographic analysis classes, five categories were obtained: Category I (Class 1) - Living and identification by the nurse of situations of violence with children and adolescents; Category II (Class 4) -Family context and violence; Category 3 (Class 5) - Health promotion actions by nurses; Category IV (Class 3) - Multidisciplinary team and services of the care network as support for the approach of the nurse; Category V (Class 2) -Capacitation and performance of the nurse facing the victim of violence. In Secondary Care emerged five categories defined as: Category I (Class 1) - Conducts directed to children and adolescents victims of violence in the service of medium complexity; Category II (Class 4) -Scope of medium complexity and actions of the nurse; Category III (Class 5) -Capacitation and the nurse's way of dealing with victims of violence; Category IV (Class 3) -Nurse's perception of the family context and the victim; Category V (Class 2) -Identification of violence against children and adolescents by nurses through nursing consultation; and for Tertiary Care the data produced six categories named: Category I (Class 1) - Reception, notification and follow-up of cases of violence; Category II (Class 5) -Nursing consultation: signs of identification of violence; Category III (Class 6) -Relation of the nurse with the relative; Category IV (Class 4) -Nurse training to approach children and adolescents victims of violence; Category V (Class 2) -Specificities of the service sectors in the highly complex service; Category IV (Class 3) -High complexity health service as a reference for situations of violence. The analysis of the three levels of health care identified weaknesses in the approach of nurses to children and adolescents in situations of violence regarding scientific and technical knowledge in undergraduate or training, in the identification of cases of violence, in relationships with victims and family, in articulation. multidisciplinary and intersectoral approach and in defining the internal flows of each level of care. It is concluded that the approach of nurses to children and adolescents in situations of violence needs qualification through specific vocational training, definition of flows and protocols and articulation with the safety net.