| Subcategory/Outline |
Statements |
Nurse Duties
The workers report about their activities in their daily life at work, showing that they share their time between managerial and care activities in the several lines of care, which are organized in weekly schedules. Furthermore, they assume extra activities necessary for the functioning of the unit. |
I am a direct care nurse, I work a lot with nursing consultations. A small part of my day I spend supervising the team, especially in the beginning of the shifts, to see if everything is working, everyone is on their scales, in short, the activities. Then, I take care of the direct assistance needs, which takes most of my time. I work with prescheduled patients and consultations, as well as with scheduling. [...] I conduct consultations related to women's health, gynecology consultations, prenatal consultations, diabetics, hypertensives, and other demands. I also carry out some specific nursing procedures, such as vesical catheterism, cystostomy tube replacement, special wound dressings, and home visits. (ENF168-PR) I work following a schedule, there are always some activities to be done. On Mondays we start prenatal consultations in the morning and make home visits in the afternoon. On Tuesday, preventive care in the morning, and every 15 days we have a team meeting, in the afternoon there is preventive care again. On Wednesday morning I attend pregnant women, and on the afternoon I do childcare. On Thursday I attend pregnant women too, make quick tests and prenatal care, in the afternoon I conduct quick tests too. On Friday, I provide general care. (ENF155-PR) Wound dressing, injections, these activities that would be the duty of a technician, we do them a lot too, depending on the demand, and if you are there you end up doing it, you provide assistance, coordination, and home family health. (ENF55-RS) Nurses do a bit of everything, and you know, it is not easy [smiles], because it seems that everything is part of the role of nurse, and when a role is not specifically made for a nurse, and there is something to do that is not anybody's specific role, you can bet they will ask the nurses to do it [...] that the nurses will find a way to solve it, such as a faucet is broken, the nurses will handle it, that definitely gets in the way. (ENF88-RS) Yes... the nurse here in [city name] is not a clinical nurse anymore, so we do a lot of nursing consultations (ENF8-SC).
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Administration/management
The reports mention daily work organization in the team, work scale verification, and professional distribution, organization of work schedules, vaccination rooms, team leadership, conflict management, management of daily issues, even if they are not the nurse's responsibility, such as filling in forms, managing human resources, and managing supplies and equipment. |
I arrived and had to do all that process of organizing the team using a scale, which activities would be done and how work would be carried out that day. Which public, which vaccines come first, which were the second application, and how to organize this whole process. I started work and made adjustments. Supporting the team in their solicitations, problem solving, and finding failures in the communication and record system, helping to overcome these failures, organizing supplies. (ENF149-PR) Of course, we have all managerial concerns to deal with, leading the clinic, leading the team, managing conflict and all that, but the clinic must become part of the practice. I have to organize my activities so that 60% of the time I'm attending people, in their different needs, and 40% of the time I do managerial tasks of the unit. (ENF171-PR) We spend some time going to the unit, especially in a city like ours, which is quite large, so you spend a lot of time going from the city offices to the health units. (ENF112-PR) But normally, "it goes together like this", I get there and I have to deal any problems that appear, everything, from a janitor that could not come, to the coffee, to the cooking gas that is over, to the broken bathroom, to the patient who is waiting at the door but has no schedule, and who is angry and screaming. Calls from the health secretariat. (ENF129-PR) I coordinate the team, carry out bimonthly meetings where they discuss cases, and the functioning of the unit, as well as practical issues related to functioning, teamwork issues, conflicts that could come up, I also dealt with that in these meetings. In monthly meetings with community health workers I asked them for their reports from home visits, and there are many details about activities involving hypertensive people, diabetics, smokers, pregnant women and their children, vaccination, and so, when getting the report I would also discuss with them specific cases of each of their micro-areas. [...] We make reports all the time, nurses make reports their whole lives, all we do has to be reported to the Ministry of Health. We have to attend every goal, there are goals to reach [...] so the municipality gets funding from the federal and state governments. (ENF-70-RS). I manage human resources, the service, and organize the working process with the team. Bureaucracy is a serious issue, including requests for supplies, organization, clocking out the workers, outsourced workers, organizing the work process as a whole, discussions with the process team, permanent education of the workers, weekly meetings, and HR management itself, HR evaluations are quite frequent, conflict mediation, meetings with the community, we have monthly meetings with community leaders. (ENF96-RS) In our unit there is a collegiate that does the management, we have a coordinator, and also a moment in the collegiate where we make decisions and share them, which also increases the autonomy of workers to make decisions regarding the work process of the teams. (ENF23-SC) |
Home visits
This activity was present in the reports of all participants and was found to be routine in their services. |
On Thursday morning we conduct a lot of home visits, and those who do the visits make multidisciplinary meetings, so it is the physician, me, and the CHW of the territory, so I like to be there, to show the CHW, so she is there, I like this multidisciplinary work a lot, because I think that everyone has to know about the patient. (ENF124-PR) We have the Home Attention Program, there are also situations that require home visits, such as child or mother death investigations, violent cases that have been denounced, and the active search for some situation that requires treatment. (ENF90-RS) Of course, home visits, home consultations, home visits. And the part of territory surveillance, health surveillance. (ENF15-SC) |
Leprosy line of care in tuberculosis
In the south of the country, the cases of tuberculosis and leprosy are frequent, and the nurses mention that they work in a more autonomous way in these cases. |
Following leprosy and tuberculosis requires many activities. (ENF99-PR) Tuberculosis (TB) patients, these are difficult. Because they want to abandon treatment, and it is a long treatment. You have to be on top of them, they give up, get tired, this is the hardest part for me, to be honest. (ENF158-PR) I follow up tuberculosis, with the physician, of course! But the nurse is the one who controls medication, its dispensation, requests for KB [Koch's Bacillus], for control. We also request KB in the invitation, the screening, but controlling is also with us, we leave the clinical evaluation scheduled, but the medication, the treatment, and the KBs are controlled by the nurse. (ENF82-RS) I monitor care spreadsheets and this is decided by each team, since I monitor it monthly, I see if they are using the medication correctly with the tuberculosis, check the LTBI[Latent Tuberculosis Infection], and attend patients who are following prophylactic treatment with isoniazid.(ENF22-SC) |
Line of care of diabetes and hypertension
Caring for chronic conditions such as diabetes and hypertension is mentioned as a responsibility of nurses, both because they need to request exams and control medication, in addition to having their own schedule for dealing with this group. |
Hypertensive and diabetic patients are in the same situation, we check if they need to undergo tests, if they already have results, if the prescription is up to date, if there is any other issue, any complaints. (ENF145-PR) We try to develop a workflow, especially with diabetics and hypertensive patients, that enable us to control the number of consultations they come to, the degree of severity of the disease, whether they are insulin-dependent or not, this is all controlled, we are the ones who conduct the triage for more urgent issues in the unit. In terms of care, if the capillary glycemia of the diabetic patient is totally altered, we receive them and carry out a nursing consultation, and if necessary refer them to the physician. (ENF143-PR) The hypertensive and diabetics, in the beginning of the month, on Monday afternoons, Wednesday afternoons, and Thursday afternoons, I go to three different communities to provide care. This activity is exclusive for them, I deliver medication, measure vital signs, monitor medication intake, who is not taking it, who is unbalanced, who is not, I write new prescriptions, some educational activities on the topics [...]. (ENF54-RS) You have a day for the hypertensive patients and diabetics. Now, with the changes in the indicators, the Ministry of Health states we must have a registered arterial pressure verification and the glycated hemoglobin must be on record too, for each diabetic or hypertensive patient, so you end up increasing nursing consultation and alternating them with clinical consultations.(ENF34-SC) |
Line of care in children/adolescent health
Evaluation of the growth and development through childcare consultations of the nurse stood out in this group, in addition to student health. |
Children, we follow their development, note anthropometric data, fill out their vaccination records, give guidance about diet, weight, whether it is normal, fill in charts and attend the needs of the parents who are the guardians of the child.(ENF145-PR) We conduct childcare, development, vaccination, in short, we attend the requirements of bolsa família [a Brazilian welfare program], the follow up, part of health in school, home visits, active searches. (ENF99-PR) We generally conduct childcare consultations every month, with the children, collecting for the heel prick test. We do it at home, we go to the home and give orientation to the mother, see everything there is to do and conduct the first consultation there. Then, we schedule the follow up of these children, up to 10 days with the pediatrician, then 1 month, 6 months, these children go through pediatrics and, in other months, they come to us, and we try to alternate, one consultation with a nurse, one with a physician.(ENF67-RS) We do all the assessments too, neuropsychomotor development, reflexes, physical examinations, weight, height, give orientations to the mother [...](ENF12-SC) |
Women's health care line
Pap smear, breast exam, contraception, postpartum care, and IUD implementation were reported practices. |
Breast and cervix cancer prevention, adolescents who will start using contraceptives, who come for the first orientations after the menarche, postpartum care during pregnancy, the start of contraceptive use, conversations about these methods, orientation so they can decide/choose which methods are better for them.(ENF145-PR) Women's health consultations too, preventive exam collections, guidance, family planning, rapid tests as well. In my unit I was the only one to conduct both the preventive exam for women and the rapid tests. (ENF86-RS) We even implement IUD [intrauterine device], not all of them do it. I am also an IUD facilitator, which means I have a practical and theoretical course on it, I am the replicator of this course, I teach the theoretical course and supervise the insertions. We are really careful, not all nurses here in (name of the city) are prepared, you cannot just arrive here and think you will place an IUD in your first day, it is not like that. (ENF1-SC) |
Prenatal care line
The nurse has an active role in the prenatal, autonomy to request exams, carry out consultations, and prescribe medication according to the Ministry of Health |
This consultation takes a long time, I spend about one hour. Because we have to fill in the chart of the pregnant women, guide them about prenatal, consultations, exams, the first consultation, when to undergo the obstetric ultrasound. Since this is the prenatal, we check the tetanus and hepatitis B vaccines, and they have many demands, especially in the first pregnancy, they have a lot of questions and the consultation takes longer as a result. Including much guidance, we prescribe folic acid and ferrous sulfate. (ENF169-PR) For pregnant women, I do as the Ministry of Health requires: six consultations, four with the nurse and two with the physician. Then, in the unit, we do seven consultations: three with the physician, because we ask for lab and imaging exams in the first three trimesters.(ENF54-RS) Here in the unit we do the entirety of the low risk prenatal, and the reception is always done by the nurse, in our team. So, even if the physician detects the pregnancy in a first consultation, they ask the team's nurse to bring the women for the prenatal (ENF9-SC). |
Mental health care line
The lack of activities toward mental health in PHC stood out, as well as the perception that the demand for these services increased. |
Currently, we notice a large demand regarding the use of controlled drugs, from children to elders. There is a lot of anxiety and many psychosomatic diseases that we have seen increase daily. (ENF110-PR) Mental health here does not receive much assistance, I have been noticing this for some time. We have no specific activities for mental health, and there is only one psychologist in the city who attends all patients. (ENF55-RS) What has required most of our attention are the issues related to mental health. A lot of people in our population use controlled medication to treat depression, so we even discuss this in team meetings, many patients seeking antidepressant treatment, many patients who come with many nonspecific demands that have a mental health component.(ENF25-SC) |
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Source: the authors.