Health care assistance in primary care: access to care
Objective: to know the health care of transvestites, from the point of view of nurses, in primary care. Method: descriptive, field study, with qualitative approach. Participated ten nurses linked to Family Health Strategies. Data were collected through a semi structured interview. The analytical procedure adopted was the Thematic Analysis technique. Results: primary health care was not the gateway for transvestites to health care, since they are unstructured to serve this population. The welcoming was presented as a tool for the implementation of transvestite care. Conclusion: the study showed that health care actions aimed at the care of transvestites are not developed. The few initiatives that were presented occurred in an isolated and fragmented way, from the individual initiatives of some nurses. Descriptors: Comprehensive Health Care; Gender Identity; Nursing; Primary Health Care. RESUMO Objetivo: conhecer a assistencia em saude as travestis, sob a otica dos enfermeiros, na atencao primaria. Metodo: estudo descritivo, de campo, com abordagem qualitativa. Participaram dez enfermeiros vinculados as Estrategias Saude da Familia. Os dados foram coletados por meio de entrevista semiestruturada. O procedimento analitico adotado foi a tecnica de analise tematica. Resultados: a atencao primaria em saude nao se constituiu na porta de entrada das travestis para a assistencia a saude, visto que o servico se encontra desestruturado para atender esta populacao. O acolhimento se apresentou como ferramenta para a implementacao do cuidado as travestis. Conclusao: o estudo evidenciou que nao sao desenvolvidas acoes de assistencia a saude direcionadas ao atendimento das travestis. As poucas iniciativas que se apresentaram ocorreram de maneira isolada e fragmentada, a partir de iniciativas individuais de alguns enfermeiros. Descritores: Assistencia Integral a Saude; Identidade de Genero; Enfermagem; Atencao Primaria a Saude. RESUMEN Objetivo: conocer la asistencia en salud a las travestis, en la perspectiva de los enfermeros en la atencion primaria. Metodo: estudio descriptivo, de campo, con abordaje cualitativo. Participaron diez enfermeros vinculados a las estrategias de salud familiar. Los datos fueron recogidos a traves de entrevista semiestructurada. El procedimiento analitico adoptado fue la tecnica de analisis tematico. Resultados: la atencion primaria en salud no se constituyo como una puerta de entrada de las travestis para la asistencia de salud, el servicio no es desestructurados para atender poblacion. El acogimiento se ha presentado como una herramienta para la implementacion del atendimiento a travestis. Conclusion: el estudio ha demostrado que las acciones de asistencia a salud no son desarrolladas, ni direccionadas para el atendimiento a las travestis. Las pocas iniciativas que se han producido de manera aislada y fragmentada, a traves de iniciativas individuales de algunos enfermeros. Descriptores: Atencion Integral de Salud; Identidad de Genero; Enfermeria; Atencion Primaria de Salud. Nurse, PhD, Professor, Nursing Course, Federal University of Pampa Uruguaiana Campus UNIPAMPA. Uruguaiana (RS) Brazil. E mail: graci_dutra@yahoo.com.br; Nero, Hospital Santo Antonio. Blumenau (SC) Brazil. E mail: enf_rodrigues@hotmail.com; Nurse, Professor, Nursing Course, Federal University of Pampa Uruguaiana Campus UNIPAMPA. Uruguaiana (RS) Brazil. E mail: jussaralipinski@gmail.com; Academics, Nursing Course, Federal University of Pampa Campus Uruguaiana UNIPAMPA. Uruguaiana (RS) Brazil. E mails: maria.eduardadeitos@gmail.com; alessandraschmidt1988@hotmail.com ORIGINAL ARTICLE Sehnem GD, Rodrigues RL, Lipinski JM et al. Health care assistance in primary care. English/Portuguese J Nurs UFPE on line. Recife, 11(4):1676 84, Apr. 2017 1677 ISSN: 1981 8963 DOI: 10.5205/reuol.9763 85423 1 SM.1104201716 The construction of the concept of health as a social right was structured in the Brazilian reality in a recent past through Article 196 of the 1988 Federal Constitution, amplifying its meaning with the advent of the Unified Health System (UHS) A system that, in order to obtain comprehensive health care for citizens, presupposes social participation, as well as articulation between the principles of universality, integrality and equity. The UHS seeks to consolidate the role to be exercised by the State in formulating and implementing social and economic policies aimed at improving the life and health of different social groups, taking into account their equally differentiated health needs. Precisely, considering such particularities, it became necessary to formulate new policies to assist specific demands. Thus, in 2011, the Ministry of Health presented the National Policy on Integral Health for Lesbians, Gays, Bisexuals, Transvestites and Transsexuals. This policy reflects the struggle for rights, initiated by movements of the population of Lesbian, Gay, Bisexual, Transvestites and Transsexuals (LGBT) structured from the "Brazil without Homophobia: Program to Combat Violence and Discrimination against LGTB and Promotion of Homosexual Citizenship" This program aims at the promotion of LGBT citizenship based on the equality of rights and the fight against homophobic violence and discrimination. With regard to this population, even in societies with advanced measures to protect human rights, discrimination and stigma related to the non heteronormative exercise of sexuality and gender issues are still present and constitute symbolic barriers to access to health care services for this minority. These barriers are especially aggravated when related to the gender identity group of transvestites, based on determinants such as the need to attend specialized demands, homophobia, the stigmatized correlation of this group with prostitution and HIV AIDS infection and discriminatory processes related to other social markers, such as levels of income and schooling, race color and physical appearance, among others. The transvestite figure breaks with the traditionally constructed gender and sexuality binary, through the experience of femininity in a (biological) body of man, with feminine as well as masculine characteristics, coexisting man and woman. The transvestite is, therefore, As a "different being," "out of the ordinary," and below the restrictive model agreed upon by society. This identity constitution configures itself as a vulnerability in the confrontation of health disease processes in the health care setting, considering the existence, at times, of prejudice in the discourses and behaviors of the professionals working in these services, as well as the values that permeate health institutions with regard to gender conformations and the treatment of users according to heteronormativity patterns. Thus, the distance and exclusion of transvestites from health services results from the establishment of hostile and unhappy environments for The assistance, in clear disagreement with the whole care and exercise of citizenship of this group. The scenario of Primary Health Care (PHC) is highlighted for the implementation of these precepts, due to its position as the gateway and communication of users with the entire network of the health system, acting in a decentralized and capillary fashion close to daily life of the subjects within the scope of the principles of the HSP. PHV needs to be organized based on the users' health needs, with a view to welcoming, co responsible, providing resolution and empowering. The nurse is an important professional for this articulation, as it acts directly in the management, planning and execution of activities in the primary health care spaces. In these spaces, they have as general competencies to seek an action backed by ethics, values and principles; promote commitment to health as an individual and collective right; be responsible for health care and contribute to its organization; know the community and establish links; promote prevention and health protection actions; Identify health problems; working with groups, respecting and interacting with cultural differences; Knowledge of the health problems of the population, as well as social determinants. Regarding the follow up of transvestites by nurses, it is perceived that the accomplishment of the humanized welcoming, the formation of links between the user and the health service, the clarification of doubts and, above all, the resolution of their demands are fundamental to ensure the realization of comprehensive, universal and equitable care. Therefore, considering the health needs of transvestites and the importance of making them visible in services for comprehensive care, this study sought to answer the following guiding question: How does it happen Health care for transvestites in INTRODUCTION Sehnem GD, Rodrigues RL, Lipinski JM et al. Health care assistance in primary care. English/Portuguese J Nurs UFPE on line. Recife, 11(4):1676 84, Apr. 2017 1678 ISSN: 1981 8963 DOI: 10.5205/reuol.9763 85423 1 SM.1104201716 primary care? To answer this question, the study aims: To know the health care of transvestites, from the point of view of nurses, in primary care. Descriptive field study, and with a qualitative approach, carried out in Family Health Strategies (FHS) of the urban area of a municipality in the South of Brazil. The scenario of this study is justified by the fact that FHS are the gateway to and communication of users with the entire UHS network. Ten nurses working in these FHS were selected to participate in this study. The sizing of the number of subjects surveyed followed the data saturation criterion. The saturation of the data is characterized when no new information is added to the research process, denoting that the researcher was able to understand the internal logic of the group or of the collectivity under study. Regarding the criteria for inclusion of the participants, the following were considered: being