Implantação de uma diretriz de assistência de enfermagem no puerpério na atenção primária à saúde

Abstract

This study aimed to verify the feasibility and effectiveness of the implementation of a guideline of puerperium nursing assistance in the primary health care area. It deals of a quasi experimental study developed in 15 primary health care unities with the family health strategy in a city of Minas Gerais state. The study population consisted of 168 mothers distributed into study and no equivalent groups. The study group was composed of 42 mothers submitted to five nursing consultations, being one in postpartum, two in late puerperium and two in remote puerperium. The no equivalent group consisted of 126 mothers not exposed to the guideline, interviewed during home visits conducted between 90 and 120 days postpartum. The data collection began in May 2011, after approval by the research ethics committee, and ended in May 2012. The descriptive analysis of qualitative variables included the calculation of absolute frequencies and percentages. The comparison between groups was obtained by the Chi-square test, considering the significance level of 0.05 and the measure of strength of association performed by odds ratio. The results showed that the mothers had an average age of 27 years, were white (46.4%), lived with a partner (68.5%), scholarity level of primary education and incomplete secondary education (57.1%) underwent more than seven prenatal consultations (71.4%) underwent cesarean section (49.4%) and offered breastfeeding within the first hours of life (62.5%). The only obstetric variable with a significant difference between groups was parity with 57.1% of primiparous in study group and only 39.7% in no equivalent. It was found statistically significant results for the variables: exclusive breastfeeding, 42.9% in the study group and 25.4% in no equivalent (P = 0.020), performance of the Pap smear for 85% of mothers in the study group and 63.2% in no equivalent (P = 0.015), use of ferrous sulfate for 90 days by 26.2% in the study group and 18.3% in no equivalent (P <0.001), with postpartum depression in 48% in the exposed group and 18.3% in no equivalent s (P = 0.033) and immunization for tetanus vaccines, coverage was 97.6% in the exposed group and 82.5% in no equivalent s (P = 0.014), vaccine rubella, with 69% in the study group and 51.6% in no equivalent s (P = 0.048), and hepatitis B, with 81% in the exposed group and coverage of only 56.3% of no equivalent s (P = 0.04). There was no significant results for the use of contraceptives (P = 0.430), febrile illness (P = 0.893) and puerperal bleeding (P=0.333). It were evidenced significant results when comparing the groups for most variables and higher chance of postpartum women in the study group to be covered with health promotion, prevention, detection and early referral, proving the feasibility and effectiveness of the implementation of the nursing care guideline in the puerperium in primary health care.