El vivir en la calle: Una revisión integrativa sobre cuidados a los habitantes de la calle

Koopmans, Fabiana Ferreira; Daher, Donizete Vago; Acioli, Sonia; Sabóia, Vera Maria; Ribeiro, Crystiane Ribas Batista; Silva, Carine Silvestrine Sena Lima da

doi:10.1590/0034-7167-2017-0653

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 72 (1) • Jan-Feb 2019 • https://doi.org/10.1590/0034-7167-2017-0653 copiar

El vivir en la calle: Una revisión integrativa sobre cuidados a los habitantes de la calle

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

identificar los elementos esenciales en las prácticas de cuidado a la población en situación de calle, en el contexto de la Atención Primaria en Salud y verificar las evidencias y la fuerza de recomendación para toma de decisión en salud.

Método:

la revisión integrativa de la literatura, con el uso de los descriptores en la salud, palabras clave y "MeSH terms" en las bases de datos: LILACS, PubMed Central y Web of Science.

Resultados:

han sido seleccionados 22 artículos científicos que se agruparon en tres categorías: La Comprensión del Otro; La Red de Apoyo; y El Cuidado Emancipador. El estudio identificó elementos importantes para el desarrollo del cuidado, como la comprensión de la persona que vive en la calle, la valorización del cuidado en red y del cuidado emancipador.

Conclusión:

se verificó la necesidad de nuevos estudios e investigaciones sobre la temática, que posibiliten la construcción de políticas y acciones de salud más equitativas e inclusivas a esa población que necesita de elementos muy singulares en las prácticas de cuidado.

Descriptores:
Personas en Situación de Calle; Atención Primaria en Salud; Vulnerabilidad en Salud; Salud Pública; Revisión

Nº	Publication Year and Journal	Authors	Title	Outline	City and Country
E1	2016 Ciência & Saúde Coletiva	Engstrom EM, Teixeira MB⁽¹⁰10 Engstrom EM, Teixeira MB. Manguinhos, Rio de Janeiro, Brazil, "Street clinic" team: care and health promotion practice in a vulnerable territory. Ciênc Saúde Coletiva [Internet]. 2016 [cited 2017 Oct 02];21(6):1839-1848. Available from: doi: 10.1590/1413-81232015216.0782016 https://doi.org/10.1590/1413-81232015216... ⁾	Equipe "Consultório na Rua" de Manguinhos, Rio de Janeiro, Brasil: práticas de cuidado e promoção de saúde em um território vulnerável	Qualitative research, with systematization of an experience	Rio de Janeiro (Brazil)
E2	2016 Escola Anna Nery	Kami MTM, Larocca LM, Chaves MMN, Lowen IMV, Souza VMP, Goto DYN⁽¹¹11 Kami MTM, Larocca LM, Chaves MMN, Lowen IMV, Souza VMP de, Goto DYN. Working in the street clinic: use of IRAMUTEQ software on the support of qualitative research. Esc Anna Nery. 2016;20(3):e20160069. doi: 10.5935/1414-8145.20160069 https://doi.org/10.5935/1414-8145.201600... ⁾	Trabalho no consultório na rua: uso do software IRAMUTEQ no apoio à pesquisa qualitativa	Qualitative research, use of interviews, use of IRAMUTEQ software	Curitiba (Brazil)
E3	2016 Patient Preference and Adherence	Steward J, Holt CL, Pollio ED, Austin EL, Johnson N, Gordon AJ, Kertesz SG⁽¹²12 Steward J, Holt CL, Pollio DE, Austin EL, Johnson N, Gordon AJ, et al. Priorities in the primary care of persons experiencing homelessness: convergence and divergence in the views of patients and provider/experts. Patient Prefer Adherence. 2016;10:153-8. doi: 10.2147/PPA.S75477 https://doi.org/10.2147/PPA.S75477... ⁾	Priorities in the primary care of persons experiencing homelessness: convergence and divergence in the views of patients and provider experts	Qualitative research, using interviews	Marrow, Maryland, Pittsburgh, Alabama (USA)
E4	2015 BMC Family Practice	Campbell DJT, O`Neill BGO, Gibson K, Thurston WE⁽¹³13 Campbell DJT, O'Neill BG, Gibson K, Thurston WE. Primary healthcare needs and barriers to care among Calgary's homeless populations. BMC Fam Pract. 2015;16:139. doi: 10.1186/s12875-015-0361-3 https://doi.org/10.1186/s12875-015-0361-... ⁾	Primary healthcare needs and barriers to care among Calgary´s homeless populations	Qualitative research, using interviews and Focus Group	Calgary (Canada)
E5	2015 Cadernos de Saúde Pública	Hallais JAS, Barros NF⁽⁷7 Hallais JA da S, Barros NF de. [Street Outreach Offices: visibility, invisibility, and enhanced visibility]. Cad Saúde Pública [Internet]. 2015 [cited 2017 Oct 02];31(7):1497-1504. Available from: http://dx.doi.org/10.1590/0102-311X00143114 Portuguese. http://dx.doi.org/10.1590/0102-311X00143... ⁾	Consultório na Rua: visibilidades, invisibilidades e hipervisibilidade	Qualitative research, using participant observation	Campinas (Brazil)
E6	2015 Saúde Debate	Silva CC, Cruz MM, Vargas EP⁽¹⁴14 Silva CC da, Cruz MM da, Vargas EP. [Care practices and homeless population: the street clinic case]. Saúde Debate [Internet]. 2015 [cited 2017 Oct 02];39(Especial):246-56. Available from: doi: 10.5935/0103-1104.2015S005270 Portuguese https://doi.org/10.5935/0103-1104.2015S0... ⁾	Práticas de cuidado e população em situação de rua: o caso do Consultório na Rua	Qualitative research, Case study	Rio de Janeiro (Brazil)
E7	2014 MedCare	Kertesz SG, Pollio DE, Jones RN, Steward J, Stringfellow EJ, Gordon AJ, Johnson NK, Kim TA, Granstaff U, Austin EL, Toung AS, Golden J, Davis LL, Roth DL, Holt CL⁽¹⁵15 Kertesz SG, Pollio DE, Jones RN, Steward J, Stringfellow EJ, Gordon AJ, et al. Development of the Primary Care Quality-Homeless (PCQ-H) Instrument: A Practical Survey of Homeless Patients' Experiences in Primary Care. Med Care. 2014;52(8):734-42. doi: 10.1097/MLR.0000000000000160 https://doi.org/10.1097/MLR.000000000000... ⁾	Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of patients' experiences in primary care	Quantitative-qualitative research, use of interviews	Alabama (USA)
E8	2014 Lancet	Hwang SW, Burns T⁽¹⁶16 Hwang SW, Burns T. Health interventions for people who are homeless. Lancet [Internet]. 2014 [cited 2017 Oct 02];384(9953):1541-7. Available from: http://dx.doi.org/10.1016/S0140-6736(14)61133-8 http://dx.doi.org/10.1016/S0140-6736(14)... ⁾	Health interventions for people who are homeless	Systematic review	Toronto (Canada)
E9	2014 Rev Interface: Com Saúde e Educação	Londero MFP, Ceccim RB, Bilibio LF⁽¹⁷17 Londero MFP, Ceccim RB, Bilibio LFS. Consultation office of/in the street: challenge for a healthcare in verse. Interface - Comun Saúde Educ [Internet]. 2014 [cited 2017 Oct 02];18(49):251-60. Available from: doi: 10.1590/1807-57622013.0738 https://doi.org/10.1590/1807-57622013.07... ⁾	Consultório de/na rua: desafio para um cuidado em verso na saúde	Experience reporting from field diaries	Porto Alegre (Brazil)
E10	2014 Rev Interface: Com Saúde e Educação	Macerata I, Soares JGN, Ramos JFC⁽¹⁸18 Macerata I, Soares JGN, Ramos JFC. [Support as care for existential territory: Primary Care and the street]. Interface Comun Saúde Educ [Internet]. 2014 [cited 2017 Oct 02];18(supl.1):919-30. Available from: doi: 10.1590/1807-57622013.0210 Portuguese. https://doi.org/10.1590/1807-57622013.02... ⁾	Apoio como cuidado de territórios existenciais: Atenção Básica e rua	Experience report	Niterói (Brazil)
E11	2014 Fractal Revista de Psicologia	Pacheco MEAG⁽¹⁹19 Pacheco MEAG. [Public policy and capital social: the Projeto Consultório de Rua]. Fractal Rev Psicol [Internet]. 2014 [cited 2017 Oct 02];26(1):43-58. Available from: http://dx.doi.org/10.1590/S1984-02922014000100005 Portuguese. http://dx.doi.org/10.1590/S1984-02922014... ⁾	Políticas Públicas e capital social: O projeto consultório de rua	Discussion/Reflection Article	Fortaleza (Brazil)
E12	2013 BMC Health Services Research	Campbell JTD, Gibson K, O´Neill BG, Thurston W ⁽²⁰20 Campbell DJ, Gibson K, O'Neill BG, Thurston WE. The role of a student-run clinic in providing primary care for Calgary's homeless populations: a qualitative study. BMC Health Serv Res. 2013 [cited 2017 Oct 02];13(1):277. Available from: https://doi.org/10.1186/1472-6963-13-277 https://doi.org/10.1186/1472-6963-13-277... ⁾	The role of a student-run clinic in providing primary care for Calgary´s homeless populations: a qualitative study	Qualitative research, use of interviews and analysis of categories	Calgary (Canada)
E13	2013 American Journal of Public Health	Kertesz SG, Holt CL, Steward JL, Jones RN, Roth DL, Stringfellow E, Gordon AJ, Kim TW, Austin EL, Henry SR, Johnson NK, Granstaff US, O´Connell JJ, Golden JF, Young AS, Davis LL, Pollio DE⁽²¹21 Kertesz SG, Holt CL, Steward JL, Jones RN, Roth DL, Stringfellow E, et al. Comparing homeless persons' care experiences in tailored versus nontailored primary care programs. Am J Public Health. 2013;103(S2):S331-S339. doi: 10.2105/AJPH.2013.301481 https://doi.org/10.2105/AJPH.2013.301481... ⁾	Comparing homeless persons' care experiences in tailored versus nontailored primary care programs	Comparative survey	Pensilvania, Alabama, California, Massachusetts (USA)
E14	2013 Rev Polis e Psique	Macerata IM⁽²²22 Macerata IM. [Experience POP STREET: Implementation of "health in motion on the streets" in Rio de Janeiro, a clinical/political device in the health system of the Rio de Janeiro. Rev Polis Psique [Internet]. 2013 [cited 2017 Oct 02];3(2):207-219. Available from: http://www.seer.ufrgs.br/PolisePsique/article/download/46178/28740 Portuguese. http://www.seer.ufrgs.br/PolisePsique/ar... ⁾	Experiência POP RUA: Implementação do "Saúde em Movimento nas Ruas" no Rio de Janeiro, um Dispositivo Clínico/Político na Rede de Saúde do Rio de Janeiro	Experience report	Niterói (Brazil)
E15	2013 Journal of the American Board Fam Med (JABFM)	Weinstein LC, LaNoue MD, Plumb JD, King H, Stein B, Tsemberis S⁽²³23 Weinstein LC, LaNoue MD, Plumb JD, King H, Stein B, Tsemberis S. A Primary Care-Public Health Partnership Addressing Homelessness, Serious Mental Illness, and Health Disparities. J Am Board Fam Med. 2013; 26(3):279-87. doi: 10.3122/jabfm.2013.03.120239 https://doi.org/10.3122/jabfm.2013.03.12... ⁾	A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities	Experience report	Philadelphia (USA)
E16	2012 Journal of the American Board Fam Med (JABFM)	Price-Stevens L, Goode JVR⁽²⁴24 Price-Stevens L, Goode J-VR. Shared Care Model in a Federally Qualified Health Care Center for the Homeless. J Am Board Fam Med. 2012;25(2):253-4. doi: 10.3122/jabfm.2012.02.110327 https://doi.org/10.3122/jabfm.2012.02.11... ⁾	Shared Care Model in a federally qualified health care center for the homeless	Experience report	Virginia (USA)
E17	2010 Revista Saúde e Sociedade	Junior NC, Jesus CH, Crevelim MA⁽²⁵25 Junior NC, de Jesus CH, Crevelim MA. [The family health strategy focused on access equity and targeted at the homeless population living in large urban centers]. Saúde e Soc [Internet]. 2010 [cited 2017 Oct 02]; 19(3):709-716. Available from: doi: https://doi.org/10.1590/S0104-12902010000300021 Portuguese. https://doi.org/10.1590/S0104-1290201000... ⁾	A Estratégia Saúde da Família para a equidade de acesso dirigida à população em situação de rua em grandes centros urbanos	Experience report	São Paulo (Brazil)
E18	2010 American Journal of Public Health	O' Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, Koh HK ⁽²⁶26 O'Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, et al. The Boston Health Care for the Homeless Program: a public health framework. Am J Public Health. 2010;100(8):1400-1408. doi: 10.2105/AJPH.2009.173609 https://doi.org/10.2105/AJPH.2009.173609... ⁾	The Boston Health Care for the homeless program: A public health framework	Document review study	Boston, (USA)
E19	2007 Revista da Escola de Enfermagem da USP	Canônico RP, Tanaka ACDA, Mazza MMPR, Souza MF, Bernat MC, Junqueira LX⁽²⁷27 Canônico RP, Tanaka ACD, Mazza MMPR, Souza M de F, Bernat MC, Junqueira LX. [Health assistance to homeless people in a health unit in São Paulo city]. Rev Esc Enferm USP [Internet]. 2007 [cited 2017 Oct 02];41(Esp):799-803. Available from: http://dx.doi.org/10.1590/S0080- 62342007000500010 Portuguese. http://dx.doi.org/10.1590/S0080- 6234200... ⁾	Atendimento à população de rua em um Centro de Saúde Escola na cidade de São Paulo	Experience report	São Paulo (Brazil)
E20	2006 Revista Saúde e Sociedade	Junior NC, Andrade MC, Luppi CG, Silveira C⁽²⁸28 Junior NC, Andrade MC, Luppi CG, Silveira C. [Organization of equanimous practices in primary health attention within the metropolitan area with respect to social inclusion and exclusion processes]. Saúde E Soc [Internet]. 2006 [cited 2017 Oct 02];15(3):30-39. Available from: doi: https://doi.org/10.1590/S0104-12902006000300004 Portuguese. https://doi.org/10.1590/S0104-1290200600... ⁾	Organização de Práticas de Saúde equânimes em Atenção Primária em região metropolitana no contexto dos processos de inclusão e exclusão social	Experience report	São Paulo (Brazil)
E21	2003 Cadernos de Saúde Pública	Junior NC, Silveira C⁽²⁹29 Carneiro Jr N, Silveira C. Primary health care organization in the context of social exclusion/inclusion processes. Cad Saúde Pública [Internet]. 2003 [cited 2017 Oct 02];19(6):1827-1835. Available from: http://dx.doi.org/10.1590/S0102-311X2003000600026 http://dx.doi.org/10.1590/S0102-311X2003... ⁾	Organização das práticas de atenção primária em saúde no contexto dos processos de exclusão/ inclusão social	Experience report	São Paulo (Brazil)
E22	2003 British Journal of General Practice	Riley AJ, Harding G, Underwood MR,Carter YH⁽³⁰30 Riley AJ, Harding G, Underwood MR, Carter YH. Homelessness: a problem for primary care? Br J Gen Pract [Internet]. 2003 [cited 2017 Oct 02];53(491):473-479. Available from: http://bjgp.org/content/53/491/473.short http://bjgp.org/content/53/491/473.short... ⁾	Homelessness: a problem for primary care?	Discussion/Reflection Article	London (England)

Category Understanding of the Other - Essential elements pointed out in the studies	Studies
- Positive interpersonal relationship between HP and healthcare professionals (respect, mutual trust, acceptance and care)	E8
- Bonding and reception (qualified listening)	E6, E19, E14
- Access and individualized care to the needs of each individual	E13, E16, E4
- Disruption of prescriptive care	E6
- Non-punctual care, with redemption of citizenship, dignity and affective-intellectual	E21
- Understanding the habitus of each individual	E11

Category Support Network - Essential elements pointed out in the studies	Studies
- Articulation of the health and intersectoral network as referential north for care	E1, E10, E17, E15, E22, E20
- Housing Coordination	E15, E22
- Articulation between government Offices (inter-office)	E17
- Catalog of services with connection to each other and articulation with therapeutic projects	E1
- Approximation of territory and understanding of the ways of living of the population	E1
- Care based on the reception and not the recollection	E1
- Teamwork with an emphasis on the articulated attention between the different knowledge and practices	E2

Category Emancipatory Care - Essential elements pointed out in the studies	Studies
- Emancipation of the subjects with focus on the political care.	E5, E18
- Recognition of the diversity and autonomy of the subjects, transforming them into participatory agents of the health-disease process.	E7
- Understanding the street as a territory of the Homeless Persons: living on the street.	E5
- Breaking with biopower: care must absorb the unexpected, the unplanned and the non-prescriptive, with the development of new research and innovative solutions.	E5, E9, E18, E7
- Care in composition: moments of deceleration of the caregiver, the caregivers are placed next to who is caring for.	E9

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Fabiana Ferreira Koopmans E-mail: fabianakoopmans@gmail.com