Rev. Enferm. UFSM - REUFSM

Santa Maria, RS, v. 9, e70, p. 1-15, 2019

DOI: 10.5902/2179769232885

ISSN 2179-7692

 

Submission: 06/06/2018    Acceptance: 16/10/2019    Publication: 02/12/2019

Revision Article

 

Scientific production on penitentiary health in Brazilian nursing

Produção científica sobre saúde penitenciária na enfermagem brasileira

Producción científica en salud penitenciaria en enfermería brasileña

 

Mayara Lima BarbosaI

Alcides Viana de Lima NetoII

Cecília Olívia Paraguai de Oliveira SaraivaIII

Manacés dos Santos BezerrilIV

Gabriela Maria Cavalcanti CostaV

Viviane Euzébia Pereira SantosVI

 

 I Enfermeira, Doutora em Enfermagem, Unifacisa, Campina Grande, Paraíba, Brasil. E-mail: mayaralimabarbosa@gmail.com, ORCID: https://orcid.org/0000-0002-8063-7903

 II Enfermeiro, Mestre em Enfermagem, UFRN, Natal, Rio Grande do Norte, Brasil. E-mail: alcides.vln@gmail.com, ORCID: https://orcid.org/0000-0001-6191-9465

 III Enfermeira, Doutora em Enfermagem, UFRN, Natal, Rio Grande do Norte, Brasil. E-mail: cecilia_olivia@yahoo.com.br, ORCID: https://orcid.org/0000-0003-4225-5194

 IV Enfermeiro, Mestre em Enfermagem, UFRN, Natal, Rio Grande do Norte, Brasil. E-mail: manacesbezerril@hotmail.com, ORCID: https://orcid.org/0000-0002-9003-2334

 V Enfermeira, Doutora em Enfermagem, UEPB, Campina Grande, Paraíba, Brasil. E-mail: gabrielamccost@gmail.com, ORCID: https://orcid.org/0000-0003-4283-8082

 VI Enfermeira, Doutora em Enfermagem, UFRN, Natal, Rio Grande do Norte, Brasil. E-mail: vivianeepsantos@gmail.com, ORCID: https://orcid.org/0000-0001-8140-8320

 

Abstract: Objective: To characterize the studies published in the Center for Studies and Research in Nursing that address the theme of penitentiary health. Method: This is a bibliographic search, which was searched in the CEPEn database, in the catalogs available electronically - corresponding to Volume XIX (2001) to XXXIV (2016). Results: The analysis was performed on the 9514 titles in the database, among which nine (0.095%) dissertations and theses were developed on the subject and make up the final sample. Of these, only one study related nursing and penitentiary health and three highlighted implications for the profession. Conclusion: It is clear that fostering discussion on the topic represents a breakthrough and is essential to fill the gaps in health care delivery in this scenario.

Descriptors: Nursing; Prisons; Nursing Graduate Education; Nursing Research

 

Resumo: Objetivo: caracterizar os estudos publicados no Centro De Estudos e Pesquisa em Enfermagem que abordam a temática saúde penitenciária. Método: trata-se de uma pesquisa bibliográfica, cuja busca foi realizada no banco de dados do CEPEn, nos catálogos disponíveis eletronicamente – correspondentes ao Volume XIX (2001) ao XXXIV (2016). Resultados: a análise foi realizada nos 9514 títulos constantes no banco de dados, entre os quais nove (0,095%) das dissertações e teses foram desenvolvidas sobre o tema e compõem a amostra final. Destes, apenas um estudo relacionou enfermagem e saúde penitenciária e três destacaram implicações para a profissão. Conclusão: depreende-se que fomentar a discussão sobre o tema representa um avanço e é essencial para suprir as lacunas verificadas na prestação da assistência à saúde nesse cenário.

Descritores: Enfermagem; Prisões; Educação de Pós-Graduação em Enfermagem; Pesquisa em Enfermagem

 

Resumen: Objetivo: caracterizar los estudios publicados en el Centro de Estudios e Investigación en Enfermería que abordan el tema de la salud penitenciaria. Método: Esta es una búsqueda bibliográfica, que se buscó en la base de datos CEPEn, en los catálogos disponibles electrónicamente, correspondientes al Volumen XIX (2001) a XXXIV (2016). Resultados: El análisis se realizó en los 9514 títulos de la base de datos, entre los cuales se desarrollaron nueve tesis (0.095%) y tesis sobre el tema y constituyen la muestra final. De estos, solo un estudio se relacionó con la enfermería y la salud penitenciaria y tres destacaron las implicaciones para la profesión. Conclusión: está claro que fomentar la discusión sobre el tema representa un gran avance y es esencial para llenar los vacíos en la prestación de atención médica en este escenario.

Descriptores: Enfermería; Prisiones Educación de Posgrado en Enfermería; Investigación de enfermería

 

 

 

Introdução

Health care is a right guaranteed to persons deprived of their liberty in Brazil since the Law of Criminal Executions (LCE) No. 7.210 of July 11, 1984.1 However, there were gaps that made health actions fragmented, inarticulate and ineffective. Due to this worrying scenario and to resume the commitment of the Unified Health System (SUS), concerning universal and equitable care for the entire Brazilian population,2 was instituted by Interministerial Ordinance No. 1777, of September 9, 2003, the National Penitentiary System Health Plan (NPSHP).3

After ten years of publication of the NPSHP, a major evaluation was carried out and it was realized that the plan was already inefficient in point of view of health needs of the population deprived of liberty in the country. Given this reality, was created the National Policy for Integral Health Care for Persons Deprived of their Liberty in the Prison System (NPHCPS), through an Interministerial Ordinance No. 1 of January 2, 2014. The NPHCPS is ruled by the principles of respect of the human rights and social justice, providing a humanized environment, the integrality of health care for the person deprived of liberty (PDL), the equity and the recognition of the uniqueness of each.4

The insertion of health professionals in the penitentiary system has occurred since the publication of the NPSHP and continued after the establishment of the NPHCPS. According to the policy, access and health care are developed by the Primary Care Teams of the Prison System (PCTPS). These are composed formed by a doctor, a nurse, a nursing technician or nursing assistant, a dentist and a dental technician or assistant, and may be added a higher level professional (physiotherapist, psychologist, social worker, pharmacist, occupational therapist, nutritionist or nurse) and / or a mental health team if necessary, considering the established criteria.4

The PCTPS professionals must perform their care practices in accordance to those offered in primary health care. Thus, the provision of comprehensive health care should be ensured through actions aimed at the treatment and rehabilitation of the most prevalent diseases, disease prevention actions and health promotion activities with the cross-cutting participation of the health care network.4

Given the inclusion of health professionals in the penitentiary system, discussions around the theme gained space in the training centers. As a result, we understand the need to recognize how nursing postgraduate programs have researched about penitentiary health, considering the importance of nursing in the multidisciplinary work developed within Brazilian prisons and the growth of Forensic Nursing field in the country.

Which all discussed, this study aimed to characterize the studies published in the Center of Studies and Researches in Nursing that address the theme of penitentiary health.

Methods

A bibliographic research, whose search was performed in the Database of the Center of Studies and Researches in Nursing (CEPEn) of the Brazilian Nursing Association (ABEn), in December / 2016, with update in September / 2019, in all electronically available catalogs that correspond from Volume XIX (2001) to XXXIV (2016).

The search for the productions of interest present in CEPEN occurred through the use of the following keywords: “penitentiary health”, “forensic nursing”, “prison system”, “judicial system” and “inmate”, using the Boolean operator "OR". The inclusion criterion was: dissertations and theses produced by nurses, components of the CEPEn from the ABEn that deals with the theme of penitentiary health.

Nine abstracts from dissertations and theses addressing the theme in question were selected. The theses and dissertations of the elected abstracts were fully read and analyzed according to the academic level of the production (master or doctorate), to the higher education institution (HEI) which belongs the work, the year of publication, the region of the country (North , South, Southeast, Midwest or Northeast), the Brazilian federative unit where is the HEI, the thematic field (Teaching, Research, Care Practice, Management), the object, objective and type of study, the chosen methodological approach (Qualitative , quantitative, mixed), the implications and final recommendations of the work.

 

Results

Table 1 shows the small number of studies that were developed about penitentiary health in nursing post-graduate studies (0.095%). There is a preponderance of studies on the subject in master courses (88.9%), rather than doctoral courses (11.1%). Regarding the institutions in which they were held, two universities, Federal University of Santa Catarina (UFSC) and Federal University of Paraíba (UFPB) stood out, with two studies each. The year of 2010 presented the largest number of studies on penitentiary health (44.4%). The Northeast region is evidenced as the largest producer of studies on the theme (44.4%). Most of the dissertations and thesis deal with assistance research (66.6%), descriptive type (88.8%) and qualitative methodological approach (88.8%).

Table 1. Characterization of studies according to the academic level, Higher Education Institution, year of publication, region/Federative Unit, thematic area, type of study and approach. Brazil, 2019.

VARIABLE

N

%

Academic Level

 

 

     Doctorate

1

11.1

     Master

8

88.9

Higher Education Institution

 

 

     Federal University of Santa Catarina

2

22.2

     Federal University of Paraíba

2

22.2

     Federal University of Bahia

1

11.1

     Federal University of Rio Grande do Norte

1

11.1

     Federal University of Goiás

1

11.1

     Federal University of Pará

1

11.1

     Federal University of Rio Grande

1

11.1

Year of work defense

 

 

     2000

1

11.1

     2005

1

11.1

     2006

1

11.1

     2010

4

44.4

     2012

2

22.2

Region o the HEI

 

 

     Northeast

4

44.4

     South

3

33.3

     Midwest

1

11.1

     North

1

11.1

Thematic Area

 

 

     Care practice

6

66.6

     Research

3

33.4

Type of study

 

 

     Description

8

88.8

     Not informed

1

11.2

Methodological Approach

 

 

     Qualitative

8

88.8

     Not informed

1

11.2

 

Chart 1 shows the characterization of theses and dissertations regarding the title, the object of study, the objective, the implications, and final recommendations. It is observed that only one publication has directed focus on nursing. The focus on assessing health needs emerged in two surveys, one focused on general health and the other on mental health. Pregnancy, childbirth and the puerperium were the objectives of two investigations. Infectious diseases were the most recurring object in postgraduate nursing productions, with three studies, one directed to HIV and two to tuberculosis.

Chart 1 it is also possible to observe that among the implications and final recommendations of the works, only three studies refer to nursing (1, 2 and 3), related to the contribution to nursing care, to foster the discussion of nursing care in the prison system and for the formation of Nurses.

 

Chart 1. Characterization of the studies as title, object, objective and implications and final recommendations.

Nº

Title

Object

Objective

Implications and final recommendations

1

Nursing behind bars: the health of prisoners.

Nursing behind bars: the health of prisoners,

Determine the health needs of prisoners and the problems that aggravate health in prison; and build nursing protocols for prisoner care.

It is intended to contribute to nursing care for prisoners or family members and people in special situations.

2

Female inmates: survivors in a world of suffering, neglection, and deprivation.

Prison system currently in our country regarding the right to health.

Identify the main mental health needs of female prisoners; investigate the presence of obstacles that prevent the meeting of mental health needs and point out strategies to cope with difficulties of mental health care.

The inclusion of nursing in the discussion of health care in the prison system is something new that requires continuity, through new scientific research that seeks to contribute to health promotion and prevention, given the gaps in the literature on the health-disease process in prison.

3

Impacts of female prisoners’ involvement with the drug phenomenon.

Involvements of women serving prison sentences with drugs.

Describe the involvement of women serving time in prison with the drug phenomenon and identify the damage caused by such involvement in their lives.

They show gender inequalities regarding women's involvement with drugs and their repercussions, highlighting the urgency of investigations on the subject. Besides, it points out the need for inclusion and/or expansion of the approach of this problem in nurses’ education.

4

Experience of women in penitentiary jail during pregnancy.

Women who live the pregnancy during the incarceration period.

To identify the sociodemographic and obstetric characteristics of women in prison situations who experienced pregnancy in the Penal Complex and to describe the experience of these women during the gestational period.

It is hoped that the study can give visibility to the subject not so discussed in the literature and contribute to the construction of specific public policies for this reality, as a way to minimize the effects of incarceration during the gestational period.

5

Puerperium in prison environment: women's experience

Puerperium in prison environment

Understand how inmates experience the puerperium in a prison environment

Not informed

6

Serological screening and epidemiology of hepatitis B virus infection in re-educated prisoners of the Goiás Metropolitan Regional Prison Complex

Serological screening and epidemiology of hepatitis B virus infection

To investigate the seroepidemiological profile of hepatitis B virus (HBV) infection in re-educated girls from the Goiás Metropolitan Regional.

The results show the need for hepatitis B prevention actions in the prison environment, including health education and hepatitis B vaccination.

7

The daily life of being a carrier of tuberculosis and deprived of freedom: nursing contributions.

The daily life of being a carrier of tuberculosis and deprived of liberty

Understand the meaning that underlies the daily life of being a carrier of tuberculosis and deprived of freedom.

It is necessary to improve the conditions of diagnosis and treatment in the prison environment; discussions on the subject should be broadened.

8

The discourse of people deprived of liberty with tuberculosis in the light of the oral history of life.

Tuberculosis control actions aimed at people deprived of their liberty

To analyze tuberculosis control actions aimed at people deprived of their liberty, according to the determinations of the National Health Plan in the Penitentiary System of the male prison units in the city of João Pessoa, PB.

To overcome the difficulties regarding access to health of the inmates and the effective control of tuberculosis among this population, efforts by the State, prison management and health professionals to carry out cohesive health actions with health policies aimed at this population and implementation of the Laws of Penal Executions.

9

The work process of a health team with inmates: a study on metaphors and stigma

The work process of a health team with incarcerated clients inside a hospital institution.

Identify how is developed the work process of a health team at a hospital with the incarcerated client; and identify the presence of elements that evidence a metaphorical and stigmatizing relationship with the detained client

The identification of the condition of human beings is present during the work process, making it possible for the worker to move away from the work object (negative metaphors generated from stigma), as well as, an approach of them (positive metaphors).

 

 

 Discussion

In Brazil, the master's and doctorate courses in nursing have their origins in the Southeast and South regions of the country, with emphasis on the states of Rio de Janeiro and São Paulo. From 1972, there was the expansion of the postgraduate study to other locations and, thus, the increase of scientific production,5 whose quality is recognized by the academic community, due to the work undertaken by the postgraduate programs and editors of Brazilian journals.6

However, it is essential to boost the internationalization of what is produced nationally, to disseminate Brazilian studies. Therefore, it is essential to train masters and doctors to use complex theoretical-methodological approaches.6 As we have shown, there is still a predominance of descriptive studies that were produced by postgraduate programs.   

This study showed the concern of researchers from the Northeast region with the production of knowledge in the area of penitentiary health. This finding corroborates the responsibility and commitment of the educational institutions for the construction of an educational project and scientific researches aligned with the advancement of science and, above all, that responded to the health needs of the population.5

It is known that in the Brazilian penitentiary system there is a high incidence of infectious and chronic diseases. This scenario is related to the diversified of shortages present in the prisons, which are presented in the lagged architectural structure, overcrowded cells, restricted diet and poor hygiene. It is therefore understood that the population deprived of liberty does not have respected several basic rights, including the access to a minimal health support.7

This scenario results from the abandonment of the prison system by the State, evidenced by the lack or shyness of the resolutive public policies in the area and, consequently, the small investments made, which resulted in the scrapping of prisons throughout the country.8 This data added to the socio-demographic profile of the deprived population, which generally comes from socially disadvantaged communities, results in a fostering of vulnerabilities and inequities among people living in national prisons.9  

In this sense, producing knowledge/researches on penitentiary health care can promote health assistance and foster actions aimed to the quality of life of vulnerable people, in addition to contributing to the social responsibility that scientific production assumes today.10 Also, contribute to the training of nurses with higher levels of qualification, prepared to work in various areas and complexities, regarding to care for the health of the person and the community.5

The number of studies on penitentiary health proves to be incipient in the national literature, even in the face of the growing interest of postgraduate nursing in research on the subject. Several factors may be related to the small number of researches conducted in the penitentiary system, such as, the incipient dissemination of information on penitentiary health during vocational training;11 the need for basic knowledge about the administrative system of prison units; the selection of methodological approaches appropriate to the scenario, whose prioritize safety; the stigma of the researcher and the establishment of contact networks with the administrative, health, security and PDL sectors.12

However, in Brazil, after the publication of the National Penitentiary System Health Plan (NPSHP); The insertion of health professionals in the national prisons and the expansion of the right to health by the PDL led to a greater stimulus to the production of scientific research related to this theme.3

We highlight the number of researches that used qualitative methods to achieve the objectives. This reality is related to the particularities of this methodological approach, such as the possibility of exploring little known themes, elucidating insufficiently answered guiding questions and apprehending aspects directly portrayed by the discourses of the actors involved.13

Emphasis was also given to care researches characterized by studies that provide answers to questions that emerge from professional practices. This type of intellectual production has been widespread and used by nurse researchers, due to the possible of reduction of the gap between theory and practice in producing innovations and improvements in loco.14

Part of the researches carried out in postgraduate nursing courses in Brazil aimed to evaluate the health needs of the population deprived of liberty, which may contribute to the resolution of the most evident health problems in the overcrowded scenario of the national prisons. Among the most emerging health problems highlights violence, drug abuse and high rates of mental and infectious diseases.12

 In our research where observed that only one study directed its objective to nursing, which corresponded to the creation of nursing protocols to assist the PDL after verifying the health needs of this population. That said, it is essential that nursing produces relevant, innovative science that adds to the existing knowledge.

The evaluation carried out due to the 40 years of postgraduate nursing in Brazil, affirms the need to develop research whose objectives reach expressive results for health services. These findings aligned with the needs of the community, contribute to the consolidation of the Unified Health System, discipline and profession.5

Regarding the implications of the studies developed, some authors highlighted the contribution to nursing care practices in the Brazilian prisons. Researches on this spectrum contributes to solving problems arising from practices and guaranteeing the full health of PDL, considering that the work process of the prison health team has specific characteristics related to the dangerousness of the people served or the security protocols.15

Finally, the need to improve the structure of health facilities in the prison environment was also highlighted. The poor working conditions of health professionals in prisons negatively affect the quality of care offered,16 increasing professional dissatisfaction related to work practice and the workload of professionals.17  

 

Final Considerations

The number of initiatives for the development of research on penitentiary health in Brazilian nursing postgraduate courses is still small, verified by the results. The studies published in the database that address the theme are characterized, for the most part, as a result of master’s courses at the Federal Universities of Santa Catarina and Paraíba, after 2010, resulting from qualitative, descriptive and assistance approaches.

Regarding the objective, only one study mentioned the nursing subject, and the others sought to assess health needs in general or with emphasis on mental health. The other themes dealt with pregnancy, childbirth and puerperium, drug use, work process and infectious diseases.

The implications of the studies portrayed the gains for nursing care practices, as well as the need for further research on the subject, the possibility of subsidizing public health policies directed to the PDLs, and also indicate the need to carry out health care actions in the prison environment and their qualification.

It is apprehended that postgraduate nursing courses, since the creation of specific public health policies for prison health, and the resulting insertion of nursing professional in prisons, has focused its attention on the production of studies on the subject. This has been happening shyly, especially in the southeast of the country.

However, fostering the discussion on the theme of prison health represents a breakthrough and is essential to fill the gaps in the provision health care for PDL, to seek the defense of life, dignity, quality of life and inherent rights of the people, regardless of where they live.

The limitations of this study are related to the lack of standardization of abstracts in the selected database, which may negatively affect the inclusion of theses and dissertations in this review study. In time, it is suggested the promotion of researches that associate penitentiary health and nursing, as well as the better structuring of the abstracts published in the CEPEn.

 

References

1. Ministério da Justiça (BR). Casa Civil. Subchefia para Assuntos Jurídicos Lei de Execução Penal, Lei nº 7.210, de 11 de julho de 1984: institui a Lei de Execução Penal. Brasília: Poder Executivo. 1984.

2. Brasil. Constituição da República Federativa do Brasil. Brasília: Poder Executivo 1988.

3. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Portaria Interministerial nº 1777, de 09 de setembro de 2003: institui o Plano Nacional de Saúde no Sistema Penitenciário. Brasília: Ministério da Saúde; 2003.

4. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Portaria Interministerial Nº 1, de 2 de janeiro de 2014:instituiu a Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: Ministério da Saúde; 2014.

5. Scochi CGS, Munari DB, Gelbcke FL, Ferreira MA. Desafios e estratégias dos programas de pós-graduaçãoem enfermagem para a difusão da produção científica emperiódicos internacionais. Esc Anna Nery. 2014;18(1):05-10

6. Scochi CGS et al. Pós-Graduação Stricto Sensu em Enfermagem no Brasil: avanços e perspectivas. Rev Bras Enferm. 2013;66(esp):80-9.

7. Soares Filho MM, Bueno PMMG. Demografia, vulnerabilidades e direito à saúde da população prisional brasileira. Ciênc. saúde coletiva. 2016; 21(7): 1999-2010.

8. Machado AEB, Souza APR, Souza MC. Sistema Penitenciário Brasileiro – Origem, Atualidade e Exemplos Funcionais. Rev Curso de Direito. 2013; 10(10): 201-212.

9. Delziovo CR et al, organizadores. Atenção à saúde da mulher privada de liberdade. Florianópolis (SC): Universidade Federal de Santa Catarina, 2015.

10. Sánchez A, Leal MC, Larouzé B. Realidade e desafios da saúde nas prisões. Ciênc. saúde coletiva. 2016; 21(7):1996.

11. Diniz RCM. A formação dos trabalhadores da saúde do Sistema Penitenciário – cartografia dos saberes e práticas [tese]. Fortaleza (CE): Faculdade de Educação, Universidade Federal do Ceará; 2011.

12. Apa, ZL. et al. “Challenges and Strategies for Research in Prisons.” Public health nursing. 2012; 29(5): 467–72.

13. Kerr LRFS, kendall C. A pesquisa qualitativa em saúde. Rev Rene. 2013; 14(6):1061-3.

14. Pivoto FL, Filho WDL, Santos SSC, Lunardi VL. Pesquisa convergente-assistencial: revisão integrativade produções científicas da enfermagem. Texto Contexto Enferm. 2013; 22(3): 843-9.

15. Barbosa ML, Celino SDM, Oliveira LV, Pedraza DF, Costa GMC.  Atenção básica à saúde de apenados no sistema penitenciário: subsídios para a atuação da enfermagem. Esc. Anna Nery. 2014; 18(4): 586-592.

16. Costa GMC, Barbosa ML, Celino SDM, Oliveira LV. Perfil demográfico e das condições de trabalho: a realidade das equipes de saúde implantadas em unidades prisionais. Rev. Bras. Pesq. Saúde. 2014; 16(4): 13-22.

17. Santos DA et al. Potencialidades e dificuldades nas práticas de acolhimento na rede de atenção básica conforme a Política Nacional de Humanização. Sau. & Transf. Soc. 2016; 6 (2): 54.-69.     

Corresponding Author

Mayara Lima Barbosa

E-mail: mayaralimabarbosa@gmail.com

Adress: Rua João Albuquerque Santiago, 181, Catolé, Campina Grande, Paraíba, Brasil

Zip Code:  58410-532

 

 

Authors Contributions

1 - Mayara Lima Barbosa

Research project design and planning, obtaining, analyzing and interpreting data, writing and critical review.

 

2 - Alcides Viana de Lima Neto

Obtaining or analyzing and interpreting data, writing and critical review.

 

3 - Cecília Olívia Paraguai de Oliveira Saraiva

Obtaining or analyzing and interpreting data, writing and critical review.

 

4 - Manacés dos Santos Bezerril

Obtaining or analyzing and interpreting data, writing and critical review.

 

5- Gabriela Maria Cavalcanti Costa

Writing and critical review.

 

6 - Viviane Euzébia Pereira Santos

Research project design and planning, obtaining, analyzing and interpreting data, writing and critical review.

 

How to cite this Article

 

Barbosa ML, Lima Neto AV, Saraiva COPO, Bezerril MS, Costa GMC, Santos VEP. Produção científica sobre saúde penitenciária na enfermagem brasileira. Rev. Enferm. UFSM. 2019 [Acess at: Year Month Day];vol.9, e70: 1-15. DOI:https://doi.org/10.5902/2179769232885