PERCEPÇÕES DE ENFERMEIROS SOBRE A ATENÇÃO AO CLIMATÉRIO* NURSES' PERCEPTIONS ABOUT CLIMATERIC CARE* PERCEPCIONES DE LOS ENFERMEROS SOBRE

Objective: to analyze women's health care regarding climateric management by Primary Health Care nurses. Method: it is a qualitative, descriptive study, which has, as theoretical reference, the concept of perception. The data transcribed was analyzed by means of a Deductive Thematic Analysis. Results: It is informed that four thematic categories have emerged: Permanent and continuous education; Organization of services; Approach to climacteric women and Use of complementary therapies. It is believed that the results will contribute to new perspectives in women's health care. Conclusion: it is concluded that the women's health care in the climacteric period occurs in a fragmented and discontinuous way. The need for permanent education on the subject of the climacteric period was perceived, as well as the elaboration of protocols, norms and current guidelines that guide the professional action. Descriptors: Climacteric; Women's Health; Primary Health Care; Nursing; Border Areas; Public Health Nursing. J Nurs UFPE on line. 2021;15:e245748 DOI: 10.5205/1981-8963.2021.245748 https://periodicos.ufpe.br/ revistas/revistaenfermagem RESUMEN Objetivo: analizar la atención de la salud de la mujer sobre el manejo del climaterio por enfermeros de Atención Primaria de Salud Método: se trata de un estudio cualitativo, descriptivo, que tiene como referencia teórica el concepto de percepción. Los datos transcritos fueron analizados mediante Análisis Temático Deductivo. Resultados: se informa que han surgido cuatro categorías temáticas: Educación permanente y continua; Organización de servicios; Aproximación a la mujer en climaterio y uso de terapias complementarias. Se cree que los resultados contribuirán a nuevas perspectivas en la atención de la salud de la mujer. Conclusión: se concluye que la atención a la salud de la mujer en el climaterio se da de forma fragmentada y discontinua. Se advirtió la necesidad de realizar una educación permanente enfocada en el tema climatérico, así como la elaboración de protocolos, reglas y pautas vigentes que orienten el desempeño profesional. Descriptores: Climaterio; Salud de la Mujer; Atención Primaria de Salud; Enfermería; Áreas Fronterizas; Enfermería en Salud Pública. 1Federal University of Fronteira Sul/UFFS. Chapecó (SC), Brazil. 1 https://orcid.org/ 0000-0002-7853-1480 2 https://orcid.org/0000-0002-9240-0065 3 https://orcid.org/ 0000-0001-7389-877X 4 https://orcid.org/0000-0001-9718-9388 5 https://orcid.org/0000-0003-3199-6384 6 https://orcid.org/0000-0003-0972-0795 *Article was extracted from the Undergraduate Thesis entitled " Women's Health Care in the Climacteric Period: Guidelines for Professionals and Managers of Primary Care Services in the Municipality of Chapecó/SC. Federal University of Fronteira Sul/UFFS. 2015. In the 20th century, public policies focused on women's reproductive period in health care were included with the objective of addressing all phases of women's lives. At the same time, in 1984, the Program on Integral Assistance to Women's Health was created, which involved all women's cycles, including the climateric period, but did not fully assist women. Thus, in 2004, the World Health Organization (WHO) launched the National Policy of Integral Women's Health Care, which brought principles and guidelines focused on the integrality of women's health in the climateric period.


RESUMEN
Objetivo: analizar la atención de la salud de la mujer sobre el manejo del climaterio por enfermeros de Atención Primaria de Salud Método: se trata de un estudio cualitativo, descriptivo, que tiene como referencia teórica el concepto de percepción. Los datos transcritos fueron analizados mediante Análisis Temático Deductivo. Resultados: se informa que han surgido cuatro categorías temáticas: Educación permanente y continua; Organización de servicios; Aproximación a la mujer en climaterio y uso de terapias complementarias. Se cree que los resultados contribuirán a nuevas perspectivas en la atención de la salud de la mujer. Conclusión: se concluye que la atención a la salud de la mujer en el climaterio se da de forma fragmentada y discontinua. Se advirtió la necesidad de realizar una educación permanente enfocada en el tema climatérico, así como la elaboración de protocolos, reglas y pautas vigentes que orienten el desempeño profesional. With a significant number of women experiencing the climacteric period, it is necessary to pay attention to health not only in the reproductive phase, which the National Health Policies prioritize, but above all, in the development of actions focused on non-reproductive health.
It is believed that climacteric and menopausal care is a line of care that needs to be perceived and understood, not only by women and those around them, but also by health professionals, as a part of ageing. It is known that considering the implications of female identity along the vital cycle is challenging, because both climacteric and aging unleash new feelings, involving losses and gains. 2 The research question was then listed: "What perception do health professionals, caregivers and managers have regarding Climateric Women's Health Care in Primary Health Care (PHC)?" To analyze women's health care regarding climateric management by Primary Health Care nurses.
It is a qualitative, descriptive study and has, as theoretical reference, the concept of perception 3 in which the way of being and seeing the world is a subjective aspect produced from external stimuli that are understood in a singular way for each individual. It is added that, in this way, researchers have directed the production of data according to the described concept.
A city in western Santa Catarina, located in southern Brazil, with approximately 216,654 inhabitants, was chosen as the study scenario, according to data from 2018 of IBGE. 4 The study was were identified by codes with letters and numbers that distinguished the care and nurse managers, with numbering from one to four, being EA1 to EA4, as well as EG1 to EG4.
It is revealed that the period for the production and organization of the data lasted eight months. The information was obtained through a semi-structured interview, with a previously elaborated script, considering the inquiries related to the research question. The interviews were individual, audio-recorded and lasted a maximum of one hour, and were later transcribed into digital files by the researcher. The purpose of the recording was to be completely faithful to the testimonies. The transcriptions were analyzed by means of Deductive Thematic Analysis, 5 classifying OBJECTIVE METHOD them into common categories according to their frequency and relevance, and later organizing them into thematic units.
In order to better understand the data collected, four categories were listed, which are intended to meet the objectives of the survey: Permanent and continuing education; Organization of services; Approach to women in climacteric and Use of complementary therapies.
The ethical and legal precepts of Resolution 466/12 of the National Health Council, which approves guidelines and regulatory norms for research involving human beings, were respected.
Participants were requested to sign the Free and Informed Consent Term (FICT). The research project was approved by the Human Beings Research Ethics Committee under the CAAE: 45129315.6.0000.5564.

Permanent and continuous education
The interviewees were approached on the subject of permanent and continuous education, when they reported the following.

Service organization
It was identified in the following lines that there is not a specific strategy for this topic, which addresses the subject and clarifies the doubts, because the activities in which these women are inserted are the same as those of the users with diverse health problems. According to the participants, the lack of training is a problem, not only in the municipal sphere, but also in the Ministry of Health itself, which produces the guidelines for women's health care.
This situation is acknowledged as important to the interviewees, since they mention to feel the lack of training. Thus, it becomes possible to evidence that this exchange of knowledge enables the updating of their assistance protocols, i.e., it standardizes the care provided.
The educational actions are constituted as a relevant dimension of the work of the nurse, being carried out from the identification of assistance gaps in the service and with the intention of increasing the quality of care provided. 6 Health professionals are trained by the permanent DISCUSSION education policy to improve the quality of assistance of the services offered by UHS. Individual actions are prioritized with a focus on the needs of each health region. It is part of the daily practice of the nurse through the national curricular guidelines, being characterized as one of the pillars of the professional exercise. 7 It is clear, however, by analyzing the lines, that the professional nurse works only for the demand of the service. The PHC requires the construction of links between professionals and their users, the capacity to deal with the complexity of the health-disease process and the articulation of practices and knowledge that go beyond the core of professional competence. It is observed that these factors are responsible for raising workloads on professionals and, by not being recognized and faced, may limit the scope of actions for promotion and integrality in PHC, going against permanent education actions. 8 It is known, in relation to continuing education, that it instigates and determines self-confidence in the care offered, providing moments for the manifestation of experiences and personal development, enabling the improvement of interpersonal relationships, with users, family and team. In order to increase the quality of the services provided, Permanent Health Education is used as a device for bringing UHS professionals' daily lives closer to the population's needs. 9 According to the participants, it is perceived that the services are not able to put into practice continued education with climateric women, so they do not have specific strategies focused on this group and they feel poorly prepared to serve them, besides their individualities in this period of life. The participants, who mentioned that they do not actively search, reported that there is still a problem with physical space, which makes it difficult to form groups.
It can be seen that specific strategies and projects aimed at the group of climateric women are lacking, thus causing many not to seek health care, thinking that because it is an expected phase, their symptoms, such as mood swings, sweating and heat waves, are common, characteristic and have no treatment. 10 Women's health care must be rethought, and reflections are needed on the opening of new programs, services, and on expanding what is already available to meet the demands of this women's cycle. 11 Mention was made, in relation to the approach to climateric women, by the participants, of the use of the Nursing consultation, and this is recognized as important to create a bond between the woman and the professional so that she can report all her complaints. It is noted that, during the climacteric period, professionals report using the consultation to provide orientation, clarify what menopause is and its correlated situations, and that not all women are the same, therefore, they do not manifest the same complaints.
The Nursing appointment should also contribute so that the woman can see herself as a being who has rights and duties, who is an autonomous being and who should always maintain her selfesteem, because, during this period, some of the psychological symptoms involve decreased selfconfidence and depressed mood. 12 The professional nurse, as a responsibility, has to associate knowledge and practices so that he can leave, in his care actions, enlightening attitudes about the changes of this new phase of women's life, since it is a natural process. 13 It can be seen, however, that they do not feel confident in discussing some topics, such as sexuality and sexual practice. They report the possession of knowledge about the climacteric and orient about, but then there is the request for a doctor's appointment, bearing in mind that, in their perceptions, the clients do not believe in some orientations.
Women generally experience this stage alone, silently and with insufficient information. For this reason, the quality of life is considered to be the foundation of the implementation of interventions in the climateric, and the subjective and cultural aspects of complaints are also valued. 14 The challenges and difficulties regarding the supply of health services are noted. In the management practice, the nurse, as coordinator and articulator of the caring process, the ideological and theoretical bases of classic administration and the practice of resource management are used. They become, for this, the managerial tools of fundamental importance, considering that they contribute to the organization and evaluation of the health services/ information and, consequently, to the improvement of the quality of the health care offered to the citizens. 15 It is identified that, when questioned about the use of complementary therapies, the interviewees know little or almost nothing about the subject, because they report to give orientation about some teas during pregnancy, but during the menopause period, generally, they do not indicate anything other than the replacement of hormone, because it is widely used by modern medicine. 16 They mentioned, in relation to other complementary therapies, that there are walking groups and auriculotherapy, but they do not give continuity, as well as they do not know about other treatments that have some kind of complementary therapy due to the lack of communication between sectors. The insertion of integrative practices in the care of climateric women in the health unit is due to the interest of the unit itself and of the municipality's health network, since there must be subsidies to train the professionals working in the unit.
It is noted that, due to the lack of integrative and complementary practices, they can help to improve the welcoming listening, creating a bond between the professional and client, integrating the human being with the environment in which he lives and using resources provided by nature. 17 It is understood that the nurse must have an active role in care, promote health education, assess the impact of climacteric period on women's health and enable the prevention of diseases and illnesses. It is known that the orientation and sensitization of women will in the future prepare them to experience possible adversities related to this new phase of life.
From this research, it was identified that the Climateric Women's Health Care, in the studied reality, is a service about signs and symptoms based, many times, on the personal experience of each professional. It is warned that the approach to women in this phase is not carried out based on rigorous scientific grounds and not on updated permanent education offered by the management of these services. In this sense, it is recommended that knowledge be improved in order for the approach to be effective, consistent, integral and, at the same time, differentiated. It is necessary, considering that women are the majority of the Brazilian population and the main users of UHS, to analyze issues related to their health, including its different dimensions. Thus, it is understood that health needs to be perceived beyond the simple access to services or absence of disease.
All authors also contributed in the conception of the research project, collection, analysis and discussion of the data, as well as in the writing and critical review of the content with intellectual contribution, and in the approval of the final version of the study.
Nothing to declare.