An educational process to strengthen primary care nursing practices in São Paulo, Brazil


Anna Maria Chiesa, Av. Dr. Enéas de Carvalho Aguiar, 419, São Paulo, SP, Cep: 05403-000, Brazil; Tel: 55 11 30617652; Fax: 55 11 30617662; E-mail:


Objective:  To describe the experience of a registered nurse (RN) training process related to the Family Health Program (FHP) developed in the city of São Paulo, Brazil.

Background:  The FHP is a national, government strategy to restructure primary care services. It focuses on the family in order to understand its physical and social structure in regards to the health–illness process. In the FHP, the RN is a member of a team with the same number as medical doctors – an unprecedented situation. The FHP requires a discussion of the RNs’ practice, by qualifying and empowering them with tools and knowledge.

Methods:  The training process was based on Freire’s approach founded on critical pedagogy in order to address the fundamental problem of inequalities in health. The first phase included workshops and the second one included a course. The workshops identified the following problems related to the RN’s work: lack of tools to identify the population’s needs; overload of work due to the accumulation of management and assistance activities; difficulties regarding teamwork; lack of tools to evaluate the impact of nursing interventions; lack of tools to improve the participation of the community. The course was organized to tackle these problems under five thematic headings.

Results:  The RN’s training process allowed the group to reflect deeply on its work. This experience led to the need for the construction of tools to intervene in the reality, mainly against social exclusion, rescuing and adapting of the knowledge accumulated in the healthcare practice, identifying settings which demand institutional solutions and engaging the RN in research groups in order to develop projects according to the complexity of the primary care services.

Conclusion:  The application of the concept of equity in the health sector represented a reaction against the processes of social exclusion, starting from performance at a local level to become a reality in the accomplishments achieved by the Brazilian National Health System. This training process allowed us to evaluate that partnership, which has produced many concrete results in addressing both parts of the Inequalities in Health dilemma and which is a productive way of building up a new model of health.