[Clinical relationships and ethical problems in primary care, Sao Paulo, SP, Brazil].
OBJECTIVE



OBJECTIVE
to identify ethical problems in primary care according to nurses' and doctors' perceptions.


OBJECTIVE
to know ethical issues of patient-professional relationships in primary care.


METHODS
Synthesis to integrate and reinterpret primary results of qualitative studies.


METHODS
Primary healthcare centers, Sao Paulo, SP, Brazil. PARTICIPANTS AND/OR CONTEXT: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience.


METHODS
Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results.


RESULTS
Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills.


CONCLUSIONS
Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation.
Campos Pavone Zoboli
Elma Lourdes
EL
Escuela de Enfermería, Universidad de Sao Paulo, São Paulo, Brasil. crzoboli@vivax.com.br
D001938:Brazil; D019555:Physician-Nurse Relations; D011320:Primary Health Care / Q000941:ethics*
Aten Primaria. 2003;32(3):135-41
12975099
J Med Ethics. 2001 Apr;27(2):98-103
11314166
Rev Saude Publica. 1994 Apr;28(2):131-6
7824846
Res Nurs Health. 1997 Aug;20(4):365-71
9256882
Aten Primaria. 2004 Jun 15;34(1):20-5
15207195
J Clin Ethics. 1999 Summer;10(2):107-15
10633281
Med Clin (Barc). 2001 Jun 9;117(1):18-23
11440697
Aten Primaria. 2009 Jan;41(1):9-15
19187836
Aten Primaria. 2005 Jul-Aug;36(3):159-61
16029746
Med Clin (Barc). 2003 Nov 22;121(18):705-9
14651821
Aten Primaria. 2005 Mar 31;35(5):240-5
15802111
Aten Primaria. 2003 Jun 30;32(2):110-7
12841998