Untitled Document



Educational actions of the nurse for elderly: family health strategy


Daiane Porto GautérioI; Danielle Adriane Silveira VidalII; Jamila Geri Tomaschewski BarlemIII; Silvana Sidney Costa SantosIV
INurse of the City Hall of Rio Grande. PhD student of the Postgraduate Program in Nursing at the Federal University of Rio Grande. Rio Grande do Sul, Brazil. Email: daianeporto@bol.com.br
IINurse. Master of the Postgraduate Program in Nursing at the Federal University of Rio Grande. Master scholarship of the Nacional Council of Scientific and Technological Development. Rio Grande, Rio Grande do Sul, Brazil. Email: daniellesvidal@gmail.com
IIINurse. PhD student of the Postgraduate Program in Nursing at the Federal University of Rio Grande. Doctoral Scholarship Amparo Foundation to Research of the State of Rio Grande do Sul. Rio Grande, Rio Grande do Sul, Brazil. Email: jamila_tomaschewski@hotmail.com
IVNurse. Doctorate in Nursing. Professor of Nursing School at the Federal University of Rio Grande. Rio Grande do Sul, Brazil. Email: silvanasidney@terra.com.br

ABSTRACT: The purpose of this reflective text is to emphasize the importance of health education based on the principles of liberating and problematical education of Paulo Freire, permeating the actions directed to elderly and developed by nurses working in family health strategy. Initially, it focuses on the process of aging, followed by Freire's liberating and problematizing education and the actions developed by nurses in the family health strategy, based on the principles of dialogue and respect for each other. The nursing staff, inserted into a discipline geared to human care and the teaching of self-care, can practice health education and actions aimed at maintaining the autonomy and independence of the elderly. The practice of health education can make the elderly aware of decisions about their health and able to perform their self-care.

Keywords: Elderly; elderly health; health education; nursing.



The Brazilian elderly population comes following a worldwide trend of change in the epidemiological profile, increasing progressively. The population aging has been determined by the reduction of fertility and mortality rates and estimates indicate that the proportion of elderly people in the total population, which in 2008 was 9.49%, may be of 29.75% in 20501.

In old age, have an active life means to maintain or restore the autonomy, which is the decision-making capacity and independence, ability to accomplish something by own means. Quantify the degree of autonomy and independence of the elderly person in performing everyday activities can be a way to assess their health and quality of life2.

The care to the elderly must be a joint work between the health team, elderly and family, being the basic attention the users ' initial contact with healthcare systems. In 1994, the Health Ministry adopted the family's health as a priority strategy for the reorganization of primary health care3. The family health strategy (FHS) has as its guideline health promotion and the professional team to mobilize efforts so that changes in health behavior occur in a continuous learning process and participation of patients in the form of the act upon himself, in the family and in the surrounding areas, enabling the transformation of the person in active and collective subject4.

The promotion of active aging, in order to maintain the autonomy and independence of the elderly, is a task that involves the achievement of quality of life and the wide access to services that allow facing the issues of aging, based on the available knowledge. To reach this situation, it becomes essential to broaden awareness about health and aging and at the same time strengthening and equipping people in their struggles for citizenship and social justice2.

The participation of elders, family and community in the actions of health education can be an effective method, enabling information sharing and implementation of practices conducive to health and well-being. When developed constructively, with the joint participation of the individuals involved, the health education activities culminate on the autonomy of the subject, in practice of self-care and, mainly, in health promotion5.

The aim of this reflective text was to emphasize the importance of health education based on the principles of liberating and problematical education of Paulo Freire, permeating the actions directed to the elderly developed by nurses working in the FHS6. To this end, initially, focuses on the aging process, followed by the problematical and liberating education of Freire and actions developed by the nurse in the FHS, on the basis of the principles of dialogue and respect for each other6,7.  


Aging process

Aging may be understood as a common process to all human beings and influenced by multiple factors (biological, economic, psychological, social, cultural, among others), giving each aging particular characteristics8. Various factors contribute negatively to determine how a person ages: inappropriate lifestyle, occurrence of diseases, accidents, stress, unfavorable environmental conditions. These, associated or isolated, may accelerate the aging process3.

Although aging is a gradual process, irreversible and uncontrollable, often characterized by decline of physiological functions, not necessarily result in disabilities. There are expected certain limitations and losses presented by the elderly, so it is important to know how to differentiate a physiological process of a pathological, even where it is something inherent to aging and from when  should seek professional assistance8. The vision of that aging is in close relationship with illness and death, needs to be modified to a perspective of health promotion of elderly, maintaining their autonomy and their independence.

The biggest challenge in attention to the elderly is able to contribute to that, despite the limitations that may occur, they would be able to rediscover possibilities to live their own life with more independence. These possibilities increase the extent that society considers the family and social context and can recognize the potentialities of every being. So, part of the difficulties of the elderly is related to a culture that devalues and limits them9. Such culture-related issues can be minimized through health education, which has a focus on problematizing education.

Liberating and problematical education of Paulo Freire

An approach of health education has been highlighted by enhancing the development of the critical conscience of people, favoring the awakening, including the need to fight for rights to health. It can be said that health education reached dimensions beyond the biological, considering also, the need to mobilize political, environmental, cultural factors, among others10.

To the formation of critical subjects, Freire proposes the liberating and problematizing pedagogy, understood as a way to read the world on work environment. This transposition of limits, of the specific field of education to the world and in the world for education, allows the use of this pedagogy in health education, in the FHS6. This pedagogy can strengthen and instrumentalize the nurses for the transformation of its local reality through the development of conscious action.

In this liberating proposal can be seen two moments. At first, the oppressed subjects are unveiling the world of oppression and reflecting what and how they live, committing, in praxis, as reflection and action of men about the world to transform it, with its transformation. In the second, the oppressive reality is already in the process of transformation and the pedagogy ceases to be the oppressed, becoming to be the pedagogy of men in permanent process of liberation. The reason to be of liberating pedagogy is in overcoming the contradiction educator-learner, so that do both at the same time, educators and students7.

Liberating pedagogy provides its agents interfere with its own reality, having as methodological principles respect for the learner, to their experiences and the conquest of its autonomy, self-determination and dialogue. It began of the study of reality, the everyday experience of educating, of its organization and reading and the experience of the educator6.

The problematizing of the way of life of the students arise the generators themes that direct the new paths. Liberating pedagogy is one of the possibilities that nurses can use to carry out health education, to be based on meaningful learning, whereas each student/user of the service has their strengths and weaknesses, emphasizing that educators and students have different roles of traditional6.

Based on the education problem, it is possible to understand that culture of devaluation of the elderly is about the question of citizenship that can be salvaged, from the process of awareness of being old and of their insertion in the world, as transformative potential of reality of vulnerability6,7. This problematizing approach can be the bridge that joins the care and education, both require forms of cooperation, involvement and mutual support so that, in a dialogic action, awareness of the world, the unveiling of the why and how of the experienced reality appear6. Is in collaboration on dialogic action that subjects-elderly, family, community and health professionals - problematize the oppression to liberation.

The Method of Popular Education, systematized by Paulo Freire, has as methodological principles the dialogue, the respect for the learner, the conquest of the autonomy, and constitutes as the guiding relationship between intellectuals and popular classes. In many healthcare institutions, professional groups have sought to meet the challenge of incorporating public service Method of Popular Education, adapting it to the new context of institutional complexity and social life in major urban centers11.

Health professionals who serve the elderly need to review their methods of work and raising awareness of issues related to the aging process. So, are more able to develop actions to promote independence, so that it becomes possible to ensure the autonomy of the elderly and still assist them fully during aging. The FHS is the suitable environment for nurses to take a new look at the needs of the elderly.

Elderly care in ESF

The reception to the elderly in the Unique System of Health, performed in the units of health of the FHS, should develop actions that promote active aging, the integral and integrated attention to health of the elderly, apart from stimulating inter-sectoral actions, among others, as determines the National Health Policy of Elderly (NHPE)12. In FHS, professionals are expected to offer the elderly  and their families and caregivers a humanized attention with guidance, monitoring and support at home, with respect for local cultures, the diversity of aging and decrease of architectural barriers in order to facilitate the access to diverse environments. The adoption of strategies that create supportive environments and promote options and healthy habits is important at every stage of life and strengthen the active aging3.

In the work of the teams of the FHS, the collective actions in the community, group activities and the participation of users ' social networks are some of the features for specialized in cultural and social dimensions3. Thus, the educational activities constitute as an instrument for the promotion of health through the articulation of technical and popular knowledge, of the mobilization of institutional and community resources, public and private initiatives.

The international conferences about health promotion advocate that actions of promotion and health education include the active participation of the users of the services, which have ability to decide about matters involving their welfare, subsidized by their own experiences and educational practices13. The team of the FHS requires knowing the habits of life, the cultural/ethical values and religious of elderly, of their families and the community. The cultural elements of society exert great influence in world view, habits, customs and behavior of people in relation to health demands14.

The targeting of actions in health for the cultural reality of elderly/students can become an effective strategy because the problem is worked from the collective thinking, analysis of beliefs and values about the given situation of illness or risk of injury to health and behavior in relation to the experienced situation. Thus, the participation of the elderly favors the educational process through learning culturally significant.

The actions of the nurse of the basic attention/FHS targeted to the elderly health, on the basis of the Pact for Life and NHPE, are: integral attention; home care, when necessary; nursing consultation; supervise and coordinate the work of the communitarian agents of health and nursing staff; permanent education and interdisciplinary activities with the other professionals of the team; orient the client and/or family/caregiver about the correct use of medicines15. Care nursing actions must go beyond reductionist vision of patient assistance (for illness), since they have focused on health under a full perspective.

Health promotion and health education are intimately linked and contribute to active aging. The formation of nurses is focused on the care of others, so, seizes, in a dynamic movement and dialogic, both of technology care as humanistic ethics required for a care to be emancipatory and solidarity10.

From the incorporation of the concept of autonomy of the subject in the process of health education, the role of the nurse went through the simple act of orienting or impose to favor awareness of people about the situation in which they live and of the consequences of their choices for their health. In this new relationship educator/educating, there are no keepers of knowledge, but different knowledges that must converge for reflection, awareness and freedom of choice7.

Health education falls within the context of the performance of nursing as a means for establishing a dialogic-reflective relationship between the nurse and the elderly/family, which seeks to make them aware about its state of health/disease and where each can act as subject of transformation of their own life16. In the case of the elderly, they often exercise in part their autonomy, because it requires assistance due to the limitations of aging or caused by pathological processes, so family members and caregivers are inserted in this dialogic-reflexive relationship.

The improvement of living and health conditions of the elderly, through health education, only occurs if faced to the reality of the main health problems that affect them. So it becomes necessary to go in the interests of the elderly/educating, providing content and practices that are in line with their needs, so the tools offered by the educational action may serve to intervene in the reality of the subject involved in the action17.

The methodology resource to be used by the nurse in health education practices, from the logical problem, needs to be defined on the basis of own everyday problems of each professional, understanding health education as a creative process, dialogic and construction. To this end, it is necessary to make some assumptions as to a new practice principles, among which are: health education to encourage the elderly to participate in the educational process; health actions targeted on freedom focus, autonomy and independence of the elderly; education in pedagogical and therapeutic health.

Considering that education involves the responsibility on the part of elderly about their habits and lifestyles, we highlight the importance of nursing as a profession of social commitment, sensitive to the problems and human rights, and as a science that seeks new methodologies to achieve the improvement of care, by means of educational activities of health and appropriate interventions10. Educational activity as a strategy for health promotion for the elderly requires approaches that value knowledge on the other, of the elderly, the aging process, of old age, so that it constitute in an instrument for nursing care to consider the specificities and the multidimensionality of human beings.


Health actions to be developed at FHS nurse directed to the health of the elderly person may be permeated by health education practices based on the principles of popular education organized by Paulo Freire.

Nursing, as discipline directed toward human care and teaching self-care, can form/stimulate the professionals practicing health education based on the dialogue and respect for the other, and so develop actions aimed at maintaining the autonomy and independence of the elderly. Thereby, health education practices can make elderly aware of decisions about their health and able to carry out their self-care.
Health education following the liberating pedagogy can also contribute to family members, caregivers and the community in general show more respect for the rights of the elderly and the elderly as citizens.


1. Instituto Brasileiro de Geografia e Estatística. Projeção da População do Brasil por sexo e idade: 1980-2050 - Revisão 2008. Rio de Janeiro: IBGE; 2008. [citado em 03 jun 2013]. Available at: http://www.ibge.gov.br/home/estatistica/populacao/projecao_da_populacao/2008/default.shtm

2. Martins JJ, Schneider DG, Coelho FL, Nascimento ERP, Albuquerque GL, Erdmann AL, et al. Avaliação da qualidade de vida de idosos que recebem cuidados domiciliares. Acta Paul Enferm. 2009; 22: 265-71.

3. Oliveira JCA, Tavares DMS. Atenção ao idoso na estratégia de saúde da família: atuação do enfermeiro. Rev esc enferm USP. 2010; 44: 774-81.

4. Machado MFAS, Vieira NFC. Educação em saúde: o olhar da equipe de saúde da família e a participação do usuário. Rev Latino-Am Enfermagem. 2009; 17: 174-9.

5. Lopes EM, Anjos SJSB, Pinheiro AKB. Tendência das ações de educação em saúde realizadas por enfermeiros no Brasil. Rev enferm UERJ. 2009; 17: 273-7.

6. Freire P. Educação como prática da liberdade. 30a ed. Rio de Janeiro: Paz e Terra; 2007.

7. Freire P. Pedagogia do oprimido. 46a ed. Rio de Janeiro: Paz e Terra; 2005.

8. Nogueira AMT, Temóteo TL, Carvalho CMRG, Carvalho AMO, Borges MESMM, Luz MEBA, et al. Estudo multidimensional de idosos diabéticos atendidos em ambulatório do sistema único de saúde. Rev enferm UERJ. 2010; 18:25-31.

9. Stone T. What’s in a word? Ageism: the bias against older people by the (temporarily) young? Nurs Health Sci.2012; 14: 433-4.

10. Sousa LB, Torres CA, Pinheiro PNC, Pinheiro AKB. Práticas de educação em saúde no Brasil: a atuação da enfermagem. Rev enferm UERJ. 2010; 18:55-60.

11. Moura ADA, Pinheiro AKB, Barroso MGT. Realidade vivenciada e atividades educativas com prostitutas: subsídios para a prática de enfermagem. Esc Anna Nery. 2009; 13: 602-8.

12. Ministério da Saúde (Br). Portaria nº 2.528, de 19 de outubro de 2006 - Política Nacional de Saúde da Pessoa Idosa. Diário Oficial da União, Brasília, 20 out. 2006. Seção 1, p. 142-5.

13. Ministério da Saúde (Br). As cartas da promoção da saúde. Brasília (DF): Ministério da Saúde; 2002.

14. Silva CMC, Meneghim MC, Pereira AC, Mialhe FL. Educação em saúde: uma reflexão histórica de suas práticas. Ciênc saúde coletiva. 2010; 15: 2539-50.

15.Ministério da Saúde (Br). Envelhecimento e saúde da pessoa idosa. Brasília (DF): Ministério da Saúde; 2006.

16. Camp YPV, Huybrechts SA, Rompaey BV, Elseviers MM. Nurse-led education and counselling to enhance adherence to phosphate binders. J Clin Nurs.  2011; 21: 1304-13.

17. Imhof L, Naef R, Wallhagen MI, Schwarz J, Mahrer-Imhof R. Effects of an advanced practice nurse in-home health consultation Program for Community-Dwelling Persons Aged 80 and Older. Am Geriatr Soc. 2012; 60: 2223-31