Brígida Gimenez Carvalho

Trabalho e intersubjetividade: reflexão teórica sobre sua dialética no campo da saúde e enfermagem

Esta reflexao teorica objetiva evidenciar a relacao intersubjetiva presente no trabalho em saude e enfermagem sob o olhar das seguintes vertentes teoricas: Analise Institucional; Psicodinâmica do Trabalho e Teoria do Agir Comunicativo, com aprofundamento da ultima. A articulacao desses referenciais a abordagem marxiana do trabalho em saude parte do reconhecimento da necessidade de sua continua reconstrucao neste caso, no sentido da apreensao da interacao e comunicacao intrinsecas ao trabalho em ato. A Teoria do Agir Comunicativo busca considerar essas duas inextricaveis dimensoes: trabalho como acao produtiva e como interacao. A primeira corresponde a acao instrumental baseada em regras tecnicas e com uma racionalidade dirigida a producao. A segunda refere-se a interacao realizada como acao comunicativa visando o entendimento entre sujeitos. Assume-se aqui que a adocao dessa perspectiva teorica na analise das praticas em saude e enfermagem abre novas possibilidades de elucidacao de suas conexoes sociais, historicas, processuais e intersubjetivas.This theoretical reflection intends to show the inter-subjective relationship that takes place in health and nursing practices under the following theoretical perspectives: Institutional Analysis, Psychodynamics of Labor and the Theory of Communicative Action, with an emphasis on the latter. Linking these concepts to the Marxist approach to work in the field of health emerges from recognizing the need for its continuous reconstruction-in this case, with a view to understand the interaction and communication intrinsic to work in action. The theory of Communicative Action seeks to consider these two inextricable dimensions: work as productive action and as interaction. The first corresponds to instrumental action based on technical rules with a production-guided rationale. The second refers to the interaction that takes place as communicative action and seeks understanding among subjects. We assume that adopting this theoretical perspective in the analysis of health and nursing practices opens new possibilities for clarifying its social and historical process and inter-subjective connections.

Concepções e tipologia de conflitos entre trabalhadores e gerentes no contexto da atenção básica no Sistema Único de Saúde (SUS)

This study aimed to analyze perceptions of conflict between workers and managers in primary healthcare units and to present a typology of conflicts on the job. This was a comprehensive interpretive case study with a critical hermeneutic approach. Data collection techniques included: focus group with managers, workplace observation, and worker interviews, conducted from April to November 2011. The results were triangulated and indicated the coexistence of distinct concepts of conflict, typified in six modalities: lack of collaboration at work; disrespect resulting from asymmetrical relations between workers; problematic employee behavior; personal problems; asymmetry with other management levels; and inadequate work infrastructure. The relevance of (non)mutual recognition, as proposed by Axel Honneth, stood out in the interpretation of the causes and practical implications of these conflicts.Este estudo objetivou analisar percepcoes de conflito entre trabalhadores e gerentes de unidade basica de saude e apresentar tipologia de conflitos vivenciados no trabalho. Trata-se de estudo de caso, de carater compreensivo-interpretativo, de abordagem critica-hermeneutica. As tecnicas de coleta foram: grupo focal com gerentes, observacao do trabalho e entrevista com trabalhadores, realizadas de abril a novembro de 2011. Os resultados foram triangulados e apontam a convivencia de distintas concepcoes de conflito. Foram tipificadas seis modalidades de conflitos, relacionados a falta de colaboracao no trabalho; ao desrespeito decorrente de relacoes assimetricas entre trabalhadores; ao comportamento do funcionario-problema; aos problemas pessoais; a assimetria com outros niveis de gestao e a infraestrutura deficitaria dos servicos. Destaca-se a relevância do (nao) reconhecimento mutuo, na perspectiva proposta por Axel Honneth, na interpretacao da genese e implicacoes praticas desses conflitos.

Força de trabalho em saúde na Atenção Básica em Municípios de Pequeno Porte do Paraná

Este artigo tem como objetivo caracterizar o perfil e as relacoes laborais dos trabalhadores da Atencao Basica em Municipios de Pequeno Porte localizados no Parana. Trata-se de estudo transversal descritivo, realizado em 49 municipios do norte do estado, por meio de questionario aplicado aos profissionais de saude. Os resultados obtidos indicaram a existencia de baixa precarizacao das relacoes de trabalho, diversidade profissional, escolaridade adequada ou superior ao cargo exercido e vinculos laborais formais. Foram classificados como aspectos negativos a inexistencia de plano de carreira, um numero insuficiente de medicos, a multiplicidade de vinculos empregaticios e o descumprimento de carga horaria. Deste modo, recomenda-se a implantacao de politicas especificas aos municipios avaliados, bem como a implantacao de medidas de acompanhamento/avaliacao.

Doenças cardiovasculares antes e após o programa saúde da família, Londrina, Paraná

BACKGROUND The reduction in morbidity and mortality rates from diseases of the circulatory system (DCS) is one of the greatest challenges in primary care, and the implementation of the Family Health Program provides access to the multisectoral and integrated measures required for dealing with these diseases. OBJECTIVE To analyze DCS mortality and hospitalization rates before and after the implementation of the Family Health Program, in Londrina, Paraná. METHODS This was an ecological study, comparing DCS, cerebrovascular disease (CbVD) and ischemic heart disease (IHD) mortality rates and hospitalization rates by the SUS, in residents of Londrina, in two 4-year periods: 1997 to 2000, and 2002 to 2005. The data were obtained from the Mortality Information System and the Hospital Information System of the SUS. The ratios between the rates were calculated for both periods at 95% confidence interval. RESULTS The DCS was the first cause of death in the city, in both quadrennia. The CbVD and IHD accounted for more than 63% of DCS deaths. In comparing the two quadrennia, there was a reduction in CbVD mortality rates, which was significant only for subjects over 59 years, in both genders, and the hospitalization rates increased by 10%. For IHD, no significant change occurred in mortality rates, and there was a 40% increase in hospitalization rates. CONCLUSION The significant reduction only in CbVD mortality in the elderly suggests the need for expanding health assistance coverage to different population groups and the development of preventive and health promotion measures.BACKGROUND: The reduction in morbidity and mortality rates from diseases of the circulatory system (DCS) is one of the greatest challenges in primary care, and the implementation of the Family Health Program provides access to the multisectoral and integrated measures required for dealing with these diseases. OBJECTIVE: To analyze DCS mortality and hospitalization rates before and after the implementation of the Family Health Program, in Londrina, Parana. METHODS: This was an ecological study, comparing DCS, cerebrovascular disease (CbVD) and ischemic heart disease (IHD) mortality rates and hospitalization rates by the SUS, in residents of Londrina, in two 4-year periods: 1997 to 2000, and 2002 to 2005. The data were obtained from the Mortality Information System and the Hospital Information System of the SUS. The ratios between the rates were calculated for both periods at 95% confidence interval. RESULTS: The DCS was the first cause of death in the city, in both quadrennia. The CbVD and IHD accounted for more than 63% of DCS deaths. In comparing the two quadrennia, there was a reduction in CbVD mortality rates, which was significant only for subjects over 59 years, in both genders, and the hospitalization rates increased by 10%. For IHD, no significant change occurred in mortality rates, and there was a 40% increase in hospitalization rates. CONCLUSION: The significant reduction only in CbVD mortality in the elderly suggests the need for expanding health assistance coverage to different population groups and the development of preventive and health promotion measures.

Descentralização da gestão: caminho percorrido, nós críticos e perspectivas

The scope of this study was to analyze the decentralization of health management at city level and its implications for comprehensive access and care for users. A “scoping review” located 1,902 references. After being subjected to the criteria of inclusion and exclusion by judges, 27 articles were selected and charted. The research revealed the following issues: what it was possible to establish by the process; problematic points in charting the path and prospects of decentralization. The following aspects were identified: increased access to primary care through increasing the number of professionals and family health teams; planning, evaluation and inter-sector aspects were seen as problematic; planning and management instruments are limited, and cities face difficulties in relation to medium and high complexity care. Funding is still a barrier to the advancement of decentralization, few studies have analyzed the guarantee of access to medium and high complexity care and studies that define the reality of small cities are needed. Several challenges were identified, such as the need for implementation of the regionalization process, shared management and an inter-federative network that ensures comprehensive access to health care.

Percepção dos médicos sobre o curso facilitadores de Educação Permanente em Saúde

Continuing Health Education is a strategy in Brazil that uses problems in healthcare practice as the object of reflection by health teams. To deal with the lack of conceptual and operational command over Continuing Health Education, a course was proposed for facilitators in continuing education. The course was conducted in Londrina, Parana State, in which 14 physicians participated. In order to analyze their opinions of the course and its repercussions on their work and healthcare practice, the 11 physicians that finished the course were interviewed using a semi-structured questionnaire. The analysis involved tabulation of the closed questions, and the content of the open questions was- Permanent Healthcare Education. analyzed using thematic analysis. According to these physicians, Continuing Health Education con- Health Work. sists of the following: reflection on daily problems, teamwork, and meaningful learning. Important changes fostered by the course included: expansion of the links between healthcare professionals, democratization of management, grasp of information systems, expansion of analytical capacity, and improvement of healthcare practice. The facilities and difficulties pertained mainly to a firm infrastructure (physical space, time, material, and support), but participants also highlighted issues related to teamwork, like motivation, interest, and participation.

Diseases of the circulatory system before and after the family health program, Londrina, Paraná

BACKGROUND The reduction in morbidity and mortality rates from diseases of the circulatory system (DCS) is one of the greatest challenges in primary care, and the implementation of the Family Health Program provides access to the multisectoral and integrated measures required for dealing with these diseases. OBJECTIVE To analyze DCS mortality and hospitalization rates before and after the implementation of the Family Health Program, in Londrina, Paraná. METHODS This was an ecological study, comparing DCS, cerebrovascular disease (CbVD) and ischemic heart disease (IHD) mortality rates and hospitalization rates by the SUS, in residents of Londrina, in two 4-year periods: 1997 to 2000, and 2002 to 2005. The data were obtained from the Mortality Information System and the Hospital Information System of the SUS. The ratios between the rates were calculated for both periods at 95% confidence interval. RESULTS The DCS was the first cause of death in the city, in both quadrennia. The CbVD and IHD accounted for more than 63% of DCS deaths. In comparing the two quadrennia, there was a reduction in CbVD mortality rates, which was significant only for subjects over 59 years, in both genders, and the hospitalization rates increased by 10%. For IHD, no significant change occurred in mortality rates, and there was a 40% increase in hospitalization rates. CONCLUSION The significant reduction only in CbVD mortality in the elderly suggests the need for expanding health assistance coverage to different population groups and the development of preventive and health promotion measures.BACKGROUND: The reduction in morbidity and mortality rates from diseases of the circulatory system (DCS) is one of the greatest challenges in primary care, and the implementation of the Family Health Program provides access to the multisectoral and integrated measures required for dealing with these diseases. OBJECTIVE: To analyze DCS mortality and hospitalization rates before and after the implementation of the Family Health Program, in Londrina, Parana. METHODS: This was an ecological study, comparing DCS, cerebrovascular disease (CbVD) and ischemic heart disease (IHD) mortality rates and hospitalization rates by the SUS, in residents of Londrina, in two 4-year periods: 1997 to 2000, and 2002 to 2005. The data were obtained from the Mortality Information System and the Hospital Information System of the SUS. The ratios between the rates were calculated for both periods at 95% confidence interval. RESULTS: The DCS was the first cause of death in the city, in both quadrennia. The CbVD and IHD accounted for more than 63% of DCS deaths. In comparing the two quadrennia, there was a reduction in CbVD mortality rates, which was significant only for subjects over 59 years, in both genders, and the hospitalization rates increased by 10%. For IHD, no significant change occurred in mortality rates, and there was a 40% increase in hospitalization rates. CONCLUSION: The significant reduction only in CbVD mortality in the elderly suggests the need for expanding health assistance coverage to different population groups and the development of preventive and health promotion measures.

Literatura brasileira sobre o trabalho de enfermagem fundamentada em categorias marxianas

This article discusses the Brazilian scientific literature on nursing work based on Marxist categories, with the aim of investigating their contributions and tendencies. The study is a quanti-qualitative review of 97 articles published between 1981 and 2008, indexed in the LILACS. It is discussed: number and periodical distribution; themes; methodological and conceptual approaches. It was identified: a growing body of literature on nursing especially from 2000 onwards; the growth of approaches on the subjects, their perceptions and social interaction; the incorporation recently into the debate on caring and nursing care management; the predominance of qualitative research and, from the 1990s onwards, the incorporation of concepts from other theoretical paths linked to Marxists categories. There was evidence of a search for understanding of the movements, contradictions and dilemmas in nursing as a heterogeneous social practice.Se analiza la produccion cientifica brasilena sobre trabajo de enfermeria basada en categorias marxianas, con el objetivo de conocer sus contribuciones y tendencias. Es una revision quanti-qualitativa de 97 articulos nacionales publicados entre 1981-2008, indexados en LILACS. Se analizan: numero y distribucion periodica; tematica; abordagem metodologica y conceptual. Se muestra: una literatura creciente sobre el trabajo de enfermeria sobretudo a partir de los anos 2000; abordagem creciente de los sujetos, sus percepcoes e interaccion social; incorporacion reciente del debate sobre cuidado y gerenciamento del cuidado de enfermeria; predominio de investigaciones qualitativas y, a partir de los anos 1990, incorporacion de conceptos de otras vertientes teoricas articuladas la categorias marxianas. Se evidencia la busqueda de compreensao de los movimientos, de las contradicciones y de los dilemas de la enfermeria como practica social.

Integralidade do cuidado no Programa de Controle do Câncer de Colo Uterino: visão das usuárias com alteração na citologia oncótica

Objetivou-se avaliar a integralidade no cuidado de mulheres atendidas pelo Programa de Controle do Câncer de Colo Uterino. Estudo avaliativo, qualitativo, que analisou o acompanhamento e o tratamento de mulheres com alteracao na citologia oncotica nos servicos que compoem a rede de atencao, segundo a percepcao das mulheres entrevistadas no segundo semestre de 2013. Realizada a analise tematica de conteudo, verificou-se que o acesso ao exame nao garantiu a continuidade do cuidado, devido a falta de acolhimento/vinculo e a dificuldade de acesso ao tratamento. Constata-se a necessidade de outras medidas de avaliacao do programa que mensurem a integralidade do cuidado, para alem da cobertura de exames.

Conceptions and typology of conflicts between workers and managers in the context of primary healthcare in the Brazilian Unified National Health System (SUS)

This study aimed to analyze perceptions of conflict between workers and managers in primary healthcare units and to present a typology of conflicts on the job. This was a comprehensive interpretive case study with a critical hermeneutic approach. Data collection techniques included: focus group with managers, workplace observation, and worker interviews, conducted from April to November 2011. The results were triangulated and indicated the coexistence of distinct concepts of conflict, typified in six modalities: lack of collaboration at work; disrespect resulting from asymmetrical relations between workers; problematic employee behavior; personal problems; asymmetry with other management levels; and inadequate work infrastructure. The relevance of (non)mutual recognition, as proposed by Axel Honneth, stood out in the interpretation of the causes and practical implications of these conflicts.Este estudo objetivou analisar percepcoes de conflito entre trabalhadores e gerentes de unidade basica de saude e apresentar tipologia de conflitos vivenciados no trabalho. Trata-se de estudo de caso, de carater compreensivo-interpretativo, de abordagem critica-hermeneutica. As tecnicas de coleta foram: grupo focal com gerentes, observacao do trabalho e entrevista com trabalhadores, realizadas de abril a novembro de 2011. Os resultados foram triangulados e apontam a convivencia de distintas concepcoes de conflito. Foram tipificadas seis modalidades de conflitos, relacionados a falta de colaboracao no trabalho; ao desrespeito decorrente de relacoes assimetricas entre trabalhadores; ao comportamento do funcionario-problema; aos problemas pessoais; a assimetria com outros niveis de gestao e a infraestrutura deficitaria dos servicos. Destaca-se a relevância do (nao) reconhecimento mutuo, na perspectiva proposta por Axel Honneth, na interpretacao da genese e implicacoes praticas desses conflitos.