Edir Nei Teixeira Mandú

Trabalho em equipe na perspectiva da gerência de serviços de saúde: instrumentos para a construção da prática interprofissional

Estuda-se a contribuicao da acao gerencial para a promocao da pratica interprofissional. Trata-se de pesquisa qualitativa, realizada em 21 servicos publicos de saude de uma regiao de Sao Paulo, por meio de entrevista semiestruturada com 21 gerentes (diretores) e utiliza-se a tecnica de analise tematica. Como resultado, para promover o trabalho em equipe, os gerentes lancam mao dos instrumentos: comunicacao, construcao do compromisso das equipes e dos trabalhadores com o projeto institucional, estimulo a autonomia das equipes, definicao de responsabilidades e accountability, promocao de mudanca da cultura institucional e supervisao externa. Conclui-se que a comunicacao e demais ferramentas quando aplicadas a promocao do trabalho em equipe estao orientadas ao trabalho, isto e, a atencao eficaz e eficiente as necessidades de saude dos usuarios.

Visita domiciliária sob o olhar de usuários do programa saúde da família

Through a qualitative study, meanings attributed to the house call by Brazilian families who benefited from the Family Health Program are analyzed, with the objective of recognizing the difficulties and potential accumulated from this practice. From October to December of 2005, thirty women and ten men participated in open interviews, all between 18 and 79 years old as well as more than six-month residents in a health region of Cuiabá, MT, Brazil. Content analysis was used for data interpretation. The house call is conceived as an important method of approaching the Family Health Program and families, favoring greater access to its services, the construction of new relationships between users and the health care team, and the creation of a link between them. It is valued as an alternative to access to clinical care and to health monitoring, reiterating the practice carried out. At the same time, one hopes that it responds to the necessities it faces in the most broadened form possible. RESUMEN: Por medio de un estudio cualitativo son analizados los significados atribuidos por las familias a la visita domiciliaria realizada por el Programa Salud de la Familia, con el objetivo de reconocer las dificultades y los potenciales relacionados con esta práctica. Entre octubre y diciembre de 2005 fueron hechas treinta entrevistas abiertas con las mujeres y diez con los hombres, todos ellos entre 18 y 79 años, residentes por más de seis meses en una regional de salud de Cuiabá MT. La categorización de los datos se hizo por medio del análisis del contenido. Se considera la visita como una importante forma de aproximación entre el Programa Salud de la Família y las familias, favoreciendo el acceso a los servicios, la construcción de nuevas relaciones entre los usuarios y el equipo de salud, y, la formación de un vínculo entre ellos. La visita domiciliaria se presenta como una alternativa importante para el acceso a los cuidados clínicos y de vigilancia a la salud, reiterando la práctica de la visita tal como recibida. Al mismo tiempo, se espera que ella promueva respuestas más amplias a las necesidades vividas. P A L A V R A S C H A V E : Programa Saúde da Família. Visita domiciliar. Atenção primária à saúde.Through a qualitative study, meanings attributed to the house call by Brazilian families who benefited from the Family Health Program are analyzed, with the objective of recognizing the difficulties and potential accumulated from this practice. From October to December of 2005, thirty women and ten men participated in open interviews, all between 18 and 79 years old as well as more than six-month residents in a health region of Cuiaba, MT, Brazil. Content analysis was used for data interpretation. The house call is conceived as an important method of approaching the Family Health Program and families, favoring greater access to its services, the construction of new relationships between users and the health care team, and the creation of a link between them. It is valued as an alternative to access to clinical care and to health monitoring, reiterating the practice carried out. At the same time, one hopes that it responds to the necessities it faces in the most broadened form possible.

Work and Inter-subjectivity: a theoretical reflection on its dialectics in the field of health and nursing

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.

Intersubjetividade na qualificação do cuidado em saúde

Esta producao teorica, apoiada em formulacoes presentes no debate academico em torno dos processos assistenciais em saude, oferece subsidios a qualificacao do cuidado individualizado. Argumenta-se em prol do resgate da intersubjetividade na atencao, focando aspectos interacionais socioculturais e psico-afetivos, tomando-os como dimensao essencial na construcao de uma nova relacao com os sujeitos alvos de atencao e de uma abordagem ampla das suas vivencias e necessidades em saude.This theoretical production, based on academic debates concerning health care processes, offers elements to support the qualification of individualized care. Arguments in favor of the recovery of inter-subjectivity in care are developed, focusing on sociocultural and psycho-affective aspects of interaction and considering them as an essential dimension in the construction of a new relation with the people who receive care, as well as a broad approach to their health experiences and needs.

Percepções de enfermeiros sobre seu trabalho na Estratégia Saúde da Família

This study aimed to analyze the perceptions of nurses regarding their work in the Family Health Strategy. It consists of a qualitative descriptive study based on the socio-historical foundations and intersubjective aspects of the nursing work. Data were collected in 11 Family Health Units in Cuiaba, Mato Grosso, Brazil, by means of semi-structured interviews with 11 nurses, and submitted to thematic analysis. The nursing work is perceived as based on strategic and preventive actions, on the participation in the delivery of care, in contrast to the administrative participation, and on embracing interactions with patients. The nurses demonstrated compliance with the axes proposed for the work in the Family Health Strategy and a certain lack of knowledge and unchallenged acceptance of these, especially with respect to the promotion of health and the renewal of the local administrative practice. This study reveals the importance of reflecting regarding the nursing work and the perceptions of nursing professionals as for the construction of the Family Health Strategy model. DESCRIPTORS: Family Health Program. Nursing. Work. Social values.4 Master in Nursing. Professor at the Undergraduate Nursing Course of UNIC. Cuiaba, Mato Grosso, Brazil. E-mail: le_elias@ hotmail.com ABSTRACT: This study aimed to analyze the perceptions of nurses regarding their work in the Family Health Strategy. It consists of a qualitative descriptive study based on the socio-historical foundations and intersubjective aspects of the nursing work. Data were collected in 11 Family Health Units in Cuiaba, Mato Grosso, Brazil, by means of semi-structured interviews with 11 nurses, and submitted to thematic analysis. The nursing work is perceived as based on strategic and preventive actions, on the participation in the delivery of care, in contrast to the administrative participation, and on embracing interactions with patients. The nurses demonstrated compliance with the axes proposed for the work in the Family Health Strategy and a certain lack of knowledge and unchallenged acceptance of these, especially with respect to the promotion of health and the renewal of the local administrative practice. This study reveals the importance of reflecting regarding the nursing work and the perceptions of nursing professionals as for the construction of the Family Health Strategy model. DESCRIPTORS: Family Health Program. Nursing. Work. Social values.

Necessidades em saúde: questões importantes para o trabalho da enfermagem

A construcao de novos parâmetros e praticas em saude e enfermagem, no sentido do efetivo exercicio de direitos sociais, e um desafio posto na atualidade. Este trabalho e uma contribuicao ao enfrentamento desse desafio. Olhando para o saber da enfermagem, reflete-se sobre um dado modo de interpretacao das necessidades em saude. A partir de uma discussao acerca das necessidades humanas e de sua relacao com o trabalho em saude, submete-se a critica a interpretacao das necessidades humanas/em saude presente na teoria de Wanda de Aguiar Horta. Destaca-se na analise a importância da autonomia/autovalorizacao humana e a interpretacao de necessidades a partir da consideracao aos sujeitos que recebem-fazem saude e ao contexto social.

Promoção da saúde na Estratégia Saúde da Família: análise de políticas de saúde brasileiras

OBJETIVO: Analizar politicas de salud dirigidas a la Salud de la Familia (SF), enfocando el acceso a medidas y bienes necesarios a la calidad de vida asi como la participacion de la poblacion en la defensa de la salud. METODOS: Se presupone que las politicas de salud se encuentran muchas contradicciones relativas a los modelos asistenciales confrontados con el escenario de salud. Fue realizado un estudio del tipo investigacion documental en cuatro documentos del Ministerio de la Salud vigentes de 1994 a 2007, que instituyen la politica especifica de SF o contienen proposiciones con implicaciones para la atencion basica. Adoptamos el analisis tematico de contenido. RESULTADOS: La promocion de la salud es precepto y area estrategica de la SF, y abarca: participacion en practicas intersectoriales; analisis de las situaciones sociales, sanitarias y familiares locales, para la planificacion de acciones; estimulo a la participacion; y, control social; entre otras. CONCLUSIONES: Las acciones promocionales no tienen destaque en las politicas analizadas, que expresan sobre todo el modelo asistencial predominante pautado en la enfermedad-prevencion.

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.

Consulta de enfermagem na promoção da saúde sexual

Methodological bases and instruments are presented in this academic paper for holding a nursing consultation focused on the sexual health of adults and adolescents. The systematized proposal is based on a promotional perspective of sexual health and on a comprehensive concept of sexuality. Emphasis is placed on the recognition of related vulnerabilities, on an ample approach of needs, and on the inter-relational and educative dimension and educative dimension in the work of nurses.Nesta producao academica, apresentam-se fundamentos e instrumentos metodologicos para a realizacao da consulta de enfermagem voltada a saude sexual de adultos e adolescentes. A proposta sistematizada orienta-se por uma perspectiva promocional de saude sexual e por um conceito abrangente de sexualidade. Da-se enfase ao reconhecimento de vulnerabilidades relacionadas, a uma abordagem ampla de necessidades, e a dimensao inter-relacional e educativa na atuacao de enfermeiras(os).

Perceptions of nurses regarding their work in the Family Health Strategy

This study aimed to analyze the perceptions of nurses regarding their work in the Family Health Strategy. It consists of a qualitative descriptive study based on the socio-historical foundations and intersubjective aspects of the nursing work. Data were collected in 11 Family Health Units in Cuiaba, Mato Grosso, Brazil, by means of semi-structured interviews with 11 nurses, and submitted to thematic analysis. The nursing work is perceived as based on strategic and preventive actions, on the participation in the delivery of care, in contrast to the administrative participation, and on embracing interactions with patients. The nurses demonstrated compliance with the axes proposed for the work in the Family Health Strategy and a certain lack of knowledge and unchallenged acceptance of these, especially with respect to the promotion of health and the renewal of the local administrative practice. This study reveals the importance of reflecting regarding the nursing work and the perceptions of nursing professionals as for the construction of the Family Health Strategy model. DESCRIPTORS: Family Health Program. Nursing. Work. Social values.4 Master in Nursing. Professor at the Undergraduate Nursing Course of UNIC. Cuiaba, Mato Grosso, Brazil. E-mail: le_elias@ hotmail.com ABSTRACT: This study aimed to analyze the perceptions of nurses regarding their work in the Family Health Strategy. It consists of a qualitative descriptive study based on the socio-historical foundations and intersubjective aspects of the nursing work. Data were collected in 11 Family Health Units in Cuiaba, Mato Grosso, Brazil, by means of semi-structured interviews with 11 nurses, and submitted to thematic analysis. The nursing work is perceived as based on strategic and preventive actions, on the participation in the delivery of care, in contrast to the administrative participation, and on embracing interactions with patients. The nurses demonstrated compliance with the axes proposed for the work in the Family Health Strategy and a certain lack of knowledge and unchallenged acceptance of these, especially with respect to the promotion of health and the renewal of the local administrative practice. This study reveals the importance of reflecting regarding the nursing work and the perceptions of nursing professionals as for the construction of the Family Health Strategy model. DESCRIPTORS: Family Health Program. Nursing. Work. Social values.