Elisabete de Fátima Polo de Almeida Nunes

Relações entre concepções e práticas de educação em saúde na visão de uma equipe de saúde da família

Este estudo objetiva analisar as concepcoes de educacao em saude de profissionais da equipe de Saude da Familia e pensar criticamente sobre a relacao estabelecida entre as praticas de educacao em saude e os discursos desses trabalhadores. Trata-se de uma pesquisa qualitativa que adota a analise de discurso como referencial teorico e tecnicas de observacao e entrevistas para a producao dos dados. Os modelos curativos e de transmissao do conhecimento encontram-se fortemente arraigados na concepcao e nas praticas de educacao em saude, prevalecendo uma relacao vertical, impositiva, superior, na qual o profissional e o detentor do saber. Os trabalhadores sentem-se educadores, e observa-se uma postura que considera o processo de trabalho educativo voltado para o aprendizado mutuo e o respeito aos conhecimentos previos da populacao, porem essa percepcao encontra-se presente somente em seu discurso, necessitando ser incorporada a sua pratica para que haja a mudanca nos servicos de saude. Verificou-se a necessidade de maior valorizacao do papel do trabalhador como sujeito propulsor de mudancas na pratica educativa e no modelo de atencao em saude vigente, bem como a importância do reconhecimento do usuario como sujeito atuante na propria saude e com capacidade de intervencao na sua realidade.

Condições de trabalho e riscos no trânsito urbano na ótica de trabalhadores motociclistas

Uma das profissoes que mais se expandem no Brasil e a dos motociclistas profissionais, o que pode aumentar os acidentes de trânsito envolvendo esta categoria. Este estudo tem como objetivo identificar e analisar qualitativamente a percepcao de motoboys acerca de aspectos relacionados ao seu trabalho, aos riscos no trânsito e a ocorrencia de acidentes. Os dados foram coletados por meio de grupo focal, realizado em fevereiro de 2005, com 11 motoboys atuantes em Londrina (PR). Este artigo focaliza os principais motivos que levaram os motoboys a insercao na profissao, suas condicoes de trabalho, os riscos a que estao expostos e seu envolvimento em acidentes de trânsito. Os principais motivos para a insercao na profissao foram o desemprego e a baixa escolaridade. A pressao exercida pelas empresas e clientes por entregas rapidas e fator determinante para a adocao de comportamento de risco no trânsito, tendo o ganho por produtividade menor peso na tomada de decisoes. Todos os participantes do estudo relataram envolvimento em acidentes de trânsito. Melhorar suas condicoes de trabalho e o grande desafio colocado no momento, tanto para os proprios motoboys, por meio da uniao da categoria e luta por seus direitos, como para a sociedade em geral, cabendo ao Estado fiscalizar as empresas que oferecem servicos de entrega e estabelecer normas que aumentem a seguranca desses motociclistas no desempenho do seu trabalho.

Os desafios da educação permanente: a experiência do curso de Medicina da Universidade Estadual de Londrina

Faculty staff of undergraduate medical school has usually a high level of techno-scientific knowledge but deficient didactic and pedagogical competences, resulting in resistance to change. The purpose of this article is to discuss the challenges posed to the implementation of a faculty development program for the medical course of the State University of Londrina. The faculty development committee introduced two activities, as there are: a) An introductory course to prepare future tutors who will provide support to the tutorial group using problem-based learning methods; b) The establishment of a study group in order to discuss and reflect about topics related to the teaching practice. For overcoming the challenges posed by nurturing medical faculty development all implanted activities need to be constantly evaluated in order to assure continuing capacity building.

O TRABALHO EDUCATIVO DO ENFERMEIRO NA ESTRATÉGIA SAÚDE DA FAMÍLIA

The objective of this study was to understand the difficulties and perspectives on change that nurses have identified in developing educational interventions in the Family Health Strategy (FHS). This is a qualitative, descriptive-exploratory study. The data were collected with 20 nurses working in the FHS of the 10th Regional Health District of Paraná, by means of semi-structured interviews carried out in April 2010, which were subjected to content analysis. The results demonstrated that nurses face difficulties in developing health education strategies with the clients, healthcare team, and administrators, especially in regards to the lack of physical, material and financial resources. However, based on the difficulties they encounter, they seek alternatives to overcome them and suggest changes aimed at improving the delivery of primary health care to the population, particularly regarding educational practices.

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.

A educação em saúde na relação usuário-trabalhador no cotidiano de equipes de saúde da família

The scope of this research was to analyze how the practice of health education occurs in the informal user-worker relationship, and the strategies used for its implementation in routine primary care. It is a qualitative study conducted with two Family Health teams and the data was collected through observation and semi-structured interviews and assessed using discourse analysis. Health education in the informality of professional-user relations occurs in everyday conversations and guidance, and permeates the various issues involving the needs of users. Workers present educational strategies that occur in a non-structured manner, some of which portray a differentiated way of implementing educational practice, though most of these are restricted to the transfer of information, in which employees seek to transfer/inform reinforcing their attitude of imposition and control of know-how they consider to be right. It is necessary to rethink and enhance health education as labor technology, which reveals different processes for action in health, reorienting the practice into meaningful learning, which promotes change among users, workers, and in the current healthcare model.

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.

Necessidades e dificuldades de tutores e facilitadores para implementar a política de educação permanente em saúde em um município de grande porteno estado do Paraná, Brasil

Para o fortalecimento da politica de Educacao Permanente em Saude (EPS), tutores e facilitadores de educacao permanente em saude foram formados. No intuito de desvendar suas necessidades e dificuldades durante o processo de implementacao da EPS, foi desenvolvida uma pesquisa qualitativa com nove tutores e dez facilitadores de EPS de Londrina, estado do Parana. Como instrumento de coleta de dados foi realizada a entrevista semiestruturada, e os dados foram analisados conforme analise de discurso proposta por Martins e Bicudo. Entre as necessidades, destaca-se a institucionalizacao da EPS, e, como dificuldade, a persistencia de praticas hegemonicas. Com base nos resultados e necessario consolidar a EPS por meio de sua pratica nos servicos de saude, pois so dessa maneira, tutores, facilitadores e demais profissionais de saude terao capacidade de superar as limitacoes que permeiam o processo de implementacao da EPS.

Perfil dos gerentes de Atencao Primaria a Saude de municipios de pequeno porte do norte do Parana, Brasil

The scope of this article was to establish the profile of Primary Health Care (PHC) managers in 49 small municipalities (up to 20,000 inhabitants) in the north of the state of Parana. A semi-structured questionnaire was applied to 90 managers in a quantitative-based study. For statistical analysis the EpiInfo 3.5.1. program was used. The results of the manager profile showed that 91.1% were women, 83.3% nurses, 50% aged 21 to 30 years and 75.6% with specialization. Concerning the entry into employment, 70% were through public exam/selective test. Regarding professional experience, 40% had worked professionally for more than 5 years, 43.4% had been involved in PHC up to 5 years and 32.2% had been in the current primary health care unit for less than 1 year. Regarding specific training for performing a managerial role, 71.1% had not taken any courses; only 23.3% reported having taken a management course, though 37.7% had already acted as managers. The conclusion reached is that there is a lack of professionalism, training and institutionalization of the position for the performance of this function.