Magda Duarte dos Anjos Scherer

Trabalho coletivo: um desafio para a gestão em saúde

Com base na teorizacao da ergologia e do processo de trabalho, este ensaio objetiva contribuir para a reflexao acerca do trabalho coletivo em saude, destacando sua especificidade e as dificuldades de construcao e gestao de coletivos de trabalho. Aborda o trabalho como atividade humana que compreende, dialeticamente, a aplicacao de um protocolo prescrito e uma perspectiva singular e historica. O trabalho em saude envolve uma relacao entre sujeitos que agem nas dramaticas do uso de si e que fazem a gestao do seu proprio trabalho; e influenciado pela historia das profissoes de saude e pelas determinacoes macro-politicas. Conclui-se que essa complexidade do trabalho em saude precisa ser considerada no processo de gestao de equipes/coletivos profissionais de modo a articular acoes que possibilitem implementar um novo projeto de atencao a saude na perspectiva da integralidade.Based on ergology and work process theorization, the study aims to contribute to reflections on health collective work, emphasizing its specificity and difficulties in building and managing groups of workers. It deals with work as a human activity that dialectically comprises the application of a prescribed protocol and a unique and historical perspective. Health work involves a relationship among individuals who act in the drama of using themselves and manage their own work; it is influenced by the history of health professions and macro-political determinations. In conclusion, this health work complexity needs to be considered in the process of management of professional teams/groups of workers, in a way that actions can interact and enable the implementation of a new health care project in the perspective of comprehensiveness.

Modelo assistencial em saúde: conceitos e desafios para a atenção básica brasileira

Trata de uma reflexao teorica com objetivo de resgatar o debate conceitual sobre modelo assistencial em saude e os desafios para a atencao basica no Brasil. O estudo caracteriza diferentes conceitos e terminologias relativas a expressao modelo assistencial e mostra que a saude da familia promoveu ampliacao do acesso e incorporacao do acolhimento e humanizacao das praticas. No entanto, verifica-se a persistencia da centralidade do tratamento de patologias e dos cuidados ao corpo biologico, as dificuldades na implantacao da integralidade e deficits na formacao das equipes e nas condicoes e relacoes de trabalho. Concluiu que o termo modelo assistencial e polissemico e que, embora existam propostas e politicas estruturantes de um modelo que avance em relacao ao paradigma biomedico, as dificuldades para sua implementacao sao significativas.

A construção da interdisciplinaridade no trabalho da Equipe de Saúde da Família

A violencia e um problema de saude publica e sua notificacao e fundamental para a vigilância epidemiologica e para a definicao de politicas publicas de prevencao e promocao de saude. O estudo objetivou caracterizar a ocorrencia de violencia domestica, sexual e de outras, a partir das informacoes do banco de dados do Sistema Informacao de Agravos de Notificacao (SINAN), das fichas de notificacao de violencia da cidade de Belem (PA), no periodo de janeiro de 2009 a dezembro de 2011. Foram sistematizadas 3.267 notificacoes, representando um aumento de 240% de 2009 a 2011. Em relacao ao sexo das vitimas, observou-se que, em media, 83,2% dos casos atingiram as mulheres, proporcao esta semelhante nos tres anos analisados. A violencia sexual foi a mais presente com 41,8%; seguida da violencia psicologica com 26,3% e da violencia fisica com 24,0%. Os resultados demonstram a importância do conhecimento do perfil das violencias para intervencao e elaboracao de politicas publicas intersetoriais que promovam a saude e a qualidade de vida nesta regiao do Brasil.Interdisciplinarity in the work routine of professionals of a Residency Course on Family Health in Southern Brazil was investigated in a qualitative study involving 11 residents and 5 su- pervisors of seven professions. Through interviews, observations and focal groups the existence of in- terdisciplinarity in practice was analyzed, duly identifying favorable and unfavorable aspects for its implementation. Interdisciplinarity was ex- pressed as a complex process and concrete action, which occurs in the dramatic implications of its usage, in a dialectical relationship with the polit- ical and institutional context. The study revealed that working in family health care renders the work more complex and that the professionals ex- perience difficulties in sharing knowledge and making the transition between multidisciplinari- ty and interdisciplinarity. The study concludes that interdisciplinarity requires the integrated use of knowledge in the multi-professional practice, the crossing of disciplinary boundaries, the develop- ment of competencies to address the challenges of the work environment and personal attitude as a basic component for professional action. Key words Work, Oganization and administra- tion, Patient care team, Health Services, Human resources, Family health care, Ergology Magda Duarte dos Anjos Scherer 1

Condições de trabalho e renormalizações nas atividades das enfermeiras na saúde da família

The objective of this article is to analyze the influence of work conditions in Family Health Nursing activities and the renormalizations they produce. It is a qualitative study carried out in a municipality in southern Brazil, involving an intentional sample of ten registered nurses. Methodological triangulation was used with the data collected through documental research, observation, and self-facing interviews. The software Atlasti 5 and the foundations of historical dialectic materialism, was used to treat and analyze the data, as well as ergology. The results demonstrate that inadequate work conditions such as insufficient workforce and precariousness in work instruments contradict or impede reaching the objectives of promoting health and integrity, as prescribed by the Family Health norms. We conclude that given these conditions, nurses renormalize their activities based on the values of ones right to health, access to health, and integrality, and become overloaded in their nursing work.

O trabalho do Cirurgião-Dentista na Atenção Primária à Saúde: entre o prescrito e o real

No cenario mundial, o Cirurgiao-Dentista atua, sobretudo, no setor privado. No Brasil, esta realidade comeca a mudar com a inclusao desse profissional na Estrategia Saude da Familia (ESF). Este estudo de caso realizado no Centro-Oeste do Brasil busca compreender o trabalho do dentista nesse contexto, atraves de analise documental, observacao do trabalho e entrevistas. Da analise tematica de conteudo emergiram duas categorias: condicoes para o trabalho na ESF e modo de trabalho na ESF. A influencia historica do modelo de atencao individual, o contexto adverso do trabalho, as concepcoes de ESF dos profissionais e a autonomia que lhes e conferida restringem sua atuacao.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Inserção de um hospital de grande porte na Rede de Urgências e Emergências da região Centro-Oeste

Em face da exigencia de se configurar as redes de cuidados, este estudo qualitativo analisa a insercao de um hospital de grande porte na Rede de Atencao as Urgencias e Emergencias na regiao Centro-Oeste do Brasil utilizando dados secundarios, analise documental e entrevistas semiestruturadas aplicadas aos gestores e profissionais que atuam no Centro de Trauma. Os resultados sugerem desconhecimento dos profissionais quanto a insercao do Hospital na rede; definicao de fluxos e pactos incipiente; boas praticas na regulacao pelo Servico de Atendimento Movel de Urgencias. Conclui-se que a insercao do Hospital acontece de forma lenta e depende da articulacao dos varios niveis do Sistema Unico de Saude.

Cursos de especialização em Saúde da Família: o que muda no trabalho com a formação?

The persistence of bio-medically oriented practices and the mismatch between training and work are identified as the challenges for the rolling out of Primary Health Care (PHC) in Brazil. This paper analyzes work changes in PHC after following specialization level training courses on community and family health, from the point of view of the trained professionals. It is a qualitative study carried on from 2011 to 2013 in the Federal District (DF) involving doctors, nurses and dentists. Data was collected with the use of digital questionnaires, semistructured interviews and focal groups. From the thematic content analysis, two categories emerged: “a universe of knowledge has opened up” and a “new way of doing things in an adverse working environment”. The context of the PHC in DF is a constraint but the training had the potential to generate professional competences. Keywords: Work in health. Primary health care. Family health. Training. ErgologyThe persistence of bio-medically oriented practices and the mismatch between training and work are identified as the challenges for the rolling out of Primary Health Care (PHC) in Brazil. This paper analyzes work changes in PHC after following specialization level training courses on community and family health, from the point of view of the trained professionals. It is a qualitative study carried on from 2011 to 2013 in the Federal District (DF) involving doctors, nurses and dentists. Data was collected with the use of digital questionnaires, semistructured interviews and focal groups. From the thematic content analysis, two categories emerged: “a universe of knowledge has opened up” and a “new way of doing things in an adverse working environment”. The context of the PHC in DF is a constraint but the training had the potential to generate professional competences.

Implantação da telessaúde na atenção à saúde indígena no Brasil

The Brazilian National Telemedicine Program in indigenous healthcare assists health professionals working in remote areas in strengthening the healthcare provided to indigenous populations. The current study aimed to analyze the implementation of the National Telemedicine Program in indigenous peoples health, from the perspective of health administrators. This was a qualitative exploratory descriptive study using document analysis and open-ended interviews with 10 administrators. Content analysis resulted in two categories: the programs process implementation and the potential of telemedicine for indigenous peoples healthcare. The results emphasize the importance of dialogue between all institutions involved and the construction of a democratic forum for evaluating this process and related decision-making: resumption of the programs implementation and subsequently its expansion and improvement of the available resources and the search for other applicable strategies for indigenous peoples health. A broad discussion on this topic is recommended that involves the indigenous peoples strategies for social control.No Brasil, o Programa Telessaude Brasil Redes na atencao a saude indigena e uma das estrategias para auxiliar na fixacao de profissionais em areas remotas e fortalecer a assistencia a populacao indigena. O estudo objetivou analisar a implantacao do programa voltado para a saude indigena, com base na visao dos gestores. E um estudo exploratorio descritivo com abordagem qualitativa (analise documental e entrevistas nao estruturadas com dez gestores) e a analise de conteudo resultou em duas categorias: o processo de implantacao do programa e as potencialidades da telessaude na atencao a saude indigena. Os resultados recomendam o dialogo entre as instituicoes envolvidas e a construcao de um espaco democratico visando a avaliacao desse processo e a tomada de decisao sobre o caminho a seguir: retomada da implantacao e consequente expansao da telessaude, a melhoria de dispositivos ja disponiveis e/ou a busca de outras estrategias viaveis para o contexto da saude indigena. Alem disso, sugere-se que o tema seja objeto de amplo debate nas instâncias indigenas de controle social.

Influence of multiprofessional work on the production of care and access to primary health care

Objective: to analyze how the work of four family health teams, in Brazilian Midwest and South regions, influences the capacity of the services in guaranteeing access. Methods: this is a descriptive study with a qualitative approach. Results: the results were systematized in nine elements, namely: (I) formation/ Knowledge of standards; (II) experience; (III) affinity of professionals with a particular theme, grievance or group of people; (IV) professional satisfaction; (V) workload; (VI) management and organization of the work process (VII) teamwork; (VIII) actions carried out with the participation of the community and; (IX) respect for the autonomy of people and different knowledge and cultures. Conclusion: the identified elements related to the individual issues, the organization of the service and the relationship and participation of the community in the actions of the health unit should be considered both in the training of new health workers and in the formulation of public policies.