Marina Peduzzi

Multiprofessional healthcare team: concept and typology

This paper introduces concept and typology to teamwork as well as criteria to identify types of teams. The concept and the typology were developed based on the literature and research on multi-professional work in healthcare, based in the theory of studies on work process in healthcare and in the theory of communicative action. According to this theoretical proposition, teamwork is a form of collective work characterized by a reciprocal relationship between technical interventions and the interaction of agents. The proposed typology refers to two forms of teams: integrated teams as opposed to groups of people. The criteria to identify the types of team are related to communication among work agents; technical differences and inequality in social recognition of specialized works; formulation of a common care program; specificity of each professional area; flexibility of work division; and technical autonomy.

Planejamento, gestão e avaliação em saúde: identificando problemas

Este texto apresenta um conjunto de problematicas para o planejamento e a gestao dos servicos de saude, a partir dos processos de trabalho produtores diretos da assistencia e dos cuidados em saude. Busca, pois, contribuir com questoes relevantes ao estudo das interfaces entre a gestao e o trabalho em saude. Aborda o proprio planejamento e a gestao como producao de um trabalho: o de organizacao e realizacao de outros trabalhos, com vistas a racionalidade produtiva dos servicos em seus diversos fins. De outro lado, pontua questoes desses outros trabalhos enquanto problemas que podem vir a ser tomados pelo trabalho gestor: a integralidade das acoes com interdisciplinaridade das tecnicas e interacao entre multi-profissionais no trabalho em equipe, ou a garantia de qualidade resolutiva da assistencia, tanto como eficacia tecnico-cientifica quanto como adesao e intercomunicacao na relacao direta entre os diversos profissionais e destes com os usuarios dos servicos. Para tanto concebe-se trabalho como processo produtivo e como interacao, levando-se em conta as articulacoes entre as acoes em saude, pelo que representam de acoes estrategicas para a producao de cuidados e assistencia, bem como as relacoes intersubjetivas, pelo que representam de acoes comunicativas e partilhas de decisoes.

ARTICULAÇÃO ENTRE AS DIMENSÕES GERENCIAL E ASSISTENCIAL DO PROCESSO DE TRABALHO DO ENFERMEIRO

The purpose of this study was to analyze the nursing management work process dimension in order to better identify and understand possibilities for linkages with the care dimension. A qualitative approach was used, referencing health care and nursing work-studies. The data was collected from June until August of 2005 at a private hospital located in Sao Paulo through semi-structured interviews with 10 nurses who work in an inpatient care unit and using thematic content analysis. The results show that supplies, equipment control, costs, and scale elaboration are the prevailing activities of the management work process dimension. The connections between management and assistance work dimensions can be shown in the nurse’s visit and the Nursing Care Systematization as actions which allow care and management interventions, within the unraveling of a set of other assistance and management actions interconnected in an understood or explicit form, as well as in the care management conception. DESCRIPTORS: Nursing. Human resources. Nursing care. Hospital, private. Work. ENLACE ENTRE LAS DIMENSIONES GERENCIAL Y ASISTENCIAL DEL PROCESO DE TRABAJO DEL ENFERMERO RESUMEN: El objetivo de la investigacion fue analizar la dimension gerencial del proceso de trabajo del enfermero para identificar y comprender las posibles conexiones con la dimension asistencial. Abordaje cualitativo basado en el referencial teorico de los estudios del trabajo en salud y enfermeria. La recoleccion de los datos se hizo por medio de entrevista semiestructurada con 10 enfermeros de una unidad de internacion de un hospital privado del Municipio de Sao Paulo, de junio a agosto de 2005, utilizando la tecnica de analisis tematica. Los resultados mostraron que en la dimension gerencial predominan actividades de gerencia de material, equipos, costos y elaboracion de escalas. El enlace de la dimension gerencial con la asistencial puede ser observada en la referencia que los entrevistados hacen a respecto de la visita del enfermero y de la Sistematizacion de los Cuidados de Enfermeria como acciones que permiten intervenciones de cuidado y de gerencia, en el relato de un conjunto de otras acciones asistenciales y gerenciales interrelacionadas de forma sobrentendida o explicita y en la concepcion de gerencia del cuidado. DESCRIPTORES: Enfermeria. Recursos humanos. Atencion de enfermeria. Hospitales privados. Trabajo.

O processo de trabalho de enfermagem: a cisão entre planejamento e execução do cuidado

Este articulo tiene tos objetivos de caracterizarei proceso de trabajo del enfermero y del auxiliar de enfermeria y de analizar contradicciones existentes en el trabajo de enfermeria. Toma como referencial teorico los estudios del proceso de trabajo en salud y en enfermeria y la teoria del actuar comunicativo. Con base en el metodo cualitativo de investigacion, el material empirico se recogio a traves de entrevista sem iestructura d a con enfermeros, auxiliares de enfermeria y medicos de un mismo equipo de trabajo, en un hospital universitario. El analisis se realizo mediante la tecnica de impregnacion y de la identificacion de nucleos tematicos interpretados con base a las categorias analiticas del cuadro teorico. Los resultados muestran contradicciones, tales como la cision entre planeamiento y ejecucion del cuidado y la ausencia de una apropiacion del saber de enfermeria, por parte de los agentes que ejecutan mayoritariamente el cuidado.This article aims at characterizing nurses and nursing assistants work process, as well as at analyzing contradictions present in nursing work. Studies on the nursing and health work process, and the communicative action theory were used as its theoretical framework. Based on qualitative research methodology, the empirical material was collected by means of semi-structured interviews with nurses, nursing assistants and physicians on the same work team in a school hospital. Analysis was conducted through the impregnation technique and the identification of thematic units, which were interpreted on basis of analytical categories from the theoretical framework. Results showed contradictions such as the separation between planning and care delivery and the absence of appropriation of nursing knowledge by the agents who are in charge of delivering care.

Atividades educativas de trabalhadores na atenção primária: concepções de educação permanente e de educação continuada em saúde presentes no cotidiano de Unidades Básicas de Saúde em São Paulo

The objective of this study was to analyze the educ ational activity practices among healthcare workers in primary healthcare units (PHUs) accordin g to the concepts of “educacao permanente em saude” (EPS) 1 and continuing education (CE), healthcare and nurs ing work processes, teamwork and comprehensiveness. This was a cross-sectional s tudy conducted in 10 PHUs in the municipality of Sao Paulo, through structured interviews with 11 0 key informants who represented all professional categories and teams at the PHUs. The interviews covered educational activities developed in 2005. The information was classified a ccording to operational categories for each study variable, based on the theoretical framework. The workers reported 396 educational activities that demonstrated the complementary nature of the c oncepts of EPS and CE. In accordance with the perspectives of the Brazilian Unified Health System (SUS) and the transformation of healthcare practices, there is a need to expand the debate rel ating to EPS as public policy.Esta pesquisa tem o objetivo de analisar a pratica de atividades educativas de trabalhadores da saude em Unidade Basica de Saude (UBS) segundo as concepcoes de educacao permanente em saude (EPS) e de educacao continuada (EC), processo de trabalho em saude e enfermagem, trabalho em equipe e integralidade. Estudo do tipo transversal, realizado em dez UBS do Municipio de Sao Paulo, por meio de entrevista dirigida com 110 informantes-chave, representantes de todas as categorias profissionais e equipes das UBS, sobre as atividades educativas desenvolvidas em 2005. As informacoes foram classificadas segundo categorias operacionais para cada variavel de estudo, com base no referencial teorico. Os trabalhadores relataram 396 atividades educativas, que revelam a complementaridade das concepcoes de EPS e EC. De acordo com a perspectiva do Sistema Unico de Saude (SUS) e da transformacao das praticas de saude, coloca-se a necessidade de ampliacao do debate em torno da EPS como politica publica.

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.

Integrative Review: Concepts And Methods Used In Nursing

Resumen 
La Revision Integradora (RI) tiene una reputacion internacional en la investigacion en enfermeria y en la practica basada en la evidencia. Esta RI tuvo como objetivo identificar y analizar los conceptos y los metodos indicados para la realizacion de una RI en enfermeria. Fueron consultados nueve recursos de informacion y fuentes de literatura gris. Se incluyeron diecisiete estudios de RI. Los resultados indican que: la mayoria de los estudios primarios fueron realizados en EE.UU.; es posible tener varias preguntas de investigacion o hipotesis e incluir estudios primarios de diferentes perspectivas teoricas y metodologias; es un tipo de analisis que puede ir mas alla de la sintesis de las conclusiones de los estudios primarios, permitiendo abarcar otras dimensiones de la investigacion y finalmente presenta potencial para el desarrollo de nuevas teorias y problemas de investigacion. En conclusion, la RI es comprendida como un tipo de revision de naturaleza compleja que demanda metodos normalizados y sistematicos para garantizar el rigor requerido en la investigacion cientifica y por lo tanto la legitimidad de las evidencias establecidas.UNLABELLED Integrative review (IR) has an international reputation in nursing research and evidence-based practice. This IR aimed at identifying and analyzing the concepts and methods recommended to undertaking IR in nursing. Nine information resources,including electronic databases and grey literature were searched. Seventeen studies were included. The results indicate that: primary studies were mostly from USA; it is possible to have several research questions or hypotheses and include primary studies in the review from different theoretical and methodological approaches; it is a type of review that can go beyond the analysis and synthesis of findings from primary studies allowing exploiting other research dimensions, and that presents potentialities for the development of new theories and new problems for research. CONCLUSION IR is understood as a very complex type of review and it is expected to be developed using standardized and systematic methods to ensure the required rigor of scientific research and therefore the legitimacy of the established evidence.

[Interprofessional education: training for healthcare professionals for teamwork focusing on users].

The theoretical constructs of interprofessional education (IPE) are analyzed based on two reviews of the literature, taking the context of training for healthcare professionals in Brazil into consideration. Three types of training are identified: uniprofessional, multiprofessional and interprofessional, with predominance of the first type. The first occurs among students of the same profession, in isolation; the second occurs among students of two or more professions, in parallel without interaction; and the third involves shared learning, with interaction between students and/or professionals from different fields. The distinction between interprofessionalism and interdisciplinarity is highlighted: these refer to integration, respectively, of professional practices and disciplines or fields of knowledge. Through the analysis presented, it is concluded that in the Brazilian context, IPE (the basis for collaborative teamwork) is still limited to some recent initiatives, which deserve to be investigated.

Mudanças tecnológicas e seu impacto no processo de trabalho em saúde

Our objective here is to analyze the contemporary changes in the world of work and their effect - or their impact - on the work processes in the area of health. The theoretical reference for this analysis is a specific stream of studies on work developed in Brazil in the area of collective health. Starting from the assumption that work and social needs are consubstantial, the analysis deepens the investigation of the work processes and their constitutive elements, as well as of the inter-subjective and ethical-moral dimensions of the production of health services. Having considered, on the one hand, the complexity of the work objects in the area of health - that demand both a vertical increase in specialized knowledge and the horizontal integration of that knowledge - ; and, on the other, the introduction of new organizational/managerial models and the constant presence of technological innovation and incorporation, we observed significant changes in the work processes, including, among others, the multi-professional and interdisciplinary character of health practices, the re-dimensioning of professional autonomy in the face of a need to recompose specialized work, and the need to provide all health workers with better and permanent professional qualifications, both in its technical and in its ethical-political and communicational dimensions.

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.