Educação permanente em saúde - espaços, sujeitos e tecnologias na reflexão sobre o processo de trabalho

Autor: Maria Jose Cabral Grillo
Jazyk: portugalština
Rok vydání: 2012
Zdroj: Biblioteca Digital de Teses e Dissertações da UFMGUniversidade Federal de Minas GeraisUFMG.
Druh dokumentu: Doctoral Thesis
Popis: The urgency to transpose the line of irreversibility in the process of change in the brazilian tecno-assistential model incites us to face all the problems at the same time, in a short time period. One of the challenges is to transform the health care services network in a space where the reflection about the work can generate alternatives that respond to the population health care needs. In this sense, the Brazilian Health Ministry defined the National Policy for Permanent Education in Health and it has invested in strategies to face this challenge. The general objective of this study was to analyze the possibility of the development of the practice of permanent education in the micro environment where the health care services are provided by inserting the primary health professionals in a distance learning qualification process. The investigation in this work has also focused on other aspects of the qualification process: the potential to bring into focus for the students the reality of the area where they work; the criteria used to chose optional courses and its relation with the professional practice; the appropriation of work process organization tools; the reflection about the work process; the change in the practice and the establishment of new habits. The qualification process studied was the Curso de Especialização em Atenção Básica em Saúde da Família that, since 2008, has been offered by the Universidade Federal de Minas Gerais as a distance learning course as a strategy to support the consolidation of the Sistema Único de Saúde. This study consists in a research based on the philosophical materialism in which the analysis of the empirical data was made by means of documental analysis, questionnaire and narrative interview, characterized by a mixed (quantiqualitative) approach. The data collected in the narrative interview were subjected to content analysis following Bardin (1979). The subjects of the research were one hundred and twenty alumni that answered the questionnaire and fifteen that were interviewed (seven dentists, five nurses and three physicians). The criteria to be included in the interview set were: to have been part of the family health-care strategy during the whole duration of the course, to be a resident of the city that is a head office of a Support Center for the Universidade Aberta do Brasil to which he/she was bound during the course. At all parts of this study, we took into consideration the Resolution 196, from 1996, of the Conselho Nacional de Saúde. The qualitative data showed that: the optional courses were chosen as a result of the need to deepen the knowledge in that subject and the relation of the subject of the course and the priority problems of the students practices; 82.4% answered that they introduced work process organization tools in their practice and these tools are categorized as: Planing, Health Diagnostic, Work Process Organization, Receptivity, Operative Group, Qualification and access to new knowledge, Team Formation and Team Work, Team Meeting, Risk classification and Information; 75.6% answered that they adopted tools related to the attention to the health of the users, with a registry of the changes that they introduced in the day to day work, during their course. Were described and interpreted, in the content analysis, five thematic categories: Interrogating an comprehending the possibility of theory to contribute with practice and practice to enrich theory; Reflecting about the work process: incorporation and application of knowledge; Difficulties and facilities lived in the implantation and implementation of a new model of health care; Commitment with the current Sistema Único de Saúde and the vision for the future: the SUS were I want to be; Some issues to be considered in an evaluation of the course. After the analysis it is possible to say that the Course potentialized the permanent education processes that already existed and generated new ones; it strengthened the permanent education practice in professionals that already practiced it and aroused a positive attitude towards permanente education in other people because it introduced a refection about the work process with the activities proposed. There were indications of changes in the practice and the creation of new habits as a consequence of the professional involvement with the activities proposed. The course has the pedagogical intention that is translated into activities that generate space and time for reflection within the work process.The urgency to transpose the line of irreversibility in the process of change in the brazilian tecno-assistential model incites us to face all the problems at the same time, in a short time period. One of the challenges is to transform the health care services network in a space where the reflection about the work can generate alternatives that respond to the population health care needs. In this sense, the Brazilian Health Ministry defined the National Policy for Permanent Education in Health and it has invested in strategies to face this challenge. The general objective of this study was to analyze the possibility of the development of the practice of permanent education in the micro environment where the health care services are provided by inserting the primary health professionals in a distance learning qualification process. The investigation in this work has also focused on other aspects of the qualification process: the potential to bring into focus for the students the reality of the area where they work; the criteria used to chose optional courses and its relation with the professional practice; the appropriation of work process organization tools; the reflection about the work process; the change in the practice and the establishment of new habits. The qualification process studied was the Curso de Especialização em Atenção Básica em Saúde da Família that, since 2008, has been offered by the Universidade Federal de Minas Gerais as a distance learning course as a strategy to support the consolidation of the Sistema Único de Saúde. This study consists in a research based on the philosophical materialism in which the analysis of the empirical data was made by means of documental analysis, questionnaire and narrative interview, characterized by a mixed (quantiqualitative) approach. The data collected in the narrative interview were subjected to content analysis following Bardin (1979). The subjects of the research were one hundred and twenty alumni that answered the questionnaire and fifteen that were interviewed (seven dentists, five nurses and three physicians). The criteria to be included in the interview set were: to have been part of the family health-care strategy during the whole duration of the course, to be a resident of the city that is a head office of a Support Center for the Universidade Aberta do Brasil to which he/she was bound during the course. At all parts of this study, we took into consideration the Resolution 196, from 1996, of the Conselho Nacional de Saúde. The qualitative data showed that: the optional courses were chosen as a result of the need to deepen the knowledge in that subject and the relation of the subject of the course and the priority problems of the students practices; 82.4% answered that they introduced work process organization tools in their practice and these tools are categorized as: Planing, Health Diagnostic, Work Process Organization, Receptivity, Operative Group, Qualification and access to new knowledge, Team Formation and Team Work, Team Meeting, Risk classification and Information; 75.6% answered that they adopted tools related to the attention to the health of the users, with a registry of the changes that they introduced in the day to day work, during their course. Were described and interpreted, in the content analysis, five thematic categories: Interrogating an comprehending the possibility of theory to contribute with practice and practice to enrich theory; Reflecting about the work process: incorporation and application of knowledge; Difficulties and facilities lived in the implantation and implementation of a new model of health care; Commitment with the current Sistema Único de Saúde and the vision for the future: the SUS were I want to be; Some issues to be considered in an evaluation of the course. After the analysis it is possible to say that the Course potentialized the permanent education processes that already existed and generated new ones; it strengthened the permanent education practice in professionals that already practiced it and aroused a positive attitude towards permanente education in other people because it introduced a refection about the work process with the activities proposed. There were indications of changes in the practice and the creation of new habits as a consequence of the professional involvement with the activities proposed. The course has the pedagogical intention that is translated into activities that generate space and time for reflection within the work process.
A urgência em transpor a linha da irreversibilidade do processo de mudança do modelo tecno-assistencial brasileiro nos incita a enfrentar todos os problemas ao mesmo tempo, em curto espaço de tempo. Um dos desafios é transformar a rede de serviços de saúde em espaço onde a reflexão sobre o trabalho gere alternativas para fazê-la resolutiva. Nesse sentido, o Ministério da Saúde definiu a Política Nacional de Educação Permanente em Saúde e tem investido em estratégias de enfrentamento desse desafio. O objetivo geral desse estudo foi analisar a possibilidade de desenvolvimento da prática de educação permanente no microambiente de produção de serviços de saúde a partir da inserção de profissionais da atenção básica em um processo de capacitação a distância. Também foram focados pela investigação: potencial de aproximar os alunos da realidade de sua área de abrangência; critérios de escolha das disciplinas optativas e a relação com a prática profissional; apropriação de ferramentas de organização do processo de trabalho; reflexão sobre processo de trabalho; mudança de prática e criação de novos hábitos; visão e participação no Sistema Único de Saúde do futuro. No caso, o processo de capacitação estudado foi o Curso de Especialização em Atenção Básica em Saúde da Família que, desde 2008, tem sido ofertado como estratégia de apoio à consolidação do Sistema Único de Saúde na modalidade a distância, pela Universidade Federal de Minas Gerais. Consiste em uma pesquisa referenciada no materialismo filosófico em que a aproximação com os dados empíricos foi realizada por meio de análise documental, questionário e entrevista narrativa, caracterizando uma abordagem mista (quanti-qualitativa). Os dados coletados por meio da entrevista narrativa foram submetidos à Análise de Conteúdo conforme proposta por Bardin. Foram sujeitos da pesquisa cento e vinte profissionais que responderam ao questionário e quinze que foram entrevistados (sete cirurgiões-dentistas, cinco enfermeiros e três médicos). Os critérios de inclusão para entrevista foram: ter permanecido na Estratégia Saúde da Família durante todo o desenvolvimento do curso; residir no município sede do Polo de Apoio à Universidade Aberta do Brasil ao qual esteve vinculado durante o curso. Em todas as etapas da realização desse estudo, foi considerada a Resolução nº 196, de 1996, do Conselho Nacional de Saúde. Os dados quantitativos mostraram que: as disciplinas optativas foram escolhidas em decorrência da necessidade de aprofundar conhecimento e da sua relação com os problemas prioritários na prática do aluno; 82,4% responderam que introduziram ferramenta de organização do processo de trabalho que não usavam anteriormente, sendo elas categorizadas em: Planejamento, Diagnóstico em Saúde, Organização do Processo de Trabalho, Acolhimento, Grupo Operativo, Capacitação e acesso a novos conhecimentos, Formação e Trabalho em Equipe, Reunião de Equipe, Classificação de Risco e Comunicação; 75,6% responderam que adotaram ferramentas voltadas à atenção à saúde dos usuários, com registro de mudanças que introduziram no dia a dia, durante o curso. Na análise de conteúdo foram descritas e interpretadas cinco categorias temáticas: Interrogando e compreendendo a possibilidade de a teoria contribuir com a prática e de a prática enriquecer a teoria; Refletindo sobre o processo de trabalho: incorporação e aplicação de conhecimento; Dificuldades e facilidades vivenciadas na implantação e implementação de um novo modelo de atenção à saúde; Comprometimento com o SUS atual e visão de futuro: o SUS onde quero estar; Questões a serem consideradas em uma avaliação do curso. Após a análise é possível afirmar que o curso potencializou processos de EP já existentes e gerou novos processos; fortaleceu a prática de EP em profissionais que já a exercitavam e despertou uma atitude positiva em relação à EP em outros, ao induzir uma reflexão sobre o processo de trabalho a partir das atividades exigidas. Portanto, foram revelados indícios de que houve mudança de prática e criação de novos hábitos a partir do envolvimento dos profissionais com as atividades propostas pelo curso. O curso tem uma intencionalidade pedagógica traduzida em atividades que geram espaços e tempo de reflexão no interior do processo de trabalho.
Databáze: Networked Digital Library of Theses & Dissertations
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