Health Work Process Research Articles

A Discussion About the Health Work Process

Objective: The objective of this bibliographical research is to investigate the health work process, with an emphasis on caring acts, aiming to understand their significant contribution to the formation of protagonists in the construction of a fairer and more humanized health system. Methods: The bases of this research consisted of the analysis of legal documents from the Ministry of Health and public policies aimed at collective health. The research focused on issues related to the health work process. Data collection involved bibliographical surveys in magazines, scientific articles and books that address the topic investigated, including reference works such as those by KUMAR et al. (2018), PENNISI et al. (2020) and DAI et al. (2016). Results: The research results indicate that Primary Health Care workers often face stressful conditions in the work environment. In this context, quality of life is considered a multidimensional construct, influenced by several aspects, such as working conditions, personal life, physical and psychological health, social relationships and living environment. Conclusion: Given the evidence presented, it is possible to conclude that an in-depth understanding of the health work process, with a focus on caring acts, is essential to promote a healthier work environment and contribute to the construction of a fairer and more humanized health system . The constant exposure of Primary Health Care professionals to stressful conditions highlights the importance of strategies that aim to improve quality of life, considering the various factors that influence this multidimensional construct.

"Even if we are the caring hand": Black doctors and structural racism in the context of primary health care.

This study scrutinizes structural racism's influence on the training and work of Black professionals in primary health care (PHC) in Rio de Janeiro, particularly focusing on the experiences of Black female physicians. Employing a qualitative approach via a Focus Group, conducted in November 2022, we adopted symbolic interactionism to interpret racism-related experiences. Our findings encompass two primary dimensions: the manifestation of structural and institutional racism within the Unified Health System (SUS), and how racism permeates health work processes and consequences. Results highlight enduring impacts, spanning education to PHC roles, hindering healthcare process recalibration. Participants identify institutional and structural racism, from managerial neglect to territorial violence and physician scarcity, constraining comprehensive care. It is crucial to unveil and grasp racism's structural essence within healthcare, aligned with the vision of health as a fundamental right.

Quick participatory estimation: a necessary tool for planning in a family health strategy

Introduction: Participatory Rapid Estimation (PRE) is a tool that allows us to know the real needs of the population, as well as to experience the health situation. In addition, it makes it possible to identify and seek the necessary changes in the work processes of the territory to face problems. Objective: To obtain a situational diagnosis of the area covered by the family health strategy based on the ERP. Methodology: The information for the ERP was collected by filling out a questionnaire answered by users and health staff with questions about the community, health problems and the functioning of health services, including access and work process. Secondary sociodemographic data from the municipal database and the Ministry of Health's e-SUS medical record were also analyzed. The systematization of the data supported the elaboration of the situational strategic planning (PES). Results and Discussion: Several weaknesses were found, such as the geography of the area being predominated by hills, pointed out as a limiting factor to access to the ESF, the increase in the incidence of mental disorders in adolescents and the significant increase in users with NCDs and neoplasms in adults and the elderly, including the distribution of age groups in the territory signaling a reality not found nationally, as it presents an inverse pyramid showing that most of our users are elderly and adults. In addition to difficulties in the work process, there was also a lack of information on gender and sexual orientation issues for the lesbian, gay, bisexual, transsexual and transgender, queer, intersex, asexual and other (LGBTQIA+) population, which should be questioned during user registration. Knowing that the lack of data collection implies the estimation of this population in the face of public policies, it is necessary to overcome this flaw through permanent education with CHWs. The social vulnerabilities of the community are notorious (unemployment, food quality and access to medications outside the SUS). Final Considerations: Based on the ERP, we recognized the territory's coverage area, as well as identified organizational problems, user access and actions that can be enhanced in the ESF's area of activity.

REORGANIZAÇÃO DO PROCESSO DE TRABALHO NA ATENÇÃO PRIMÁRIA À SAÚDE NO ENFRENTAMENTO À COVID-19

ABSTRACT Objective: to assess the work process of Primary Health Care professionals in coping with COVID-19. Method: a qualitative study that used the health work process as conceptual basis and qualitative research as methodological framework. The collection procedure was carried out with 23 health professionals from July to September 2021, in the basic health units from a municipality in northwestern Paraná, Brazil. For the analysis, the data were organized by means of the MAXQDA software, and each data segment was organized according to the meanings. Results: two categories emerged, namely: Difficulties faced in reorganization of the ambience, programmatic activities and staffing of Primary Health Care professionals; and Organization of the care flow for users with COVID-19 in Primary Health Care. Conclusion: this study reinforces the indispensability of assessing the work process for health care improvement, especially in conditions of a public health emergency.

DISPOSITIVOS INTRA-HOSPITALARES E PRÁTICAS ASSISTENCIAIS: IMPLICAÇÕES PARA A INTEGRALIDADE E CONTINUIDADE DO CUIDADO

ABSTRACT Objective: To analyze the care production in a public hospital and the devices used for comprehensive care. Method: This was a health interference study, in which data collection was carried out from September 2019 to June 2022. Observations and field researcher diary records, individual interviews were conducted with coordinators and managers, and focus groups with workers, of a large hospital in Belo Horizonte, Minas Gerais. The empirical material was submitted to thematic content analysis. Results: Devices that contribute to the construction of new management and care practices were identified. These included the Lean in Emergencies project (Fast Track, Kanban, and Huddles tools); the Internal Regulation Unit; the role of hospitalist physicians, co-managers, and shift coordinators; the work of the home care team within the hospital; and devices for interdisciplinary management, such as interdisciplinary bed runs, case discussions, and shared construction of therapeutic projects. Conclusion: The implemented devices contribute to the transformation of the health production model and work process in favor of integrating the hospital into the healthcare system.

Cuidado centrado na pessoa na atenção psicossocial: desafios para a relação terapêutica na perspectiva de profissionais

Abstract Objective to analyze the challenges for the therapeutic relationship from the perspective of person-centered care. Method strategic social research, with a qualitative approach, carried out with 17 professionals from two Psychosocial Care Centers (CAPS) in central Brazil. Data were collected through individual online interviews with a semi-structured script and notes in a field diary. They were organized with the help of the ATLAS.ti software, submitted to thematic analysis. Results four categories emerged on the challenges for the therapeutic relationship that addressed aspects related to health teams, users, family and work processes of the services studied. Conclusion and implications for practice challenges were identified that interfere with the establishment of the therapeutic relationship between CAPS professionals, users and their families that make it impossible to implement the person-centered care model. Fragile interpersonal relationships constitute obstacles to bond building, which demands continuing and permanent education processes to transform this reality.

Comunicação interprofissional e participação do usuário na Estratégia Saúde da Família

Abstract This study deals with collaborative competencies to strengthen teamwork and interprofessional collaboration in Primary Health Care services, supported by the framework of the health work process, interprofessional work and competencies. Its objective is to understand the conceptions and experiences of professionals from the Family Health Strategy teams regarding the core collaborative competencies: interprofessional communication and patient-centered care. This is an exploratory and interpretative qualitative study. A secondary database was used, with 34 interviews conducted with professionals from the teams of three health units located in two municipalities. Thematic content analysis was adopted, with support by the WebQDA software. The findings show the professionals’ understanding of collaborative competencies as complementary and as impossible to being treated independently. Interprofessional communication is recognized as a focus on meeting the user’s health needs, limited by unsatisfactory working conditions. Patient-centered care appears weak, since the sense of user participation prevails as a transfer of responsibility for their care to professionals and in a minority way, as sharing the construction of the care plan.

Planning and management of the health work process: advances and limits in the SUS-Indigenous Health Care Subsystem

Resumo O Subsistema de Atenção à Saúde Indígena (SasiSUS), como parte do Sistema Único de Saúde (SUS), é responsável pela atenção à saúde dos povos indígenas do Brasil. Em âmbito local, são os Distritos Sanitários Especiais Indígenas (DSEI) os responsáveis pela gestão, planejamento e organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI), que realizam a atenção primária à saúde para essa população. O objetivo do estudo foi analisar como ocorrem o planejamento e a gestão do processo de trabalho das EMSI. Foi realizado um estudo de casos múltiplos holístico, considerando sete DSEI como unidades de análise. A principal fonte de dados utilizada foi a entrevista e, de forma complementar, a observação direta. Os resultados indicaram que, de forma geral, o planejamento está presente na organização do processo de trabalho das equipes, com variações entre os DSEI. A efetivação das ações planejadas foi relacionada à disponibilidade de diferentes recursos: funcionamento adequado do sistema de informação e a articulação intra e intersetorial do SasiSUS. Como conclusão, apontou-se a necessidade de radicalização da participação no planejamento e na gestão, necessária a uma ação coordenada para garantia da atenção diferenciada e dos princípios do SUS.

Estratégias dos serviços de Atenção Primária durante a pandemia da COVID-19 no Brasil: uma revisão de escopo

Abstract Primary Health Care is the gateway for users to access the Brazilian healthcare system and has been particularly affected by the COVID-19 pandemic demands. This review systematically identified and mapped evidence regarding novel or adapted strategies developed within PHC during the COVID-19 pandemic in Brazil. Our results are presented as a narrative synthesis following the JBI methodology. They were analyzed and discussed through the lens of the Health Work Process Theory, which allowed us to categorize the publications into two principal domains of strategies, managerial and clinical, encompassing strategies that were new, adapted, or maintained in healthcare services. Two hundred twenty-six interventions were identified (130 managerial and 96 clinical) from 49 studies. The new strategies appeared more frequently in both domains, while the maintained ones were less prevalent. The array of interventions highlights different care models, sometimes aligned with a biomedical approach. In contrast, others focus on comprehensiveness and longitudinality based on a person-centered care, in the family, and the community. Thus, this review identified that the same pre-pandemic challenges persist.

Teleodontologia como ferramenta para atenção à saúde bucal do adolescente

ABSTRACT Adolescence comprises a life cycle with high contact to information and communication technological tools. For this reason, it was decided to incorporate these tools into the oral health work process aimed at this public. The COVID-19 pandemic contextualized the use of digital technological tools in several productive sectors, including oral health care in the Unified Health System. Objective: The objective was to stimulate the use of teledentistry in the oral health care of adolescents in Primary Health Care in the Ceará interior. Methods: The participants were adolescents between 12 and 15 years old from two micro areas of the territory, in total there are 25 participants. The intervention was divided into three stages: application of an electronic form, creation of an instant messaging application group and creation and expansion of a flow for access to the service. Results: The reasons for the dropout in dental consultations by adolescents were the lack of vacancies, long wait and the low number of educational actions aimed at health. In the messaging application group, remote educational activities were carried out, as well as restructuring of the dental care flow with the possibility of scheduling a first appointment through the group. Conclusion: The interaction obtained in the intervention favored the improvement of access to dental appointments.

Workers with disabilities and significance of the Health-Work process. Making visible keys for prevention

People with disabilities at work have great potential and their incorporation into organizations would mean taking advantage of efficient and responsible human resources for the company. This research aims to frame some social elements related to the world of work from the perspective of workers with disabilities, as a phenomenon and invisible social reality. The structuring of training strategies for the protection of health at work, elaborated according to the specific limitations that these workers face in their work environment and their daily life, as well as the representations of these limitations in society, is identified as a key. Which condition their inclusion in the world of work. That is to say, the investment in the establishment of alliances for the differentiated training of workers with disabilities gains strength, taking into account their perspective, towards health, the prevention of occupational risks and accidents in the workplace, with the purpose of strengthening an environment of preventive culture and revealing the positive pole and the negative pole of the work process, with a view to favoring the quality of life of these workers. The incorporation into the labor market of people with disabilities must start from a process of social awareness from the very condition of disability, understanding it as a social construction that historically relegated millions of individuals to a diminished and inferior social position

Uma análise do processo de trabalho dos profissionais da saúde e educação no PSE

ABSTRACT Studies contribute to the School Health Program. However, only some investigate the work process of professionals to understand the possible conformation of intersectoral and integrated projects, or technologies as mediators in work practices. The present study sought to analyze the practices of professionals in a Family Health Unit/Primary Health Care unit in Salvador, Bahia, Brazil. This qualitative case study involved a Primary Health Care unit and four schools. The data collection procedures comprised semi-structured interviews, document analysis, and participant observation. The analysis categories were built from the theoretical framework of the health work process by Mendes Gonçalves. The results showed: weak partnership relationships between agents; professionals’ perception of the object of work, predominantly identifying diseases and preponderant clinical knowledge vis-à-vis the knowledge of collective health. Health actions gathered the agents, but they presented hegemonic, disjointed, sectoral practices, focused on the disease, and conducted mainly through lectures. No integrated and intersectoral projects or educational technology as an additional resource in the work practices were observed. The products deriving from the participation of all will improve articulation between the professionals working in these spaces.

The future of health digitalization: The case of Primary Health Care in Portugal

Abstract Background The sustainability of Healthcare Services will depend on the proper implementation of the digital transformation of Primary Health Care (PHC) Services. COVID-19 Pandemic have shown precisely this, where there was pressure from health Professionals and managers for the integration of teleconsultations within the health work processes. This study aims at developing scenarios for the digitalization of PHC in the Portuguese Health System. Methods This study follows the methodology of scenario development, similar to the future of community pharmacy services scenario study. A conceptual model of PHC services was developed, based on the literature and a set of interviews. The target group was the primary healthcare professionals: family doctors, nurses, and operational assistants. The time horizon was 2032 and, by selecting actors from different regions of Portugal, it was possible to achieve broad representativeness. Results Three focus groups were conducted. The first enabled to identify the two driving forces that may influence the digitalization of PHCs in the next 10 years: 1) service innovation and 2) Governance and Regulations. These two driving forces enabled to design three plausible scenarios: a) Innovate or Fade-away; b) Isolated PHC and c) Digital PHC. These scenarios were developed, and their impacts were reflected upon. It was found that the role of human Resources is critical. Conclusions The process of reflection and discussion for the identification of the different driving forces made the different actors discuss the different points of view and find a meeting point to reach a conclusion. Furthermore, this study allowed the different stakeholders to understand the measures and actions to be taken for PHC digitization to be implemented in the most effective way, allowing the sustainability of the National Health Service in Portugal, which until this point were only ideas discussed at the institutional and individual level.

Nursing supervision: interfaces with power relations in family health.

To analyze nursing supervision from the perspective of power relations in family health. An exploratory, descriptive and interpretive research with a qualitative approach. Data were collected through semi-structured interviews with 37 workers from six health teams in a city in the countryside of São Paulo. They were submitted to thematic content analysis, based on the health work process theoretical framework and Foucault's power category. Two thematic categories were constructed: Nursing supervision from the perspective of surveillance and control in relationships of disciplinary power in family health; The duality of nursing supervision in family health between oppressive power and positive power. The power present in nursing supervision is expressed as control and producer of things, which not only oppresses, but also has positive effects on building healthy work environments, valuing interactions, establishing trust, strengthening teamwork and supporting workers, aspects that result in the promotion of psychological safety in family health.

Time Motion Study to analyse the Medication Management from Prescription to Administration in a Private Hospital at East India

Indian healthcare systems have passing through a state of transition and especially tertiary hospitals face daunting challenges, like evolving technologies and reimbursement policies, and a worsening skilled workforce shortage. A reconsideration of skilled health manpower and work processes holds the potential to affect the efficiency and effectiveness of health care delivery for the foreseeable future. The time and motion study are to understand the time taken in several work stations and used for performance, evaluation, and planning of any process. The Hospital under study was facing some issues of Medication management and there by Patient satisfaction and patient safety was under risk. This is a Cross sectional Observation study. It starts from Medication prescription to Indenting, arranging, dispensing, and finally to administration to the patient. Three Volunteers were recorded the data One at Ward level, One at Pharmacy Level and One at Transportation Level. A total of 80 prescriptions were tracked from different Wards or ICU areas. A total six time were recorded and six duration were found namely D1 (Prescription to Indent Time), D2(Indent to Dispense Time), D3(Dispense to Delivery Time), D4(Delivery to Receiving Time), D5(Receiving to Administration Time) & D6 (Prescription to Administration Time).It was found that average time taken for various process are as D1 – 236 minutes (3 Hrs 56 mints), D2 -120minutes (2 Hrs), D3 – 162 minutes (2 Hrs 42 mints), D4 - 38 min, D5 – 535minutes (8 Hrs 55 mints), & D6 – 1091minutes (18 Hrs 11 mints). In all areas average distribution of five duration are D1(22%), D2(11%), D3(15%), D4(3%) and D5(49%). On detail discussion over interview, it was found that Pharmacist and Nursing Manpower may need optimization. Although an age-old technique, Time Motion study can be used to analyse any process flow to detect the bottlenecks and find the suitable solution to the problems.

Educação permanente em saúde como dispositivo para transformação das práticas em saúde na atenção básica

Este estudo teve como objetivo analisar as tendências das produções brasileiras, com base nas teses e dissertações, acerca da Educação Permanente em Saúde com trabalhadores da Atenção Básica. Trata-se de uma revisão narrativa, desenvolvida com teses e dissertações disponíveis no Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. A busca foi realizada em dezembro de 2020, com a estratégia: “educação permanente em saúde” and “trabalhadores”. Após aplicar os critérios de seleção, 24 produções compuseram o corpus deste estudo. A maioria dos estudos é proveniente de dissertações (87,5%), com delineamento qualitativo (66,6%), produzidos em instituições da Região Sudeste do Brasil (45%). Evidenciaram-se estudos que investigaram, principalmente, o conceito de Educação Permanente em Saúde, destacando-se que há pouca clareza na diferenciação com os conceitos de educação continuada e educação em serviço, o que pode interferir na sua operacionalização e nos resultados junto aos trabalhadores, gestores e usuários. Também, se identificou que a Educação Permanente é uma estratégia potente para a transformação das práticas em saúde. Concluiu-se que a Educação Permanente mostrou-se como uma oportunidade de reflexão sobre o processo de trabalho em saúde, em que os sujeitos têm a possibilidade de se expressar, olhar para a própria prática e buscar novos saberes.

Hospitalizations for conditions sensitive to primary care: an integrative review of the Brazilian literature

Hospitalizations for Conditions Sensitive to Primary Care have been used as an indicator of the quality of the first level of health care. The objective of this work is to analyze the national scientific production, aiming to identify notes referring to: types of data; health financing; social determinants of health and the articulation of Health Care Networks. This is an integrative literature review carried out in Medline, Lilacs and Scielo databases. After applying the inclusion and exclusion criteria, 39 works were selected for analysis. Results demonstrate the need for caution in the evaluation of secondary data of the indicator and the need to expand the use of complementary strategies that help in the identification of factors associated with hospitalization. Being the indicator of hospitalizations sensitive to primary care, strategic for the planning of actions and the correct use of health resources. A great association of avoidable hospitalizations with social determinants and conditions of health was identified, however, being this theme and the articulation, communication of the Health Care Network, with the smallest number of works developed. Thus, we can conclude that it is necessary to expand studies focused on these themes, aiming at pointing out actions and policies that contribute to the development and formation of participatory teams and to change the hegemonic paradigm of health work processes.

COSTS AND ROOT CAUSES OF MEDICATION ERRORS AND FALLS IN A TEACHING HOSPITAL: CROSS-SECTIONAL STUDY

ABSTRACT Objectives to characterize accidents/falls and medication errors in the care process in a teaching hospital and to determine their root causes and variable direct costs. Method cross-sectional study implemented in two stages: the first, was based on the analysis of secondary sources (notifications, medical records and cost reports) and the second, on the application of root-cause analysis for incidents with moderate/severe harm. The study was carried out in a teaching hospital in Paraná, which exclusively serves the Brazilian Unified Health System and composes the Network of Sentinel Hospitals. Thirty reports of accidents/falls and 37 reports of medication errors were investigated. Descriptive statistical analysis and the methodology proposed by The Joint Commission International were applied. Results among the accidents/falls, 33.3% occurred in the emergency room; 40.0% were related to the bed, in similar proportions in the morning and night periods; 51.4% of medication errors occurred in the hospitalization unit, the majority in the night time (32.4%), with an emphasis on dose omissions (27.0%) and dispensing errors (21.6%). Most incidents did not cause additional harm or cost. The average cost was R$ 158.55 for the management of falls. Additional costs for medication errors ranged from R$ 31.16 to R$ 21,534.61. The contributing factors and root causes of the incidents were mainly related to the team, the professional and the execution of care. Conclusion accidents/falls and medication errors presented a low frequency of harm to the patient, but impacted costs to the hospital. Regarding root causes, aspects of the health work process related to direct patient care were highlighted.

Uma análise acerca da humanização da assistência em unidades de terapia intensiva

Objetivo: Identificar as principais evidências científicas sobre a humanização do cuidado nas Unidades de Terapia Intensiva nos últimos cinco anos. Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados Literatura Latino-Americana e do Caribe (LILACS) e Base de Dados de Enfermagem (BDENF) via Biblioteca Virtual em Saúde (BVS) usando os descritores em saúde (Decs) “assistência à saúde”, “humanização da assistência” e “Unidades de Terapia Intensiva”. Resultados: Foram identificados 11 artigos que compuseram a revisão. Que evidenciaram um dos principais objetivos do cuidado humanizado em Unidades de Terapia Intensiva relaciona-se à necessidade de manutenção da dignidade do ser humano e o respeito por seus direitos em todas as fases da vida. Mas, além disso, ele envolve também a forma de gerir os processos de trabalho em saúde para o alcance de melhorias, não só individuais, mas também coletivo-pessoais e estruturais nas instituições de saúde Considerações finais: Com a realização do presente estudo foi possível constatar que para a humanização assistencial nas Unidades de Terapia Intensiva é necessário aliar a utilização da tecnologia disponível à empatia, resinificando o que se compreende sobre cuidado, que dever ser entendido como um relacionamento interpessoal terapêutico seguro, responsável e ético a indivíduos.

Reflexões sobre competências do enfermeiro especialista em dermatologia

Objetivo: promover a reflexão sobre as competências do enfermeiro na área de dermatologia. Método: trata-se de uma reflexão teórica baseada em uma pesquisa bibliográfica para fundamentação teórica. Resultado: na realidade multifacetada do cotidiano da enfermagem, o enfermeiro é um agente do processo de trabalho em saúde, com formação generalista. Um dos desafios tem sido se defrontar com uma diversidade de situações que nem sempre é capaz de intervir com resolutividade, realidade que leva a categoria enfrentar dilemas de ordem ética e moral. Nesse contexto, destaca-se que as doenças dermatológicas estão entre as três principais demandas de busca aos serviços de saúde, exigindo do enfermeiro competências para prevenção, tratamento e recuperação. Outro aspecto que prejudica a qualidade de atendimento a esta clientela específica relaciona-se à formação dos especialistas em dermatologia, pois os conteúdos programáticos dos cursos privilegiam temas relacionados ao tratamento de feridas, preterindo os cuidados às pessoas com afecções cutâneas, fato que dificulta a assistência digna e livre de riscos a esta clientela específica. Conclusão: para garantir a qualidade do cuidado da pele, torna-se necessário ao profissional enfermeiro um conjunto de saberes, habilidades e capacidades para adequado preparo do ambiente, avaliação integral da pessoa; seleção coerente de recursos e produtos; implementação de protocolos e guias, além da realização de pesquisas com níveis de evidências significativos junto a esta clientela específica. Acredita-se ser essencial estabelecer as competências e habilidades do enfermeiro especialista em dermatologia no brasil para que programas formadores se alinhem as propostas definidas.