Multiprofessional Work Research Articles

Vivências do cotidiano hospitalar no processo formativo da residência em saúde: estratégias pedagógicas e desafios para a prática

Objetivo: analisar o processo de formação interdisciplinar em um programa de residência multiprofissional com ênfase hospitalar. Método: estudo com abordagem qualitativa, e enfoque crítico- reflexivo. O cenário da pesquisa foi um hospital de referência terciária, em Fortaleza-Ceará, que contém a residência multiprofissional voltada ao cuidado cardiopulmonar, campo que comporta a população em estudo do presente trabalho, sendo 10 entrevistados, entre residentes e preceptores que orientam o processo de trabalho das categorias profissionais. A coleta de dados foi dividida em duas fases: a priori aplicou-se a entrevista semiestruturada aos residentes e preceptores, posteriormente, realizou-se a análise documental do Projeto Político Pedagógico da Residência Integrada em Saúde. Resultados: os residentes reconhecem a importância do programa para o aperfeiçoamento profissional, para o fortalecimento da gestão em saúde e para a construção de uma formação pautada no trabalho multiprofissional, e com um método problematizador, coerente com as necessidades da comunidade. Evidenciam-se vulnerabilidades, enfatizadas pela pouca valorização dos profissionais e por métodos formativos ainda distantes da prática cotidiana. Conclusão: A residência como processo formativo na relação entre ensino-serviço, no qual ocupa espaço nos cenários de saúde, buscando alinhamento nas propostas do Sistema Único de Saúde e no fazer saúde.

Care needs of the elderly who live alone: an intersectoral perception

Objective: to understand the perception of health and law professionals regarding care for frail elderly people who live alone. Methods: qualitative research, carried out through interviews with health and law professionals, using a vignette as a trigger, presenting the description of the story of a frail elderly woman who lived alone. Data were submitted to the thematic analysis technique. Results: the 23 professionals pointed out that the family members should be the responsible ones for the elderly; that institutionalization should take place as the last option; stressed the importance of multi-professional and intersectoral work; and recognized the limitations of the state. The professionals reported the appropriate interventions for the case. Conclusion: in care for the elderly who live alone, there are limitations for families, social care, and health services for the elderly, as well as the State, with the need to strengthen legally guaranteed resources.

Continuing Education in Health: interprofessional practices in the field of Collective Health

Abstract Family Health Support Centres (NASFs, in Portuguese) aim to develop interprofessional practices anchored in the assumptions of Primary Health Care, guided by the criteria of shared care specific professional interventions, management processes, interdisciplinarity, intersectoriality, Continuing Education in Health and health promotion. This health management methodology (Matrix Support) still represents a challenge to workers and managers, as it switches the logic of clinical thought from individual-centred, ambulatory and disciplinary care to collective, territory and interdisciplinary care. This study might illustrate and allow sharing of experiences about a work management format for multidisciplinary teams in Primary Health Care. A partnership between the University and the state health department was established in order to elaborate a collaborative, educational and supportive action. We formed a group of workers in the target area (24 municipalities and 18 teams) who had a focus on Continuing Education in Health using Institutional Analysis as theoretical reference. The main goal of the action was to provide spaces to share experiences and learning in the perspective of Continuing Education in Health. How does Continuing Education in Health support interprofessional practices in the field of Collective Health? Among the main results, we list: reflection about organisation practices of multiprofessional work, reflection about care practices and clinic management in the technical-assistance and pedagogic perspectives of Matrix Support; encouragement to improve the services offered in this level of care and their relationship with other points of the network. This experience showed us the importance of three main aspects: Continuing Education in Health, as a strategy of critical analysis about work and workers; the partnership and integration between teaching and service; and interprofessional formation processes (necessary to NASF and Collective Health). Key messages Continuing Education in Health is a strategy to deal with challenges and possibilities of interprofessional practices in the field of Collective Health. Enabling experiences and providing spaces for health professionals to share experience and learning.

Paroles de réanimés, énigme de la mort en réanimation

ContextThrough our daily clinic of clinical psychologist in resuscitation along with the doctoral research work entitled “Dreams of resuscitation. Experiences of coma in adult intensive care unit”, a reflection emerged on the experience of patients during coma, as well as the awakening and post-discharge from intensive care. For many of them, resuscitation's hospitalization is traumatic and the confused state of the coma experience is as much, if not more, than the somatic crisis they are going through. Work on psychic processes in intensive care has evolved a lot, in the past several years. Enriched with the contributions of M. Grosclaude and R. Minjardin particular, the consideration of these resuscitative stories paved the way to a psychological approach to delirium. It is defined, according to the American Psychiatric Association in DSM IV, by a disturbance of consciousness accompanied by cognitive changes. The etiologies are varied and the clinical signs are characterized by a disturbance of consciousness, memory disorders, disorientation, hallucinations, modification of psychomotor behaviour (hypo or hyperactive forms), an inversion of the sleep-wake cycle. ObjectivesThis research work has a theoretical aim by proposing a modeling of the coma experience and its awakening through the subjective content of resuscitation stories, beyond elements objectified by scales, generally barely used by care workers not trained in psychiatry. This work also has a clinical aim as well as to provide awareness of the caregiver to the prevention, screening and management of this syndrome. MethodsIt was the clinic that first motivated this work, using a qualitative approach, during semi-structured interviews with patients and their families during hospitalization or in the aftermath. The therapeutic space offered makes it possible to share this delirium experience with multi-professional resuscitation teams, with the aim of improving practices. The clinic is closely linked to the theoretical psychoanalytic field, for listening and reading interviews. The population studied is centered on twelve patients who have been in intensive care; postoperative or due to organ failure, and experienced an artificial coma. ResultsThis research work is progressing but the challenge to identify and take care of these traumatic experiences by the care teams are already taking shape. This is explained by the lack of training of caregivers on this subject but also the lack of psychologists in these services. The traumatic issue is central to patients. Through dream work, the fantasy of death and a “fragmentary” experience, there would be an attempt to represent the experience of the body. ConclusionsThe clinical and psychoanalytic approach is necessary to develop and maintain a psychic presence in these highly technical services. “Being with” patients intertwined with multi-professional work constitute the foundation of the living and desired subject, while defending freedom and the acceptance of words.

Tuberculosis, difficulties and facilities for Nurses

The study proposed to analyze the amenities and difficulties faced by nurses’ professionals in the fight against tuberculosis within the field of primary health care. This was a cross-sectional study with a qualitative approach. The sample consisted of 36 participants, all of whom were nurses. The statistical program IRaMuTeQ was applied and we also applied Laurence Bardin and Minayo content analysis to discuss both aprioristic and non-aprioristic categories. In the study it was clear that the difficulties are diversified, such as: personal matters from the professionals, physical and organizational structure, awareness of patients and family about the therapeutic process and the administration, the latter being the one most pointed out as difficult; regarding the amenities, the multi-professional work and protocols defined by the National Tuberculosis Control Program were pointed out. The study proves that the administrative question is the key to the function of the entire process of fighting tuberculosis, serving as a reference for improvements and adjustments.

Modes of care production and universal access - an analysis of federal guidance on the work of Primary Healthcare teams in Brazil.

This article analyzes federal guidance on the organization of primary healthcare work processes and the modes of production of care aimed at promoting universal access to services. A qualitative document analysis was undertaken of documents related to the National Health Policy, National Program for Improving Primary Care Access and Quality, More Doctors Program, and National Tele health Networks Brazil Program. Five thematic categories were defined for content analysis: staff training, valuing staff and work, organization of health actions for/with people and communities, complexity of healthcare and multiprofessional work, and collective construction of health as a right. The results show that advances were made in promoting universal access, particularly in the documents issued before 2015, with actions related to staff training, welcoming, the establishment of evaluation processes, and expansion of the scope of actions. However, there has been a shift towards the universal coverage model, as shown by measures encouraging reductions in the functional diversity of health teams and the flexibilization of working hours, hindering the implementation of the SUS as an inclusive social policy.

A cultura de segurança do paciente na perspectiva multiprofissional

Objetivo: analisar as dimensões da cultura de segurança do paciente na perspectiva multiprofissional. Método: estudo exploratório-descritivo, com abordagem quantitativa realizado em duas instituições hospitalares do Sul do Brasil. Participaram do estudo 108 trabalhadores da equipe multiprofissional da saúde. A coleta de dados foi realizada entre agosto a dezembro de 2017 tendo como instrumento a aplicação do questionário Hospital Survey on Patient Safety Culture. A análise dos dados se deu por estatística descritiva e analítica. Resultados: as crenças, atitudes e percepções dos profissionais de saúde em relação à segurança do paciente ainda apresentam importantes fragilidades nos hospitais avaliados. Mesmo tendo considerado a percepção geral da cultura de segurança como adequada, destacam-se as fragilidades quanto ao dimensionamento de pessoal, respostas não punitivas aos erros e trabalho em equipe entre as unidades. Conclusão: a consolidação da segurança do paciente se configura como estratégia para melhoria da qualidade e remodelamento dos processos, possibilitando que práticas seguras qualifiquem o trabalho multiprofissional e ao mesmo tempo garantam a qualidade da assistência, a qual é um direito do paciente.

Training and work process in Multiprofessional Residency in Health as innovative strategy.

reflect about education in health and work process on three programs of multiprofessional residency in Florianópolis/SC. Reflexive study about Multiprofessional Residency Health Programs of Florianópolis. Multiprofessional Residency characterizes training health professionals through service education. Developing these professionals' specialization with assignments that promote professional exercise and magnifies multiprofessional work at the same time, for excellency in unabridged healthcare. Multiprofessional Residency Programs make interdisciplinary education, sharing knowledge between residents and other professionals stimulating development of innovation skills.

Nurses in the Kanban: are there news meanings of professional practice in innovative tools for hospital care management?

Kanban is a care management tool that values multi-professional work and intensive use of data and has been growingly used in Brazil to address overcrowding in hospital emergency services (HES). The researchers monitored the Kanban for ten months in multiple wards of a municipal HES, and their observations were recorded in field diaries and discussed in biweekly research team meetings. The empirical material was organized from two questions: Are there changes in "traditional attributions" of Kanban-operating nursing? Are Medicine-Nursing interprofessional relationships transformed? A strong nurse adherence to this tool was observed, coupled with greater specialization and fragmentation of their work: nurses working as diarists assume more traditional administrative functions, while those on-call develop more direct assistance to patients. Nurses consider that clinical decisions are still in the doctors' hands, although Kanban provides them with a stronger influence on such decisions. Nurses' role in the management of significant mass of clinical and operational data, central to Kanban's operationalization, strengthens their professional authority.

Physicians and management of emergency hospitals: professional power threatened?

Kanban is a technical arrangement for the organization of hospital care focused on the management of beds and clinical care, aimed at the quality and comprehensiveness of care and greater hospital bed turnover, and thus a reduction in length-of-stay and hospital costs. The system's most striking and innovative feature is constant, updated patient follow-up, shared by the professional team in systematic meetings. Characterize the probable impacts from the arrangement's adoption on physicians' professional power (autonomy and authority). Qualitative study in a municipal urgency-emergency hospital using the following data production techniques: ethnography of the hospital's routine, with observation and records in field diaries, and shared seminars with researchers and teams. Physicians value multi-professional work for qualifying their practice, as an ancillary and complementary line. Kanban tends to be controlled by "hybrids" (physicians who accumulate management and clinical functions) that express synergies between "clinical management" and "hospital bed management". Thus, in this arrangement interferences in physicians' work are not exercised from outside, and physicians' clinical decisions still condition the work of the other professional groups. Physicians do not see their authority and autonomy threatened by Kanban, given the linkage between management authority and professional authority. Still, aspects related to hybridization and internal stratification of the medical profession need to be better addressed in the debate on health professionals' power.

Contradictions in Children’s Centre service provision: the art of the possible in multi-professional work

ABSTRACT This paper makes the claim that establishing successful multi-professional working in Children’s Centres can be viewed as the art of the possible when the work focuses on children’s needs rather than on the availability and expertise of the multi-professional team. This requires a model for working that enables loose flexible arrangements of professional networks in order to collaborate on specific cases, thereby starting with the needs of the child. Exploring through interviews the working practices as perceived by a number of different professionals working in two Children Centres in London, the data identifies difficulties and contradictions in joint professional work.

Treatment in Adolescent Psychiatry: Results of a Germany-wide Survey

The aim of the study was to examine adolescence-specific treatment models throughout Germany, to describe the implementation process of transition psychiatric care and to identify relevant health care problem areas for adolescents with mental disorders. A questionnaire-based cross-sectional survey (N = 26) of hospital-based adolescent psychiatric treatment models was conducted. Service structures, treatment groups and interventions were investigated by the 28-item questionnaire. There is an increase in adolescence-specific hospital-based services in Germany. These are characterized by multi-professional team work in diagnosis and adolescence-specific therapy approaches. Most of the treatment available is for young adults only (>18years). Some of the services are organized in interdisciplinary cooperation models. Structural deficits in acute and crisis treatment, cross-sectoral cooperation and systematic transition are reported. Conclusions There is growing interest throughout Germany in the development of adolescent psychiatric treatment. Close interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry is necessary to overcome interface problems with the aim of a successful transition, but has not yet been implemented. Structural problems should be reduced in order to facilitate further development in transition psychiatry.

Intersectoral coordination and multiprofessional teams: merging primary care and social services

Abstract Background Since the 2000s, integrated care has been a policy aim in Finland. Reforms for creating larger care authorities have failed at national level, but municipalities have established regional joint health and social integrated care authorities. Our study focuses on integration of services for children and young people and adults’ psychosocial care. The aim is to evaluate integration in terms of success and its underpinning factors in two authorities with merged primary and specialised healthcare and social services. Methods South Karelia and North Karelia were selected as case studies, because these regions were pioneers in establishing integrated care authorities in 2010 and 2017. Document analysis and individual and group interviews with managers (32) and employees (22) were carried out; the analysis draws on Auschra’s classification of barriers and facilitators of integration. Results The regions (pop. 130.000-169.000) comprise a larger town, a specialised hospital and several rural municipalities. The integration of children’s and young people’s services is based on organisational changes, in which the services from primary healthcare, hospitals, social work and schools (pupils’ and students’ healthcare) were merged into one organisation. The health and well-being centres were created by bringing mental health, substance abuse services and social services into health centre facilities, but under their own managers. In both cases, the experiences are mostly positive but the success of implementation varies; commitment and cooperation between managers, shared goals and mutual understanding of each other’s work as well as the planning process were crucial factors to support implementation. Conclusions Comprehensive organisations with unified management foster integration. The implementation of multiprofessional work is facilitated by organisational culture and collaboration between managers.

The Human Ecological Perspective and Biopsychosocial Medicine.

With regard to philosophical anthropology, a human ecological framework for the human–environment relationship as an “ecology of the person” is outlined, which focuses on the term “relationship” and aims to be scientifically sound. It also provides theoretical orientations for multiprofessional clinical work. For this purpose, a multi-dimensional basic grid for the characterization of the individual human being is proposed. The necessity and meaningfulness of a differentiation and systematization of the terms “environment”, and above all “relationship”, are demonstrated, and practical examples and links to similar framework models are given.

A realidade da prática do enfermeiro em um Serviço de Diálise: confrontando aspectos das Diretrizes Curriculares Nacionais

Objetivo: Analisar a prática do enfermeiro em um serviço de diálise de um Hospital, considerando as Diretrizes Curriculares Nacionais (DCN) do curso de enfermagem. Métodos: Trata-se de uma pesquisa qualitativa realizada em um serviço de diálise de um Hospital em Minas Gerais, cujos participantes foram 9 enfermeiros. A coleta de dados foi realizada mediante observação e análise documental das DCN do curso de Enfermagem. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Percebeu-se que o enfermeiro assume papel de liderança, mas, as atividades burocráticas são realizadas em detrimento da assistência; as tecnologias em saúde precisam ser articuladas e; o relacionamento interpessoal e o trabalho em equipe multiprofissional precisa ser valorizado. Conclusão: A realidade demonstra que os enfermeiros nem sempre agem em consonância com as DCN, sendo importante rever as atribuições do enfermeiro, visando favorecer a qualidade do cuidado ao paciente e estar em consonância com o preconizado na formação desses profissionais.

PRÁTICAS DESPORTIVAS NA INFÂNCIA E O IMPACTO NA VIDA ADULTA

The sports practice started in childhood promotes several health benefits for the child, improving and developing the natural abilities acquired over time, as well as socialization, bonding, friendships, etc. The way this process occurs can significantly alter this child's future as well as their health. Therefore, the objective of the present study was to reflect on the importance of sports practice in childhood, its relationship with possible reasons for abandoning the practice permanently, and the impact of this in adult life. In order to carry out this research, we used the Scielo, Google academic database with theoretical scanning through the keywords: "sports initiation", "health" and "abandonment", in the search period between 1998 and 2018. The data analyzed indicate that even if a child is part of a sports team, the play should prevail, especially for those who practice a certain sport only for leisure and / or for non competitive purposes. It is up to the teacher / coach / coach to instruct each child in order to provide health gains as well as strive for a balance between recreation and competition. Frustrated sports practices in childhood can impact on a sedentary adult, since the previous experiences of the same were not positive, with that the culpabilization of this can fall on the professional. The more playful and entertaining your experience in practice, the easier your staying will be. When it comes to the children's audience, the Physical Education professionals who work in this environment, in a multiprofessional work with Sports Psychology, must take into account the taste that the child acquired with the practice of sports, creating strategies of motivation for the permanence of it in the sport . With this, sports initiation assumes a significant role of social, physiological and psychic development of the child, making sports practice more pleasurable and healthy.

Program EducAtivo: physical activity as a health education strategy

This study aimed to describe the transition from the intervention protocols of the research project entitled "Active Environment" to the conception of the university extension program known as "EducAtivo". Considering the complexity of the context of physical activity promotion and the need to understand its processes, this manuscript justifies itself as it addresses such need by reporting the procedures adopted along the extension program implementation. The result of this transition is the current proposal of EducAtivo, aimed at creating opportunities for health experiences and reflection, using physical activities/body practices as a health education strategy, apart from approaching related topics such as healthy eating. With an itinerant design, this program implements its activities in social spaces, bringing the university closer to the community. Furthermore, EducAtivo welcomes students from different courses, fostering qualification for multi-professional work, since this is fundamental in the health field. Fundraising has been sought, aiming to improve and increase the program.

Therapeutic attitudes and structures in (open) acute psychiatry: the Wedding model

The Wedding model is arecovery-orientated treatment model that was implemented in 2010 as part of acomplex change project in the Department of Psychiatry of the Charité at the St. Hedwig Hospital (PUK-SHK). According to this model, all ward structures were changed in order to promote transparency, participation, trialogue and multiprofessional work. Astrong focus was also laid on therapeutic attitudes and the opening of acute psychiatric wards. The relevance of the Wedding model as a possible tool to implement arecovery-orientated, person-centered approach of care and its possible role in the reduction of coercion are the subject of this article.

Maîtrise des risques liés à la production des fluides de dialyse dans une unité de télédialyse

ObjectiveThe “Centre Hospitalier Francois Dunan” is located on an isolated island and ensures patients care in hemodialysis thanks to telemedicine support. Many research studies have demonstrated the importance of hemodialysis fluids composition to reduce morbidity in patients on chronic hemodialysis. The aim of this study was to identify the risks inherent in the production of dialysis fluids in a particular context, in order to set up an improvement action plan to improve risk control on the production of dialysis fluids. MethodsThe risk analysis was conducted with the FMECA methodology (Failure Mode, Effects and Criticality Analysis) by a multi professional work group. Three types of risk have been reviewed: technical risks that may impact the production of hemodialysis fluids, health risks linked with chemical composition and health risks due to microbiological contamination of hemodialysis fluids. ResultsThe work group, in close cooperation with the expert staff of the dialysis center providing telemedicine assistance, has developed an action plan in order to improve the control of the main risks brought to light by the risk analysis. ConclusionThe exhaustive analysis of the risks and their prioritisation have permitted to establish a relevant action plan in this improving quality of dialysis fluids approach. The risk control of dialysis fluids is necessary for the security of dialysis sessions for patients, even more when these sessions are realized by telemedicine in Saint-Pierre-et-Miquelon.

Tinnitus and its relationship with anxiety and depression in the elderly: a systematic review

ABSTRACT Objective: to verify, in the literature, a probable association of tinnitus with anxiety and depression in the elderly. Methods: a systematic review (through a search in the indexed databases - Lilacs, Scielo, Pubmed, Science Direct, The Cochrane Library) of studies published between 2013 and 2018, in Portuguese and in English, involving adults and/or elderly (18 years and older). The descriptors used were: “tinnitus", "depression", "anxiety", "adult", "elderly", interspersed by the Boolean operator AND. Results: 11 studies were selected, from which, 5 compared adults to elderly and only 2 evaluated such relationship in the elderly alone. Studies suggest that, as age increases, tinnitus severity and psychological symptoms also increase, affecting both men and women. Conclusion: few studies compared the relationship between the variables among the elderly. A probable association between the variables for both genders has been found, suggesting that the advancing age contributes to the increase of tinnitus severity and its psychological symptoms, affecting the quality of life of these individuals. Further studies are suggested to confirm the association between tinnitus, anxiety and depression in the elderly. Multi-professional work is important for the evaluation and treatment of these people.