Permanent Health Education Research Articles

Analyzers of Support Practices in Humanization and Permanent Health Education

Abstract The National Policies of Humanization and Permanent Health Education (PHE) have shown advances and setbacks in their historical process. Some concepts from the theoretical framework of institutional analysis can contribute in these themes, such as the concept of analyzer. This article discusses the analyzers identified in an intervention research with professionals who work as supporters of humanization and/or articulators of PHE in municipalities of the state of São Paulo. The theoretical-methodological framework is the institutional analysis, socio-clinical line, focusing on the work of the analyzers. The intervention groups were composed of 30 participants. We highlight three analyzers: (1) the COVID-19 historical analyzer; (2) the time analyzer; (3) the silence analyzer. These analyzers evidence tensions such as: the peripheral place of primary care, discomfort in the face of “not knowing” and/or lethargy in the face of imposed non-doing, and the paradox of creating and interrupting both care actions and support for the teams.

“Na verdade eu nunca participei e nem ouvi falar sobre”: a Política Nacional de Saúde Integral da População Negra na perspectiva de gestores e profissionais da saúde

Abstract This study analyzes how the National Policy on Comprehensive Health of the Black Population (PNSIPN) has been implemented in three municipalities in the state of Bahia, Brazil. This qualitative study is part of an ongoing action research, in which semi-structured interviews were performed with 27 professionals from family health, primary health care, and health district headquarters. Content analysis presented four categories: primary health care (PHC); Black health; health care in diversity; and PNSIPN. Health professionals showed a superficial understanding of PHC, despite recognizing it as a gateway. A specific health care for the Black population was considered irrelevant, on the grounds that everyone is equal. Diversity was linked to the LGBTQIA+ population and life cycles, but not to ethnicity or skin color. All municipalities lacked knowledge about the PNSIPN and the practical means to implement it in their daily work. Its absence in the services’ planning and work processes shows an urgent need for permanent education in health so that managers and professional can appropriate the principle of equity.

Interdisciplinarity in the construction of Permanent Education in Health with management teams

RESUMO A gestão no Sistema Único de Saúde (SUS) requer das equipes gestoras a compreensão e o desenvolvimento de um conjunto de habilidades e competências que os auxiliem no cotidiano e nos desafios da gestão pública. Este artigo apresenta um processo de Educação Permanente em Saúde (EPS) desenvolvido com equipes gestoras de duas regiões de saúde do Paraná, com intuito de ampliar o olhar dos participantes para a reorganização da gestão e da implementação do SUS no território, pautado na interdisciplinaridade. Trata-se de um relato de experiência desenvolvido com equipes gestoras, realizada no ano de 2019, apresentado em cinco seções: a primeira descreve o contexto em que a experiência foi desenvolvida, elucidando motivos, atores e a localidade em que ocorreu; a segunda apresenta a proposta de trabalho, a confecção das oficinas e os recursos metodológicos utilizados; a terceira relata o caminho percorrido na sua operacionalização; a quarta discute as características de interdisciplinaridade existentes no processo de EPS e a última apresenta algumas considerações. A proposta mostra-se como uma potente estratégia para promover o diálogo entre diferentes atores e instituições, principalmente no contexto de crise sanitária e fiscal do Estado, qualificar e tornar reflexivo o trabalho no campo da gestão em saúde.

Trajectory of the National Policy of Permanent Education in Health in Brazil

Resumo A Política Nacional de Educação Permanente em Saúde estabelece como pressuposto a centralidade nos processos de trabalho para nortear as atividades de qualificação dos trabalhadores da saúde. O presente estudo tem por objetivo discutir a trajetória de institucionalização da Política Nacional de Educação Permanente em Saúde de acordo com a percepção dos atores representativos dessa política pública (gestores federais, gestores estaduais e municipais, e pesquisadores), considerando os 16 anos de sua institucionalização até o ano deste estudo (2004-2020). Trata-se de pesquisa qualitativa, com a aplicação do método Delphi. Os resultados obtidos mostraram que a Política se encontra frágil quanto à sua implantação. No que se refere aos impactos, constatou-se que ela oportunizou o estreitamento da relação entre os serviços de saúde e as instituições de ensino, e promoveu mudanças significativas nos processos de trabalho em equipe, independentemente da sua composição.

Síndrome Respiratória Aguda Grave por COVID-19: Perfil Clínico-Epidemiológico e Distribuição Espacial dos Óbitos nas Unidades Federativas do Brasil

Severe Acute Respiratory Syndrome (SARS) is a severe manifestation of COVID-19 infection that, in some cases, can result in death. In the current global epidemiological scenario, Brazil is the second country with highest number of deaths from the disease; thus, it is necessary to know the clinical and epidemiological characteristics of deaths and how they are spatially distributed across territories. Therefore, the objective was to describe the clinical and epidemiological characteristics and the spatial distribution of SARS deaths due to COVID-19 in the Brazilian federative units (states). This is a descriptive and ecological study of SARS deaths due to COVID-19 in Brazilian states, from March 2020 to June 2021, based on secondary data available on the openDataSUS database. Descriptive statistics were performed for the clinical-epidemiological variables and the monthly mortality rates were determined by state and thematic maps were made in QGIS software version 2.4.17. A total of 196,109 deaths were recorded in the investigated period, predominantly male, older, white, and low-educated. Among the clinical variables, cough, respiratory distress, dyspnea, and the presence of comorbidities stood out. A heterogeneous spatial distribution of deaths was observed, with rates ranging from 0.00 to 24.59 deaths/100,000 inhabitants, the highest rates were in the states of Rio de Janeiro, Amazonas, Ceara, Sergipe, Sao Paulo, and Pernambuco. These findings raise the need for investments on the part of public management and health systems and services in the most affected states, improvements in epidemiological surveillance, permanent health education, increased access to immunization and health prevention measures to control and monitor SARS caused by COVID-19.

Articulating Methodology – Weaving a Trans-Disciplinary Knowledge

Background: With the emergence of the SARS-CoV-2 pandemic, the educational context became more complex, and other challenges were added to the already-existing ones. The way of doing and thinking about education mediated by digital technologies emerged suddenly. It put our view of the world into question because the world has changed, we are no longer the same, and the need for humanitarian health and transdisciplinary education has expanded in all contexts. The new educational reality is evidenced by the social distancing and the teaching and learning processes, requiring prepared teachers and committed to the act of educating. The current pandemic exposed some needs that foster policies, projects and actions with innovative strategies, which enhance learning, so that participants are immersed in an inclusive, trans-disciplinary, dialogic, free and universal education, with a view to unraveling the complexity of social interactions. The new reality aspires to generate a transforming awareness of society, in which people recognize themselves as part of the problems, but above all as part of the solutions. In the education and health sectors, it is essential to reconstruct dynamics, processes, participatory methodologies, and forms of democratic management, which are reaffirmed in the daily practice of educators and health professionals. Objective: Systematize the concepts of the Articulating Methodology (AM) with the Permanent Health Education principles in a perspective that promotes transdisciplinarity, multiple identities, knowledge exchanges and singularities that configure the subjects involved in the education and learning act. Method: This is a descriptive-exploratory study carried out in three stages: description of the authors' personal and professional experiences; conducting of bibliographic research; conducting of an integrative review for a broad discussion on the contextualization of active methodologies in the education and health sectors. Results: We identified important elements in the bibliographic and integrative review that can be added to the Articulating Methodology. In addition, we note that information technology can facilitate trans-disciplinary, as well as a fast, effective and inclusive communication, as long as some dimensions brought by the Articulating Methodology (e.g. lovingness, humanization, intersectoriality, for example, articulation of education and health sectors), interculturality and internationalization of knowledge. Conclusion: We emphasize that it is essential to reaffirm the importance of the role of the educator in the construction of knowledge, whether in the education and health sectors, however, it is necessary to develop a "sensitive reason" for a more humanized practice filled with meanings, emotions and motivation. The applicability of AM, as a device that enhances Permanent Health Education, reinforces dialogue, exchanges of experiences, trans-disciplinary, intersectoral and intercultural actions. In addition, Articulating Methodology, through Proactive Agendas, encourages social participation, the use of information technologies and the creation of bridges between policy maker, managers, inter-disciplinary professionals and social environment, allowing the tone of the narratives and propositions to emerge from the experiences, voices and intercommunication of the participants, thus, enabling a direct impact on the practice of educators and health professionals.

Care for women in situations of violence: construction of a model of permanent health education.

To propose a Permanent Health Education Model with strategies linked to the Five Disciplines framework for the development of competencies of professionals who work in direct care for women in situations of violence. A qualitative research carried out by the focus group technique, with professionals who are part of an intersectoral network in Curitiba-PR, from August to October 2019. Data analyzed by content analysis in the thematic modality, in the light of the theoretical framework of the Five Disciplines: personal mastery; mental model; shared vision; team learning and systems thinking. The Five Disciplines were evidenced in the categories, as well as strategies to be used for competence development. A diagrammatic representation was used to be covered during the learning process. The strategies suggested by professionals who work in the care for women in situations of violence supported the proposition of a Permanent Health Education Model based on the adopted theoretical framework.

Care for women in situations of violence: construction of a model of permanent health education

RESUMO Objetivo: Propor um Modelo de Educação Permanente em Saúde com estratégias vinculadas ao referencial das Cinco Disciplinas para o desenvolvimento de competências dos profissionais que atuam na atenção direta às mulheres em situação de violência. Método: Pesquisa qualitativa realizada pela técnica de grupo focal, com 16 profissionais que integram uma rede intersetorial em Curitiba-PR, de agosto a outubro de 2019. Dados analisados por análise de conteúdo na modalidade temática, à luz do referencial teórico das Cinco Disciplinas: domínio pessoal; modelo mental; visão compartilhada; aprendizagem em equipe; e, pensamento sistêmico. Resultados: As Cinco Disciplinas foram evidenciadas nas categorias, bem como estratégias a serem utilizadas para desenvolvimento de competências. Utilizou-se uma representação diagramática a ser percorrida durante processo de aprendizagem. Conclusão: As estratégias sugeridas pelos profissionais que atuam na atenção às mulheres em situação de violência apoiaram a proposição de um Modelo de Educação Permanente em Saúde baseado no referencial teórico adotado.

O medo ao cuidar: reflexões sobre uma experiência de educação permanente em tempos de Covid-19

ABSTRACT This article presents an analysis of the actions to support health teams in a small city in the State of Rio de Janeiro in the fight against Covid-19, in a university-municipal partnership. The cartographic approach of the micropolitics of work and health care was the framework that guided the work. Permanent health education workshops were held over the internet, with the healthcare teams and managers of the Primary Care teams, coordinated by the researchers. In these meetings, problem situations were identified and, among them, the fear of being contaminated, of contaminating others, and of dying emerged, negatively interfering with daily work. These fears were mapped, as well as their concrete implications and the potencies and tools to face them; Fear in times of pandemic was discussed, as a weakness and as a power, the recognition of intuition-intelligence and collective practice, as elements for facing difficulties, from which is possible to observe the passage from the state of hope as a noun to hope as verb, or ‘hope-doing’.

Problem-solving approach to continuing health education in nursing training: an experience in hospital care.

To report the experience of an educational practice of sensitization of health workers to the actions of Permanent Health Education. This is an experience report, of a qualitative and descriptive nature, conducted through the Arc of Maguerez, in 2019, in a reference hospital for the treatment of infectious diseases in the state of Rondônia. The Arc of Maguerez was an important point for intervention in the context reality, through two dynamics entitled "myths and truths" and "ludic wheel", which facilitated reflection and understanding of the role of continuing education in the services studied. Continuing education actions play a fundamental role in the construction of expertise, expanding knowledge, as they facilitate the sharing of new experiences with the team and the external public.

Transitions of Permanent Education in Health Professionals in the Face of COVID-19 Pandemic

Objective: The main objective of this study was to understand how the pandemic influenced Continuing Education in Workers’ Health in the face of the COVID-19 pandemic. Methods: This study was performed using a qualitative exploratory and descriptive research. We analyzed the content of semi-structured interviews that were carried out with the worker’s health team of a big company. Results: The results were categorized and three categories emerged: Organization of Continuing Education before the pandemic; Changes in Continuing Education resulting from the pandemic; and Long-term implications for Continuing Education in the face of the pandemic. Conclusion: So, with the large impact of COVID-19 we conclude that Permanent Health Education moved from a face-to-face model to e-learning; from professional topics to issues related to the pandemic. The knowledge in technology area was renewed to maintain communication in times of social distance. It is necessary to strengthen return-to-work policies, which highlight the quality of life and the impacts on workers’ mental health, inserting consistent and significant educational policies and mechanisms of confrontation (coping).

Entre nós: educação permanente em saúde como parte do processo de trabalho dos Núcleos Ampliados de Saúde da Família e Atenção Básica

Abstract The article presents a study aimed to analyze the work process of an Extended Nucleus of Family Health and Primary Care (NASF-AB), questioning: who are those that support the matrix supporter? and how these professionals learn/understand their work? The research studied the work process with the NASF-AB supporters and, articulated with the perspectives of servitude and freedom in Baruch Spinoza, problematized how they feel and how they act, evoking thought-affection and thought-action. Methodological choices involved cartography and research-with. It was possible to identify team behavior that promotes permanent education in the healthcare field and the necessary collective enunciation that the NASF-AB must represent. It can be understood that “support for supporters” is objectively expressed through the processes of self-analysis (institutional), measures of permanent health education (among peers) and efforts to allow fear and hope to be expressed so that affections appear genuine and encounters may thrive (freedom). The action among peers, within the NASF-AB to learn, get ownership and practice the matrix support led to the understanding that it is something that happens as “among us” (the supporters themselves), invested with the perseverance of freedom in the face of servitude.

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.

Conhecimento técnico dos profissionais de saúde quanto ao manejo da sífilis e a sua relação com a Educação Permanente em Saúde

Objetivo: Mapear o conhecimento técnico dos profissionais de saúde quanto ao manejo da sífilis e a sua relação com a Educação Permanente em Saúde. Metodologia: Estudo de revisão integrativa, realizado no período de novembro de 2020. Foram encontradas 793 publicações, sendo 459 no Portal BVS e 334 no Portal de Periódicos CAPES. A amostra final foi constituída por 10 artigos sendo 08 artigos do Portal BVS e 02 artigos do Portal Periódicos CAPES. Resultados: A abordagem metodológica foi na totalidade quantitativa nas temáticas sífilis congênita e sífilis na gestação, sendo 3 estudos internacionais e 7 nacionais. Lacunas de conhecimento foram encontradas como definição de casos de sífilis congênita, uso de testes sorológicos e escolha alternativas de antibióticos para tratamento de gestantes alérgicas à penicilina. Apenas dois estudos utilizaram ferramentas tecnológicas para educação permanente e demonstraram efeito positivo no incremento do conhecimento dos profissionais de saúde. Conclusão: Faz-se necessária publicação de mais estudos que avaliem conhecimento e a produção de ferramentas de Educação Permanente em Saúde para a melhoria da qualidade no manejo da sífilis.

Nursing care for patient in post operatory heart surgery in the Intensive Care Unit.

To investigate the critical nodes related to nursing care for patients in the postoperative period of cardiac surgery. Exploratory study with a qualitative approach. Data collected through semi-structured interviews with 27 members of the nursing team working in the Intensive Care Unit. Material submitted to thematic analysis. Three categories emerged: Flaws in the professional qualification for patient care in the postoperative period of cardiac surgery; Team challenges concerning specific patient care in the postoperative period of cardiac surgery; and (dis) organization of work in the Intensive Care Unit and its impact on nursing care for patients in the postoperative period of cardiac surgery. Given the identification of the critical nodes, the professionals presented suggestions to overcome daily difficulties: investments in strategies for Permanent Education in Health; creation of tools to guide patient assistance in the postoperative of cardiac surgery; and provision of adequate human resources.

Blended learning in permanent education of nursing professionals on smoking cessation.

To develop and validate the content of an educational intervention on smoking cessation for Nursing professionals using a Blended Learning approach. A development and validation study by consensus of experts of the "Smoking Cessation" course for Nursing professionals on approaches to the smoking patient carried out in 2018. For refinement and validation of the final content, a convenience sample was made up of 12 professionals with expertise in the subject natter and an 80% consensus among the participants was considered. The construction of the course involved the choice of subjects, production, and content validation. As a teaching strategy, Blended Learning was used, which has an interactive online stage and a face-to-face meeting to discuss concepts and exchange experiences. The course using a Blended Learning method proved to be innovative, low-cost, and with great capacity for disseminating knowledge, being an important ally to permanent education in health.

Construction and validation of digital education resources for the health and safety of workers.

To build and validate the content of digital educational resources (DERs) for the promotion of health and safety for professionals working in Primary Health Care (PHC). Methodological study consisting of two stages: the first describes the phases of the construction of DERs; and the second validated the content of DERs by a Committee of Experts that used the Instrument for Validating Educational Content in Health (IVECH) and applied the Content Validity Index (CVI). Seven storyboards have been built in MP4 obtaining the overall CVI from 0.84 to 0.96. In relation to "objectives", the CVI ranged from 0.84 to 0.95; in "structure/presentation", from 0.91 to 0.99; and in "relevance", from 0.81 to 0.95. The seven DERs are validated products that can be used for permanent health education on health and safety at work of PHC professionals.

Use of technologies by nurses in the management of primary health care.

To analyze the management actions of nurses in Primary Health Care services from the perspective of technologies. Descriptive-exploratory study with a quantitative approach, carried out from February to April 2019. Through the snowball technique, the sample consisted of 42 nurses from Primary Health Care, using an electronic tool for data collection. The data were analyzed using descriptive statistics techniques. 54.8% of nurses use technologies through SISREG and PEC electronic systems, care training related to permanent health education, online and face-to-face courses, in addition to care technologies such as telehealth and telemedicine. Management actions focused on technology showed restricted use. Nurses need to empower themselves with these organizational devices, with the aim of improving the provision and quality of care for users.

A Educação Permanente em Saúde e os desafios das Comissões de Integração em ensino Serviço


 Em 2004 o Ministério da Saúde cria a Política Nacional de Educação Permanente em Saúde (PNEPS), que tem como conceito pedagógico a Educação Permanente em Saúde (EPS). A Portaria GM/MS nº1996, de 2007, alinhou a PNEPS à proposta de fortalecimento da regionalização, sendo estruturadas as Comissões de Integração Ensino e Serviços (CIES). Esta pesquisa analisa o contexto da estruturação da PNEPS no estado de Goiás no período de 2009 a 2018. Estudo qualitativo realizado mediante a análise de documentos e de entrevistas com os sujeitos envolvidos neste universo. Observou-se que, apesar das CIES terem sido estruturadas nesse período, a descentralização da EPS pouco avançou, evidenciando pontos dificultadores, como: a baixa execução de ações pelas CIES, a descontinuidade dos processos formativos, ações educativas desvinculadas da PNEPS e pouca transparência no direcionamento do financiamento das ações de EPS.

Estratégias para a promoção da segurança do paciente em hospitais de urgência

Objetivo: Estudo com objetivo de descrever os principais problemas relacionados à segurança do paciente e as propostas implantadas para sua superação em serviços hospitalares de urgência. Método: Foi desenvolvido por meio da análise documental de quatro projetos gerenciais elaborados por líderes de instituições hospitalares de uma capital brasileira, como produto de um processo formativo de um programa de Educação Permanente em Saúde. Resultados: Foram elencados problemas, como falhas no atendimento às metas de segurança do paciente, insuficiência de recursos físicos, materiais e de pessoal, ausência de gestão de leitos e de risco, que resultavam em superlotação. A maioria das propostas de superação estavam relacionadas aos processos de trabalho. Conclusão: A descrição de problemas estruturais, de processo e resultados comuns aos hospitais, bem como ações de melhoria, pode colaborar para a construção de diretrizes imprescindíveis à segurança do paciente.