In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination.
RESUMO: Elementos da sociedade atual evidenciam a impossibilidade se compreender o direito que está em curso diante da crise do direito estatal se se insiste em manter o constitucionalismo sob as vestes do direito estatal. Instituições sociais públicas e privadas, corporações transnacionais, agrupamentos financeiros, ONGs têm promovido influências na prática do direito sem precedentes na história. Para lidar com a multiplicidade de constituições civis, proponho o constitucionalismo societário transnacional. Palavras-chave: Teoria dos sistema. Constitutionalismo social. Sistema de poder mundial. Regulação. Risco. ABSTRACT: Elements of actual society show that it is impossible to understand the law that is underway in the face of the crisis of the rule of law one insists on maintaining constitutionalism under the guise of state law. Public and private social institutions, transnational corporations, financial groups, NGOs have promoted influences on the practice of law unprecedented in history. In order to deal with the multiplicity of civil constitutions, we propose transnational corporate constitutionalism.
Objective: This study sought to understand how social violence affects the work of family health teams in a basic health unit in Belo Horizonte -MG. Methods: This is a qualitative case study. Data were collected by semistructured interviews with 12 individuals working in a basic health unit in Belo Horizonte -two nurses, five auxillary nurses, three ACS's, a doctor and a guard -interviews were then subjected to discourse analysis. Results: The workers recognized the violent situations in the community where they work; they feel fear, insecurity, and adopt several defense mechanisms to reduce suffering. They also reported feeling hurt by their poor working conditions. Conclusion: The effectiveness of health care is challenged by violence, and it and requires strategies for coping with the same within the unit by establishing links with other social institutions. Keywords: Violence; Patient care team; Family health; Working conditions RESUMO Objetivo: Este estudo buscou compreender como a violência social interfere no trabalho das equipes de Saúde da Família de uma Unidade Básica de Saúde de Belo Horizonte -MG. Métodos: Trata-se de um estudo de natureza qualitativa do tipo estudo de caso. Os dados foram coletados por entrevistas de roteiro semiestruturado com 12 trabalhadores de uma Unidade Básica de Saúde de Belo Horizonte -2 enfermeiros, 5 auxiliares de enfermagem, 3 ACS's, 1 médico e 1 vigilante -e submetidos à análise de discurso. Resultados: Os trabalhadores reconheceram as situações de violência na comunidade onde trabalham, sentem medo, insegurança e adotam vários mecanismos de defesa para diminuir o sofrimento. Referiram também sentirem-se prejudicados com as precárias condições de trabalho. Conclusão: A efetividade da assistência à saúde é desafiada pela violência, e requer estratégias para lidar com a mesma dentro da unidade estabelecendo relações com outras instituições sociais. Descritores: Violência; Equipe de assistência ao paciente; Saúde da família; Condições de trabalho RESUMEN Objetivo: En este estudio se tuvo como objetivo comprender cómo la violencia social interfiere en el trabajo de los equipos de Salud de la Familia de una Unidad Básica de Salud de Belo Horizonte -MG. Métodos: Se trata de un estudio de naturaleza cualitativa de tipo estudio de caso. Los datos fueron recolectados por entrevistas con preguntas semiestructuradas realizadas a 12 trabajadores de una Unidad Básica de Salud de Belo Horizonte -2 enfermeros, 5 auxiliares de enfermería, 3 ACS's, 1 médico y 1 vigilante -y sometidos al análisis de discurso. Resultados: Los trabajadores reconocieron las situaciones de violencia en la comunidad donde trabajan, sienten miedo, inseguridad y adoptan varios mecanismos de defensa para disminuir el sufrimiento. Refirieron también sentirse perjudicados con las precarias condiciones de trabajo. Conclusión: La efectividad de la asistencia a la salud es desafiada por la violencia, y requiere estrategias para lidiar con la misma dentro de la unidad estableciendo relaciones con otras instituc...
RESUMOObjetivo: analisar como se configuram as práticas cotidianas dos profissionais do Serviço de Atendimento Móvel de Urgência (SAMU) de Belo Horizonte, Minas Gerais, Brasil. Método: estudo de caso qualitativo, com referencial pós-estruturalista. Realizaram-se 13 entrevistas semiestruturadas com profissionais de diferentes funções, sendo atendidos todos os quesitos éticos. Resultados: na cotidianidade, os discursos legitimam as relações de poder, fazendo a manutenção dos discursos de verdade, de controle e de vigilância. O discurso de utilidade e essencialidade mantém o imaginário sobre um SAMU, como um serviço que não pode parar nem falhar. Conclusão: essa análise do SAMU, numa vertente mais reflexiva e crítica, apresentou a necessidade de se superar as descrições dos serviços de saúde, reconhecendo a presença das relações de poder nos cotidianos e a perpetuação de discursos hegemônicos. Palavras-chave: Conhecimentos, Atitudes e Práticas em Saúde; Serviços Médicos de Emergência; Dominação-Subordinação; Poder. ABSTR ACT
An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well‐developed, and family care‐givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia.
Araujo MT, Velloso ISC, Queiroz CF, et al. RESUMENObjetivo: analizar el diseño de personal de enfermería en la unidad de cuidados de Betim, Minas Gerais, a través de la Resolución N ° 293/04 COFEN. Método: Estudio cuantitativo y descriptivo. Los datos se incluyen con el programa Stata 12 para dibujar el perfil de la unidad y de los pacientes, la clasificación en tipos de atención, así como el tamaño ideal para coche. Resultados: La edad media fue de 62 años; hubo un predominio de pacientes del sexo masculino; el paciente-día promedio fue de 34,1; 91,51% de los pacientes no tenía compañero. De acuerdo con la Clasificación de pacientes en relación con el tipo de atención se obtuvo 5,3 (15,52%) de cuidado mínimo, 3,9 (11,42%) de cuidados intermedios, 8,5 (24,87%) atención de alta dependencia, 9 (26,44%) de los cuidados semi-intensivos y 0.3 (0.97%) de cuidados intensivos. Se constató cantidad inadecuado de personal. Sólo 60,8 horas de cuidados de enfermería (8,8 horas de enfermera y 52 horas de enfermería-técnicos) se dispensa en 24 horas, y hecho necesario para 211,8 horas promedio diario de 34 pacientes. Conclusión: el diseño de personal de enfermería es inadecuado para la resolución COFEN porque había una cobertura de sólo 60,8 horas de cuidados de enfermería en 24 horas y luego 1,87 horas por paciente con un déficit diario de 7.53 horas. Descriptores: Administración de personal en hospitales; Dimensionamiento personal; Servicios de enfermería.
The aim of the present study was to discuss the way visibility constitutes a power device in the everyday practice of the Mobile Emergency Care Service in Belo Horizonte, Minas Gerais, Brazil. A qualitative case study was developed and data were collected through semi-structured interviews with 31 workers of the service (five physicians, 11 nurses, seven nursing assistants and eight ambulance drivers) and submitted to discourse analysis. The analysis of power relations in the service allowed to verify that there is not an only one source from which the power emanates in this organizational structure. Power is exercised through many techniques and their sources are scattered, diffuse, interchangeable and even confusing. Although there is a hierarchical structure formally established, a parallel network to this structure is formed. It was also observed that the visibility generated by radio communication provides constant supervision, which generates tension within the team.
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