Family health: limits and possibilities for an integral primary healthcare approach in BrazilSaúde da família: limites e possibilidades para uma abordagem integral de atenção primária à saúde no Brasil
Foram analisados os processos de trabalho de três equipes da ESF no município de Nova Iguaçu, Rio de Janeiro, Brasil, bem como a gerência do cuidado, tomando as visitas domiciliares como foco da análise. Optou-se pelo estudo de caso, selecionado em um contexto complexo, com pessoas em situação de fragilidade, incerteza e sofrimento. Resultados da pesquisa destacam o improviso dos profissionais frente à precariedade das condições de trabalho e aos desafios impostos cotidianamente para a realização das visitas e para lidar com demandas que emergem no território. Embora a visita domiciliar se apresente como instrumento potente para o planejamento das ações de saúde e a reorientação das práticas, ainda encontra importantes entraves para sua consolidação, especialmente por exigir grande disponibilidade interna do profissional de saúde para lidar com o inesperado e o diverso.
The article presents partial results of a study at Hospital Edgar Santos, Universidade Federal da Bahia (HUPES), Brazil, analyzing the service's experience with improvement in quality of care within a context of hospital accreditation. The article focuses on the hematology service and specifically its quality of care and intersubjective processes. The study adopted a qualitative approach, using interviews and observation. From the theoretical point of view, the work of Campos, Cecílio, and Merhy acknowledge healthcare's complex nature and micropolitical and intersubjective dimension and the capacity of health professionals to produce meanings and practice creativity. To understand the health professionals' processes of psychosocial linkage and subjective mobilization, we drew on concepts from the French school of psychosociology (Enriquez) and Dejours' psychodynamics of work. The analysis was organized along three lines: psychosocial linkage and the imaginary of self-management; bonding and affect: singularity of the subject's care and clinical case; real work and the healthcare team. One of the main conclusions is the building of a self-management imaginary, expressed in shared projects, expectations, and some forms of interpreting and operating reality, based on affectively invested representations of autonomy and unity. Alongside technical elements such as protocols, the article highlights professional judgment, proper to the intersubjective dimension, fostering the singularity of care. In our view, the real work in the patient care scene is traversed by adjustments that demonstrate team cooperation.
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