Supervisão de trabalhadores de enfermagem em unidade básica de saúde

Abstract

Resumo Aborda-se, neste artigo, a supervisão de trabalhadores de enfermagem de nível médio no atendimento da demanda espontânea em uma unidade básica de saúde na cidade de São Paulo. Seu objetivo foi analisar como se processa a supervisão desses trabalhadores e a maneira de atuação do supervisor. É um estudo qualitativo baseado na observação direta de uma semana típica de trabalho, com análise temá-tica apoiada no software NVivo e no referencial da supervisão do processo de trabalho. Observaram-se 55 atendimentos realizados pelos trabalhadores de enfermagem com a solicitação de supervisão em 23 casos. Tanto nas solicitações de supervisão quanto nas respostas dos supervisores predominou o enfoque biomédico centrado em queixas agudas ou crônicas e prescrições medicamentosas e de exames. Concluiu-se que a supervisão dos trabalhadores de enfermagem de nível médio por profissional de nível superior na recepção da demanda espontânea potencializa a resolubilidade dessa atividade. Recomenda-se, no entanto, ampliar o enfoque da apreensão e da análise das necessidades do usuário na perspectiva da integralidade. Palavras-chave acolhimento; supervisão de enfermagem; atenção primária à saúde; trabalho; relações interpessoais. AbstractThe issue addressed in this article is the supervision of middle-level nursing staff in serving spontaneous demand at a basic health unit in São Paulo (Brazil). The goal was to analyze how these workers are supervised and how the supervisor proceeds. It is a qualitative study based on the direct observation of a typical work week, with thematic analysis supported by the NVivo software and by the work process supervision framework. Fifty-five cases served by the nursing staff, done at the supervisor's request in 23 cases, were observed. The biomedical approach focused on acute or chronic complaints and on drug prescriptions and tests predominated both in cases requested by the supervision and in the supervisors' responses. It was concluded that the supervision of the mid-level nursing staff by a higher level professional in the receipt of spontaneous demand enhances this activity's solvability. It is recommended, however, to expand the focus of the understanding and analysis of user needs from the perspective of completeness.

Nursing supervision for care comprehensiveness

“…As far as administration is concerned, nursing has historically adopted management models derived from other productive sectors, incorporating Taylorist principles that emphasize the division of work, which assigns particular tasks to workers (1,5) .…”

“…Finally, the sense of political articulation pervades all supervision actions, including those related to the monitoring of the work process and education: these actions lead to taking ethical and political stands (5) .…”

“…Both participative management and continuous education enable the grounding of technical decisions and enhance worker autonomy (5) .…”

“…This can limit the focus of supervision, restricting it to monitoring and controlling work without going any further in terms of educational aspects and ethical and political articulation, which can help improve care and working conditions (5,8) .…”

“…This will increase participation in care and monitoring its results, in addition to empowerment and satisfaction (8) . This situation demands new organizational work arrangements focusing on flexible management models that are based on practices based on dialog and inter-professional teamwork (5) .…”