O agir dos profissionais de saúde em um hospital urgência emergência (hue): multiplos arranjos multiprofissionais de cuidado
Data
2022-11-28
Autores
Cruz, Nelma Lourenço de Matos [UNIFESP]
Orientadores
Andreazza, Rosemarie [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Analisar a atuação dos profissionais em seu trabalho em equipes multiprofissionais para a produção do cuidado num hospital de urgência emergência – seus desenhos e suas dinâmicas de trabalho, suas relações e seus entornos. Método: Pesquisa de caráter qualitativo, tipo estudo de caso. Usou a cartografia a partir da observação participante de um arranjo de gestão do cuidado – o Kanban – com produção de diários de campo por meio dos quais foram descritos os fenômenos, processos, ambientes físicos e sociais dos cotidianos das equipes do Hospital de Urgência e Emergência (HUE). Estes são os acontecimentos que guiaram os movimentos em campo sem perder o foco da pesquisa. Resultados: No HUE, existiam diferentes desenhos e dinâmicas de equipes multiprofissionais, com distintos agires no cuidado à saúde: não só a multiprofissionalidade e a interprofissionalidade estavam presentes, mas também a multidisciplinaridade e a interdisciplinaridade. Os membros de uma equipe mostraram que influenciam os desenhos, as dinâmicas e as ações das equipes; a relação de poder analisada a partir da composição de campo de forças era plástica e movente entres seus membros a depender do local onde aconteciam; a gestão se mostrou presença marcante nas equipes, pareceu ter um olhar “panóptico”; os membros das equipes se protegiam e protegiam a equipe; os conflitos entre os membros das equipes se fizeram presentes; o trabalho do entorno se mostrou importante na configuração do HUE e nos agires das equipes; os funcionários demonstraram satisfação e um grande sentimento de pertencimento. Convivem no hospital estudado forças instituídas – como a divisão técnica e social do trabalho em saúde e a instituição médica – que parecem manter uma organização bastante tradicional, pois há relações de autoridade e de controle estabelecidas – o que sabidamente pode dificultar a produção de um plano comum de ação, necessário para produção de um processos interprofissionais e interdisciplinares e a produção de um cuidado mais integral e equânime. Também há forças instituintes que agem. A própria manutenção dos arranjos de gestão do cuidado, pela forte adesão dos trabalhadores a elas; os instrumentos de avaliação e de monitoramento profissionais individuais compartilhados com todos via Prontuário Eletrônico do Paciente (PEP); a ação profissional independentemente da demanda médica; as dinâmicas distintas das reuniões são exemplos dessas forças. Conclusão: O trabalho em equipe multiprofissional, na complexidade inerente à produção de um plano comum de cuidado, a partir de um processo de interprofissionalidade, com maior ou menor grau de interdisciplinaridade, que acontece de formas distintas e não lineares, aumentando ou diminuindo sua potência. O campo das relações interage com o projeto institucional. Há uma composição a ser permanentemente analisada para sair do plano do conteúdo – da necessidade do trabalho em equipe – e dar visibilidade à expressão desse trabalho em suas múltiplas possibilidades. Os profissionais da saúde agem não apenas operando seus núcleos profissionais, mas, sobretudo, na produção de relações de afeto e de poder. Nem sempre submissos, nem sempre protagonistas, cumprem papéis diferentes nas relações, se calam, se expressam, afetam e são afetados.
Objective: To analyze the professionals of performance in their work in multiprofessional teams for the production of care in an emergency hospital - their work designs and dynamics, their relationships and their surroundings. Method: Qualitative research, case study type. Cartography was used as from participant observation of a care management arrangement - Kanban - with the production of field diaries through which the phenomena, processes, physical and social environments of the daily lives of the teams at the Urgency and Emergency Hospital (HUE) were described. These are the events that guided the movements in the field without losing the focus of the research. Results: In the HUE, there were different designs and dynamics of multiprofessional teams, with distinct actions in health care: not only multiprofessionality and interprofessionality were present, but also multidisciplinarity and interdisciplinarity. The members of a team showed that they influence the design, dynamics and actions of the teams; the power relations analyzed from the composition of the field of forces were plastic and moving among its members depending on where they happened; the management showed a strong presence in the teams, it seemed to have a "panoptic" look; the members of the teams protected themselves and the team; the conflicts among the members of the teams were present; the work of the surroundings proved to be important in the configuration of the HUE and in the actions of the teams; the employees showed satisfaction and a great sense of belonging. Instituted forces coexist in the hospital studied - such as the technical and social division of health work and the medical institution - which seem to maintain a very traditional organization, since there are established authority and control relationships - which can be known to make it difficult to produce a plan. action necessary to the production of an interprofessional and interdisciplinary process and the production of a more integral and equitable care. There are also instituting forces that not only react, but act. The very maintenance of the care management arrangements, due to the strong adherence of the workers to them; the individual professional evaluation and monitoring instruments shared with everyone via the Electronic Patient Record (EHR); the professional action independent of the medical demand; the different dynamics of the meetings are examples of these forces. Conclusion: The multiprofessional teamwork, in the complexity inherent to the production of a common care plan, from a process of interprofessionalism, with a greater or lesser degree of interdisciplinarity, which happens in distinct and non-linear ways, increasing or decreasing its potency. The field of relationships interacts with the institutional project. There is a composition to be permanently analyzed in order to leave the content plane - the need for teamwork – and give visibility to the expression of this work in its multiple possibilities. Health professionals act not only operating their professional nuclei, but, above all, in the production of relationships of affection and power. Not always submissive, not always protagonists, they play different roles in relationships, they keep quiet, express themselves, affect and are affected.
Objective: To analyze the professionals of performance in their work in multiprofessional teams for the production of care in an emergency hospital - their work designs and dynamics, their relationships and their surroundings. Method: Qualitative research, case study type. Cartography was used as from participant observation of a care management arrangement - Kanban - with the production of field diaries through which the phenomena, processes, physical and social environments of the daily lives of the teams at the Urgency and Emergency Hospital (HUE) were described. These are the events that guided the movements in the field without losing the focus of the research. Results: In the HUE, there were different designs and dynamics of multiprofessional teams, with distinct actions in health care: not only multiprofessionality and interprofessionality were present, but also multidisciplinarity and interdisciplinarity. The members of a team showed that they influence the design, dynamics and actions of the teams; the power relations analyzed from the composition of the field of forces were plastic and moving among its members depending on where they happened; the management showed a strong presence in the teams, it seemed to have a "panoptic" look; the members of the teams protected themselves and the team; the conflicts among the members of the teams were present; the work of the surroundings proved to be important in the configuration of the HUE and in the actions of the teams; the employees showed satisfaction and a great sense of belonging. Instituted forces coexist in the hospital studied - such as the technical and social division of health work and the medical institution - which seem to maintain a very traditional organization, since there are established authority and control relationships - which can be known to make it difficult to produce a plan. action necessary to the production of an interprofessional and interdisciplinary process and the production of a more integral and equitable care. There are also instituting forces that not only react, but act. The very maintenance of the care management arrangements, due to the strong adherence of the workers to them; the individual professional evaluation and monitoring instruments shared with everyone via the Electronic Patient Record (EHR); the professional action independent of the medical demand; the different dynamics of the meetings are examples of these forces. Conclusion: The multiprofessional teamwork, in the complexity inherent to the production of a common care plan, from a process of interprofessionalism, with a greater or lesser degree of interdisciplinarity, which happens in distinct and non-linear ways, increasing or decreasing its potency. The field of relationships interacts with the institutional project. There is a composition to be permanently analyzed in order to leave the content plane - the need for teamwork – and give visibility to the expression of this work in its multiple possibilities. Health professionals act not only operating their professional nuclei, but, above all, in the production of relationships of affection and power. Not always submissive, not always protagonists, they play different roles in relationships, they keep quiet, express themselves, affect and are affected.
Descrição
Citação
CRUZ, Nelma Lourenço de Matos. O agir dos profissionais de saúde em um hospital urgência emergência (hue): multiplos arranjos multiprofissionais de cuidado. São Paulo, 2022. 178 p. Tese (Doutorado em Saúde Coletiva) – Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo(UNIFESP). São Paulo, 2022.