Trabalho, Educação e Saúde - TES (Work, Education and Health) is an open access scientific journal, edited by the Joaquim Venâncio Polytechnic School of Health, from Oswaldo Cruz Foundation.
Editorial
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Review Article
The goals of this article are to summarize the characteristics of the Brazilian scientific production regarding the activities performed by the professionals of the Family Health Support Centers, to analyze the content of those activities, and to identify the facilitating and hindering aspects in the teams’ work process. We performed a review of the literature published between 2008 and 2015 in the SciELO e LILACS electronic databases. The results evince the prevalence of qualitative studies that describe the activities performed by specific professionals, particularly the user embracement, the care and the rehabilitation, with the actions of promotion of health, prevention, protection and vigilance, planning, programming, control, evaluation and management being less expressive. The training and permanent education actions are the least discussed actions. Among the facilitating aspects are proactivity and good interprofessional relationship, and among the hindering aspects are the persistence of the biomedical model within the Health of the Family field, the precarious working conditions, and the lack of support on the part of the management. We noticed a tendency to reproduce the hegemonic care perspective within the Health of the Family Support Centers, to the detriment of a process of change geared towards the comprehensiveness of care.
Article
The social determination of health and the social determinants of health have been presented as synonyms in a context in which this topic is being revisited. The conception of determination and determinants and the historicity of these theoretical models transcend the academic realm, once we consider the particularity involving public health, collective health, and social medicine, in which science and politics have a close relationship. Through the description of the differences between these two terms, our aim in this essay was to bring back, in theory, the elaboration of the social determination of health, highlighting its relationship with the knowledge produced in Latin America and its repercussions in Brazil, as well as the influences of the scientific and epistemological paradigms, the set of theories, and the projects that are in dispute in this field. In order to encompass the academic and political dimensions contained in the theoretical models, we sought the help of authors that move among different fields of knowledge. Without the intention of covering all of the points of observation that our incursion provided, we present a summary of our conception of the theoretical model of the social determinants of health and, chiefly, of the social determination of health, which we suggest should be divided into two categories, structural determination and structural-relational determination, in order to enable a better observation of the theoretical and methodological improvements, by emphasizing complexity epistemologically.
Article
In order to understand certain effects of the More Doctors Program (Programa Mais Médicos, in Portuguese), we studied the subjectivation processes that occurred in the constitution of the Cuban doctors throughout the revolutionary process triggered ever since the end of the 1950s. To do so, we analyzed many publications, and considered our experiences with these professionals using Michel Foucault’s formulations about how the power-knowledge relationships constitute the individuals, in the connection between political aspects and ethical processes. We demonstrate the role that the public health system has in the Cuban Revolution, identifying the centrality of the doctors in this process; we discuss the moral aspects that have an impact on the ethical constitution of the Cuban doctors, especially the figure of the revolutionary and the practices of solidary internationalism. Lastly, we analyze the recent transformations in that country and their yet undefined consequences for the subjectivation of the Cuban doctors.
Article
The article opens a methodological discussion on health research prompted by discomfort caused by dominant directrix for which there is a reality ready to be unveiled, and the expectation is that the researcher will access it. We describe a cultivation of an investigative process by means of the return of results of an epidemiological research in Rio de Janeiro, Brazil, between 2010 and 2013. The return prioritized dialogue with the nursing teams, framed by the concept of restitution, from French Institutional Analysis. We discussion groups on findings and meetings on nursing workers’ health that brought together hospital managers and workers to agree measures on worker’s health field. Participation by all stakeholders changed manners of researching and intervening, on the basis that health practices are produced in encounters among subjects. Drawing on tools commonly used only to report fin-dings, we walked from the merely informative return to participative restitution. In shaping the return process collectively, the intention was to challenge researches such as those that consider a dichotomy between researchers and researched, since we consider that methodologies and instruments arise in process of co-engenderment. In that respect, it comes to transform health researchers ’ ethical concerns into a health researchers’ ethos, from the understanding that research happens in the collective, which includes researchers and researched in the production of a common.
Article
Ethical problems in public health – especially those concerning primary health care – require a specific and adequate approach. The factor analysis of quantitative data about ethical problems in primary health care pointed to management, longitudinality, team experience, professional profile, secrecy and privacy as specific topics. In the subsequent qualitative stage, we searched for examples and solutions through a focal discussion with primary health care teams in the cities of Porto Alegre and Sapucaia do Sul, in the state of Rio Grande do Sul, Brazil. The adopted methodological approach was the Grounded Theory. The analysis of the results had as reference points the causal and intervening conditions and the strategies for action when facing these problems. The fragmentation of care and the lack of prominence, caused by insufficient planning and permanent education, weaken the users and the professionals. The refinement of these results through selective codification reached the nuclear category of programmatic vulnerability as an explanatory category for the occurrence of ethical problems in primary health care.
Article
The main goal of the present study was to analyze the politics of human resources in health in state hospitals managed by health social organizations in the state of Espírito Santo, Brazil. We conducted a qualitative research, choosing as the field of investigation the social organizations that manage public hospitals in the state. During the data collection process, we sought the regulations and management contracts signed between 2008 and 2016, and performed individual interviews with the human resources managers of the participating institutions. During the analysis of the fieldwork materials, we used the content analysis technique, and chose five empirical categories of analysis of the contracts: the employment relationship model, the permission to hire legal entities, the percentage of expenses with staff, the procedure used to hire staff, and the goals regarding people management. The interviews were analyzed through the units of meaning proposed by Kvale. The results showed that the contracts omit legally-required information and have too many amendments. The people management practices are typical of private companies, and follow some guidelines of the work in health, but without reference to the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym). They adopt methods that are different from the rules of the public service entrance exams and the non-precarization of labor.
Article
The research had the goal of analyzing the perception regarding the work on the Family Health Strategy. We conducted a case study in the city of João Pessoa, in the state of Paraíba, Brazil, in 2014, with a questionnaire applied to a sample of workers with higher education (n = 342), interviews with managers (n = 6), professionals (n = 12), and a simple in loco observation. The data were treated by means of an analysis of the content and by descriptive statistics. The most evident qualitative goal of the work performed by the Family Health Strategy was improving the health conditions of the users. It was put into effect though the prevention, promotion, education and treatment of diseases, incorporating the expanded concept of health and autonomy of the population. However, according to the quantitative data, little time was devoted to these activities when compared to the time devoted to the spontaneous demands, generating a significant number of individual consultations. Activities regarding education, prevention, promotion and group approaches must be stimulated and incorporated into the everyday activities of the Family Health Strategy in a manner that intersects all of the actions, in which the expanded medical practice is a powerful tool. More involvement on the part of the professionals in these activities will enhance the quality of the assistance though interprofessionality, and will help break free from curative practices.
Article
Undergraduate studies in the fields of health are currently being debated regarding the need for change in their syllabuses concerning the principles of the Brazilian Unified Health System, among other topics. Overcoming the operational and technicist education and expanding the critical thinking abilities of the students about the historical and political determinations of health are among the challenges highlighted. The article analyzes the teaching/learning process with a critical perspective based on the Historical and Political Education Course for Undergraduate Health Students, an extension semi-virtual course offered nationally, and supported by the National Policy for Popular Education in Health within the Unified Health System. In the present article, we analyzed the experiences brought about by the course, which took place between March and December 2014. The development of the course was based on the theoretical and methodological conceptions of the construction of shared knowledge, guided by the field of Popular Education and Health. The article presents: the history and the process of development of the course, the political and pedagogical project, the educational and pedagogical materials, and the contributions and questions, with notes on the potential future implications in educational processes in the field of health.
Article
Brazilian higher education has been historically marked by the presence of private institutions. During the unhindered expansion that took place over the past two decades, the private sector presented a growth in the number of enrollments and in the percentage of participation. This article describes the private participation in the undergraduate courses in health in the period between 1993 and 2013. The review of the literature on Brazilian higher education and the descriptive analysis of the secondary data evinced that the participation of the private sector in the training in health, in many aspects, has been compatible with the dynamics of the higher education sector. In the 1990s, the growth of the private sector was a trend in all undergraduate courses in health, and, in most courses, the growth rates were higher than the national average. In the period between 2003 and 2013, the courses of Medicine, Odontology and Social Services presented growth rates that were higher than those of the preceding period, and the other courses presented a decrease in the growth rates; as for the courses of Biology, Speech and Language Therapy and Occupational Therapy, a decrease in the number of enrollments in private institutions was observed.
Article
We analyzed the training of health care professional for the care of women in instances of sexual violence in two Brazilian state capitals, in a qualitative study with 140 professionals of different categories working in 18 health care institutions in the cities of Fortaleza and Rio de Janeiro. Semi-structured interviews were performed, and the empirical material was analyzed according to the content analysis technique. Gaps in the training of the professionals due to an insufficient approach of this topic during the undergraduate studies in the field of health were observed in both municipalities. The weakness of the professional training for this kind of practice was reinforced by gaps in the training actions. In the city of Rio de Janeiro, these actions were more frequent and continuous. The inclusion of this topic in the professional training, the expansion of training processes, and the continuing education of the health care teams in the services are important. Such measures will make viable a critical understanding of this phenomenon, contributing to the implementation of diverse interventions.
Article
Tuberculosis is one of the main grievances to be combated throughout the world, and the high incidence among the population that is deprived of freedom (904.9/100 thousand inhabitants, in 2013) contributes to increase the dimension of the problem. This study presents the analysis based on action research, which was developed through an institutional intervention that used Ongoing Education in Health to reorganize the care provided to those deprived of freedom who have tuberculosis. The participants of the research were the nursing workers at a penitentiary in the state of Paraná, Brazil; the workers participated in seven Ongoing Education in Health workshops. Three of the workshops were on team work, user embracement and joint responsibility; two other workshops discussed the current aspects of the disease, the care practice developed, and a new work proposal was established by the team. The last two workshops monitored the implemented proposal and corrected mistakes. The action research combined with the Ongoing Education in Health was adequate regarding the development of the intervention, and enabled the change in the practices of the workers and the transformation of the care for people with tuberculosis in that institution.
Article
The article is the result of a cross-sectional study about care in mental health with 29,778 teams from the Family Health Strategy from all over Brazil (87.1% of the total of teams), including a normative evaluation of the data of the second cycle of the National Program for the Enhancement of Access and Quality in Primary Health Care (2013-2014) in the dimensions of the profile of the professionals, promotion of mental health, management, and offer of care. The results showed that 33.8% of the interviewees had precarious labor relationships, and that 60.3% of them did not feel prepared to work in mental health. The offer of the set of actions evaluated only occurred in 9.5% of the teams in all of Brazil (2.2% in the Northern region). Around half of them did not develop strategies to promote health, and only 9.8% actually carried out the management of care. We concluded that the low percentages of implementation on the national level coexist with significant regional inequalities, with the worst results coming from the Northern region. It is necessary to strengthen the actions of promotion of health, the qualification of the teams, to reverse the precariousness of the labor relationships, and to reorganize the management of care.
Article
The damages resulting from alcohol abuse gained prominence in the eighteenth century, with the rise of capitalism. Sanitary and governmental control measures followed the sociohistorical construction. In Brazil, the Alcohol and Drug Policy of the Ministry of Health, implemented in the first decade of the twenty-first century, proposed network care actions, including primary health care services. In spite of the efforts to train the professionals, the actions in health are little welcoming, stigmatizing and inefficient due to the complexity of the topic. With the aim of getting to know and analyzing the beliefs and health practices in the care offered to alcohol users in primary health care, we conducted this qualitative research with the health professionals of a primary health care service using semi-structured interviews and content analysis. The theoretical references related to collective health and social sciences support this analysis. The results pointed to moralizing and bigoted attitudes, with a practice that criminalizes alcohol use, mainly among lower-income classes, guided by normalized conducts, with a focus on the removal of risk and on complete abstinence, according to the hegemonic biomedical model, and distant from the needs of the subjects and the complexity that surrounds the issue.
Article
This study had the aim of understanding the dynamics of the process of institutionalization of the only Family Health Support Center set up in the city of Campinas, in the state of São Paulo, Brazil. Even though the city is a pioneer in the practice of matrix support, in it, the establishment of the Center happens at a very slow pace, and it is relevant to identify the factors related to the inexpressive presence of this organizational arrangement, as well as to analyze its practices. We chose to make a single-case research, and, in order to produce the empirical material, we used participant observation and focal groups. The data were grouped in two axes: the ‘made history’, which focus on the context of the municipal health policies; and ‘history in the making’, which refers to the comprehension of the perceptions of the participants of that history. We observed that the experience of the studied Family Health Support Center presents potentialities and tensions. The matrix support methodology is the basis of the practice of the team, and favors the bond with primary health care, the development of an interactive interprofessional relationship, guided by the exchange of knowledge and the strengthening of the work in network. However, the difficulties in the expansion of these centers as an imperative organizational arrangement point to the permanence of the tensions regarding the history of the conformation of the matrix practices, which are based on independent teams and are organized by topics.
Article
The aim of this study was to systematize the configurations of Family Health Support Centers. A qualitative study was conducted in three municipalities of metropolitan Recife, in the state of Pernambuco, Brazil, and considered data collected from focus groups in three Family Health Support Centers and analyzed through the meaning condensation technique. The study’s findings allowed the systematizing of three types of configurations: the assistive-curative, which shows great distancing from the family health support center’s goals; the semi-matrical, considered to be an intermediary configuration, and the matrical, which stays closer to the ideal model, recommended by the Ministry of Health. In conclusion, there is, on all three municipalities, a recent and fragile family health proposal that, despite its potentialities, is permeated with conflicts, contestations and uncertainties. The findings of the present study can assist in the planning and execution of actions that seek to break from various hegemonic concepts regarding the work of primary healthcare professionals.
Article
The career path plays a significant role in the lives of people nowadays. Based on this premise, we sought to understand the meaning of community in the work context of a multiprofessional hospital team. The qualitative research was conducted through semi-structured interviews with eight professionals of the outpatient hematology and pediatric oncology services at a public hospital in the Southern region of Brazil, from April to June 2015. The interviews were analysed using Discursive Practices. We established four categories, which originated from the theoretical components of the meaning of community. The results indicate that the elements of belonging; influence; integration and satisfaction of needs; and shared emotional bonds were present in the discourses of the team. There was a proximity among the narratives of the participants and the concept of community in order to characterize the contexts of the work and of the relationships developed. However, we also noticed signs of hierarchical tensions in the relationships, the validation of individualist practices, non-externalized conflicts, and the difficulty to deal with differences. We concluded that there is a need for higher investments in the validation and integration of the different professionals implicated in the process of promotion of health and of the meaning of community among Brazilian teams.
Article
What is the relationship between urgencies and chronic care? This question, which is appa-rently paradoxical, was approached in an ethnography conducted at the largest emergency care hospital of a Brazilian metropolis; the ethnography investigated medical care from admission to the confirmation of the clinical and functional condition of the patient with severe sequelae. Between December 2012 and August 2013, we conducted interviews and participant observation with 43 physicians: 25 men and 18 women, aged between 28 and 69 years. The analysis, which was guided by the signs, meanings and actions model, led to the realization that the care varies according to the context: at the ‘gateway’ and at the ‘intensive therapy center’, the struggle to maintain life is intense; at the “chronic patient” sector, care is provided to people who survive, but who have a high degree of dependence. For the physician, ‘life’ means regaining previous function, while survival with dependence would mean a ‘living death.’ The physician refrains from dealing with a highly-limited human being, for he/she feels somehow guilty of the clinical picture, even though he/she feels compassion towards the patient who requires chronic care. The insufficiency of a long-term care network and the lack of palliative training on the part of the physicians cause suffering in those who care and in those who are cared for.
Article
The research analyzed the transfer of funds to Health Social Organizations through congressional amendments in the Legislative Assembly of the state of Espírito Santo, Brazil. The study was conducted through an analysis of documents. A cross-check of data was performed in order to identify the possibility that these organizations indeed received funds through congressional amendments between 2009 and 2014. We analyzed 109 amendments that proposed the transfer of funds to the Health Social Organizations and their sponsoring entities. In that period, a total of R$ 4.817 million were proposed for those institutions: R$ 4.627 million for the Evangelical Benevolent Society of Espírito Santo (from the Portuguese Associação Evangélica Beneficente Espírito-Santense), and R$ 190 thousand for the Santa Catarina Congregation association (from the Portuguese Associação Congregação de Santa Catarina). According to the data, there is a relationship between the number of congressional amendments that were proposed for these sponsoring entities and the political parties that won the elections. In election years, there is an increase in the number of amendments proposed. We highlight the inexistence at the Espírito Santo Legislative Assembly of transparency instruments to oversee the executions of the congressional amendments.
Article
The study had the goal of presenting the distribution of nurses in the job market with a weekly workload greater than or equal to forty hours according to the regions of Brazil and the kind of workplace (whether in the private or public sectors). It was a cross-sectional study, conducted between 10 and 27 of February 2017, with on-line data from the medical-sanitary researches conducted in 2002, 2005 and 2009 by the Brazilian Institute of Geography and Statistics. We analyzed a total of 179,337 nurses in the 3 evaluated years. We compared their proportions according to each geographical region of Brazil and the workplace using Pearson’s Chi-squared test (α = 5%). Nursing was the only college-level healthcare occupation that presented a larger and increasing proportion of professionals with a weekly workload greater than or equal to 40 hours (p < 0.001), and this proportion is greater in the public sector and in the Northern, Midwestern, and Southern regions of the country. The occupation of nurse still has an unfavorable workload, which constitutes a challenge to the nurses and to nursing as a profession.
Article
The aim of this qualitative and quantitative research was to get to know and analyze the working conditions of the public servants who work at the National Institute of Social Security (from the Portuguese Instituto Nacional de Seguro Social) and have ties with the Social Security System in the south of the state of Santa Catarina, Brazil, focusing on the implications to their health. This exploratory research was performed between 2013 and 2017. The sample was composed of 165 workers from 11 agencies of the National Institute of Social Security in that region, who filled out a questionnaire with scales to rate working conditions and well-being in association with open questions. In a second moment, we adopted the narrative technique with the goal of complementing the data. The mean result of the working conditions scale (0-10) was 6.65 (SD = 1.39); as for the well-being, the mean result of the scale (0-7) was 4.99 (SD = 1.13). We observed ethical dilemmas deriving from the quality of the work, with the prioritization of the fulfillment of quantitative goals due to the introduction of the logic of the private sector within the management of the work in the public sphere. We concluded that the working conditions and well-being have negative repercussions on the health of the workers.
Article
We discuss the professional integration of Collective Health graduates, particularly regarding the challenges, the potentialities and the strategies of integration in the world of labor. The production of data occurred mainly by means of three focal group sessions with the graduates from the classes of 2012.2, 2013.2 and 2014.2 of the undergraduate course on Collective Health of the Federal University of Rio Grande do Norte (Universidade Federal do Rio Grande do Norte, in Portuguese). The resulting accounts were systematized and subjected to Bardin’s thematic content analysis technique. Regarding the professional challenges, we discuss the subcategories: salary, recognition of the Collective Health profession, political interference, and identity. As for the potentialities, they have the following subcategories: practical experiences during the undergraduate studies; a center for knowledge and practice in Collective Health; and the circumstances within the Municipal Health Department of the state capital of Natal. Regarding the strategies for professional integration, we identified actions of an individual as well as collective nature, a movement organized by graduates and students, who aim to divulge the course and its professional, as well as to make progress in the process of construction of a new profession.
Article
The reorganization of the world of labor has a strong impact over the life and health statuses of the working class. Teachers, as well as other workers, have been going through a process of precarization of labor, among other consequences of flexible accumulation, with the increase in the requirements without a sufficient increase in the resources that are needed in order to perform the work. The significant increase in mental suffering among teachers seems to be connected to the new working conditions. With the goal of providing elements in order to face this issue, we developed a research with the aim of observing the association between the increase in exploitation in the work of the teachers and mental suffering. We performed a cross-sectional study using the Limesurvey online survey tool, in which 1,201 teachers of the state school system answered 2 online questionnaires: the Self-Reporting Questionnaire-20 and another one, developed by the researchers, about the working conditions of the teachers. The weekly working hours, the amount of students per classroom and the amount of classes of students per teacher showed an association with minor psychological disorders. The association between the amount of students per classroom and the presence of a minor psychological disorder was statistically significant. We concluded that the prevalence of cases that indicate psychological disorders is very high among teachers, and there are signs of an association with many different kinds of exploitation in the work of teachers.
Article
The goal of this study is to assess the elements associated with the negative self-assessment of health among nursing workers. We performed a cross-sectional exploratory study, with a probability sample composed of 451 Primary Health Care nursing workers. We applied a questionnaire with sociodemographic data, as well as data on life habits, occupations, psychosocial aspects and satisfaction at work and morbidity of the workers. The self-assessment of health was measured through the question “Overall, in comparison with other people your age, how would you consider your own health status?” The data was analyzed using the model of logistic regression in blocks. We identified a prevalence of 15.8% of negative health self-assessments. The factors associated to it were: incompatibility of the activities developed with the position, medium and high housework overload, active work situation (high control, high demand), poor assessment of the quality of life, and common mental disorders. The findings confirm the relationship between the health-disease process and the life and working conditions, and point to a need for public policies of prevention and promotion of the health of nursing workers. By constituting favorable work situations, these policies may be highly relevant for the quality of the care provided to the users of the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym).
Article
The research analyzed the process of socialization and transformation of nursing technicians into nurses through a descriptive and exploratory study, with a qualitative approach, conducted with 24 nursing technicians enrolled in an undergraduate course at a university in the state of Ceará, Brazil. The study was conducted between September and October 2016, through individual semi-structured interviews, with a thematic analysis in order to organize the data, which were discussed according to the presuppositions of the sociology of professions. Based on the results, three categories emerged: motivations for career progression; the dissimilarities between the work of the nurse technician and the nurse; and professional growth in the course of their studies. We noticed a process of professional socialization in the educational path of a nurse technician, which was motivated by a desire for career progression. The gradual transition is important so the technician can adapt to a new identity in the making, which can facilitate the migration among individuals with different levels of complexity in the nursing practice.
Article
The present article analyzes the indexation and data retrieval tool called Descriptors in Health Sciences (Descritores em Ciências da Saúde, DeCS, in the Portuguese acronym) as an ideological-discursive object, through the perspective of the Franco-Brazilian discourse analysis. The research was performed between 2014 and 2015. In order to do so, we considered the historical conditions in which the Descriptors in Health Sciences were created, and we compared between a particular aspect of education and the meanings of some of the entries related to the field labor, education and health. Lastly, we sought to contribute to the field of library ccience with considerations about discourse and ideology in reading, selection and development of documentary languages.
Article
Regulation NR 32 has the goal of reducing accidents and disease among health workers. Adopting the perspective of the discourse analysis proposed by Michel Pêcheux, in this research we had the goal of understanding the process of signification regarding safety and health at work within the NR 32, and learn how this process signifies in the public policies in Brazil. We show that, even though the regulation is a means of guaranteeing the safety and health of the worker, its discursiveness formulates safety as a myth based on claims that are not part of the process of regulation of labor conditions and are unconnected to the collective and cultural requirements for production. In this process, the responsibilization of the worker is produced, and the workers become watchmen of themselves, and are held accountable for that in an individualized manner. Finally, we could observe an effect of meaning that points to a connection that, in practice, results in financial support to the companies that make and/or sell the safety devices for sharps.
Article
This is a study about the participants of clinical trials in the field of oncology that discusses the paradox between scientific advances and social inequality. We sought to get to know these people and to analyze the aspects involved in their decisions based on interviews and documents. Female participation was more expressive. The participants tend to have low schooling and low income. Most of them are retirees and housewives, and do not get assistance from the private health system. Their decisions revolved around the search for cure or recovery, as well as for the assurance of regular access to comprehensive health care and medicines. Signing the free and informed consent form did not guarantee the expression of autonomy, because crucial information, such as the goals, risks and post-study care are virtually unknown. The research participants tend to not understand the goals of the investigation, or they overestimate the direct medical benefits of their participation, and they tend to be unaware of the risks involved and of what does a research mean. The results should stimulate more critical practices and dialogues among the different players and institutions involved in the field of the research with human subjects, with the goal of promoting a science that is conscious and responsible, and that prevents people from being put in situations of inequality, vulnerability and moral suffering.
Article
The study investigated how the Physiotherapy undergraduate courses take into consideration the teaching of Primary Health Care within the context of the expansion of the Family Health Strategy, taking as reference the Brazilian National Syllabus Guidelines for Undergraduate Courses in Physiotherapy. We analyzed 10 out of the 14 Physiotherapy courses accredited by the Brazilian Ministry of Education that were being offered in the city of Rio de Janeiro at the time of the research. We interviewed the ten course coordinators and analyzed the documents regarding the teaching and the syllabus. The collected data indicate that two courses followed the Syllabus Guidelines by offering activities and/or disciplines and supervised internships in Primary Health Care, with a redistribution of the credit hours, and activities involving assisted practices and extension. Seven courses had implemented partial syllabus changes, but they did not incorporate other recommendations of the Syllabus Guidelines, especially the inclusion of Primary Health Care disciplines or modules, and did not offer training opportunities in Family Health units. One course had not implemented the Guidelines. The coordinators mentioned difficulties in developing a participatory syllabus. We concluded that we observed a significant progress in the incorporation of Primary Health Care in the analyzed syllabuses, and we discuss some of the obstacles in the implementation of the National Syllabus Guidelines.
Article
Phenomenology as an inquiry method reveals itself as a possibility of making the relationship between the health professionals and the users of the health care system closer. This study aims to contribute to the process of philosophical appropriation of this perspective within the researches in this field. The research was conducted with the goal of analyzing the periodical scientific production related to this subject, identifying the phenomena assessed in these studies, the theoretical phenomenological perspectives adopted, as well as the fields of origin of the articles found between 2010 and 2014. The data were collected between December 2014 and February 2015 in the Scientific Electronic Library Online, Virtual Health Library (“Biblioteca Virtual de Saúde”, in Portuguese) and Capes Periodical Portal (“Portal de Periódicos Capes”, in Portuguese) databases. In the 17 selected articles, the prevailing field is nursing, which follows this metho-dology; Alfred Schutz is predominant as a philosophical guide, followed by Heidegger. In 12 of the works, the studied topics were related to women. Most of the studies did not provide reflections about the phenomenological research, focusing on hearing the narratives and on the phenomenal description that is revealed with the use of thematizations. The Brazilian publications are scarce, and, moreover, they do not provide enough guidance for the production of the investigation of the essences.
Ensaio
In this thoughtful theoretical essay, we developed a discussion regarding the assessment of learning in the process of training for care in Nursing in Collective Health throughout the supervised internship. We had conversations with the authors of Collective Health and of the assessment of learning by competencies, mainly those involved in medicine, who were pioneers in this debate, using the hierarchical-conceptual model of assessment by competencies proposed by George Miller. We sought to make a contribution by presenting the possibilities of methods, tools and procedures for the assessment of learning in summative or formative contexts, and the perspectives and tendencies of the assessment of the teaching-learning process in the field of Nursing. We verified that the assessment by competencies needs to be more discussed in order to be in line with the ongoing syllabus changes and the demands for the training of professional profiles that is in accordance with the needs and principles of the Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym).
Review
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