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
Article
This article discusses the recent progress made in the counter-reform of the State in health, particularly in the privatization of the management for social organizations, and it also presents an explanatory theoretical focus on this phenomenon today.The new settings of the Brazilian health system resulting from the interactions between the State and the market are investigated by addressing the years beginning in the first Lula administration, from 2003 to the present, and the focus of the social organizations based or active in the states of Rio de Janeiro and São Paulo. Despite the expectations created for substantial changes in the economic and social policies, the Lula administration maintained important elements of governments that preceded him from the 1990s. At the state level, the Sérgio Cabral Filho administration clearly prioritized outsourcing. A critical analysis of the arguments used to boost this counter-reform is made based on a few case studies. At the end, an explanatory thesis is presented on the progress made in the light of the transformations of the material base, of the political superstructure of contemporary capitalism, and of the Brazilian social formation.
Article
This article aims to analyze the work of Brazilian author Carlos Rodrigues Brandão as related to the field of education and participatory research, highlighting his theoretical assumptions and establishing relationships with the field of healthcare. We conducted a qualitative, exploratory-descriptive investigation, using literature research as a methodological procedure. 'Education' was the main theoretical category. Additionally, we obtained the following empirical categories arising from textual analysis: 'Educations;' 'always learn from each other;' 'a participatory anthropology;' 'freedom, autonomy, and hope;' 'participatory research;' 'dialog: (Re)construction of knowledge or construction of knowledge;' 'research, knowledge, and time;' 'The sense of the word: the right to pronounce the meaning of the world.' We checked important foundations of a critical conception of education that can contribute as a basis for democratic health practices, such as the idea of 'dialog' as a pedagogical cornerstone that enables interaction processes among individuals and the social construction of knowledge.
Article
The National Policy on Continuing Education in Health was established in 2004 as the National Health System's strategy for human resource training. A Ministry of Health ordinance set guidelines for its implementation, reinforcing the technical Health System schools as priority institutions in coordinating and implementing the training of mid-level workers. This article was based on the results of a qualitative survey.Data collection consisted of the thematic analysis of documents originating from the awareness raising workshops and from interviews applied to regional, state, and technical managers of the regional health departments who attended the workshops, in addition to technicians from the State School of Professional Education in Health of Rio Grande do Sul (Brazil). The results indicate that they had knowledge of the ordinance and that the potential was in federal funding, access to the Regional Management Board, and in the commitment of those involved. The difficulties, meanwhile, were the lack of human resources in the State Department of Health, causing work overload; the fact that the school is neither decentralized nor accredited by the state; the release of municipal workers for training, and operational barriers in the implementation of financial resources in the state.
Article
This article focuses on the implementation of the National Men's Health Care Policy from the nurses' perspective. It is an exploratory and descriptive qualitative study in which 17 nurses from the municipalities of the Entre Rios Municipalities Association, in Santa Catarina (Brazil), were interviewed. After analyzing the data, it was concluded that there are knowledge gaps both concerning the NationalMen's Health Care Policy and on the actions carried out at the municipalities. Men's health is focused on the biomedical health care model. It is concluded that there is need to train the professionals in order to attain the development of the policy pursuant to its assumptions.
Article
The 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.
Article
This study aimed to analyze the determining factors for the choice of the Family Health Strategy as a field of professional practice in order to check for the influence of academic education and its implications. From October 2006 to February 2007, 22 higher level professionals (dentists, nurses and physicians) working in Family Health teams in a municipality of the state of Mato Grosso do Sul (Brasil) were interviewed individually. The interviews were recorded, transcribed, and analyzed pursuant to the theoretical and methodological framework of socio-historical psychology. It was observed that the professional choice of the Family Health Strategy was not reflective and critical, rather influenced mainly by the expansion of the area and job offers, a fact that may compromise their professional activities. We suggest investing in educational processes as a way to encourage and promote the work and the commitment of professionals with the Health System and, especially,Family Health.
Article
This study aimed to understand the hospital cleaning work from the workers' perspective and to describe, from their viewpoint, the impact the hospital environment has on their daily life and work. It is a qualitative case study that uses hermeneutics as its theoretical and methodological support. Data were collected through non-participant observation and interviews were carriedout with five cleaningworkers at a university hospital. The analysis was based on reading, seeking for the units of meaning contained in the transcript of the empirical data, which allowed for distribution into two categories: Daily hospital cleaning work and reflections on the outsourcing of the hospital cleaning workers' lives. At the hospital that was studied, female labor and the constant concern with health risks, especially biohazards, predominated. Outsourcing has a direct impact on the workers, as it makes them feel less valuable from the social and human viewpoints. The study points to the need for hospitals to offer a more welcoming environment for outsourced cleaning workers, upon whom so much physical and mental demand is imposed.
Article
This qualitative study aimed to address the care given to professionals who work at health care units, particularly the impacts, meanings and relationships at work, in addition to vulnerability to stress at work. The survey was conducted in the city of Santa Maria, state of Rio Grande do Sul (Brazil), with a sample of 14 participants from five health care units. The data were collected through interviews, observations and testing, and, subsequently, analyzed using content analysis. As a result, at times the work appears to be structuring, i.e., a key operator in the constitution of the subject, while at others deconstructive, able to destabilize one's identity and personality and cause mental illness. The motivations, the relationship with the community, and the dialog in labor relations, as well as the need for actions with the health professionals, from the perspective of caring for the caregivers' health, were perceived as fundamental in the relationship between mental health and work.
Article
This is a field study, with a quantitative approach, on the level of organizational commitment among municipal health surveillance inspectors. An analysis was made of possible differences between the sample groups, which were divided according to their sociodemographic characteristic s. The study included 335 inspectors from 53 Goiás, Brazil, municipalities, who responded to the 2011 Organizational Commitment Scale Bases. The scale covers seven different types of ties that employees have with the institutions they work for, as well as personal and professional data. The analyses were descriptive, variance, and chi-square tests. Noted were a high affective commitment and high sense of obligation for job performance, low feelings of affiliation and obligation to continue working in municipal health surveillance, in addition to differences between groups when the individual and professional characteristics were taken into account. The area's public managers should pay attention to the importance of human resources in the development of public policies and prioritize actions that result in high levels of commitment among these professionals.
Article
University extension in the educational process allows for the preparation of the praxis and scientific knowledge through actions in the community, generating a systematic process of knowledge exchange. This study evaluated the educational interventions of private higher education in public high school applied to the areas of sciences and prevention in health, conducted from February 2005 to November 2008. The intervention trained 20 high school students, and held the Youth Health Day, attended by 362 students from Salvador, Brazil. Anonymous questionnaires containing questions about the subject's activities were completed before and after each seminar and workshop. The importance of the intervention of private higher education in the training of public high school students was noted. Private higher education can participate in social inclusion, qualifying individuals to join the professional training process in a manner more attentive to the social dynamics. The challenge for higher education in the health field remains reconceptualizing its active role in health education and prevention, with the effective participation of academics, scientists, and educators.
Review
O mito da grande classe média: capitalismo e estrutura social. Marcio Pochmann. São Paulo: Boitempo Editorial, 2014, 148p.
Review
Diálogos paradigmáticos sobre informação para a área da saúde. Virgínia Bentes Pinto e Henry de Holanda Campos (Orgs). Fortale za: Edições UFC, 2013, 444p.
Ensaio
Healthcare regulation is a complex activity that includes many tools and strategies and can be divided into two dimensions: Socioeconomic and managerial. This theoretical-conceptual study discusses how the references of the ergological approach contribute epistemologically to healthcare regulation. Ergology is considered as an attempt to understand how the microcosm of human activity flows into and out of the macrocosm of social life. This perspective discusses the debate concerning norms and values and the ongoing crisis among the economic, political, legal and human activity that exists in society. In this sense, this study discusses how the dialectic approach of ergology, i.e. a perspective that considers that historical and social progress occurs through opposition, can contribute to the understanding of the arena of disputes that the regulatory activity in health is turned into, in the consequent strengthening of its social, economic and managerial objectives, and in minimizing its main limitations.
Experience Report
Those who suffer from mental health problems are usually exposed to psychosocial vulnerability due to factors not only related with their clinical condition but also with the stigma associated with mental illness. In this paper we present how a non-governmental organization in Buenos Aires, Argentina, promotes through a work and employment training program, social participation and work inclusion of people with mental illness. It is a case report that during six months two subjects participated in this program as they were assisted by the program. The results observed were mainly related with improvement of their occupational performance, changes in their daily life and their relation with others. The articulation of mental health professionals with Argentina's Ministry of Work, Employment and Welfare, meant challenges inside and outside of the worplace. It allows exploring and provides a view of how the inclusion process can be created with the commitment of different stakeholders and sectors of society.
Acknowledgements