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
The technical cooperation among Latin American countries has been promoting great debates in the field of collective health and in the consolidation of labor management in the Brazilian Unified Health System (SUS, in the Portuguese acronym). The present paper had the goal of understanding the conceptions of Primary Health Care managers in a municipality located in a border region - which has been historically distant from the Brazilian sanitary reform movement - regarding the implementation of the “More Doctors” Program. The study is of a qualitative nature, and it was based on the hermeneutic-dialectic method, with an exploratory approach, and was conducted in the tri-border area of Brazil, Paraguay and Argentina. We performed open interviews that were recorded, transcribed and analyzed in an interpretive and dialectic manner in the empirical-conceptual context. In the understanding of the managers, the Program contributed to the continuance of the offer of services in the local Primary Health Care, and it is a way to ensure the provision of medical care in a municipality located in a border region. The Program also contributed to the co-responsibilization for the care. We observed a dialectic movement in the longitudinality attribute as well as in the difficulties to operationalize the binomial management-planning, demonstrating a contradiction in the operational praxis of the services. We concluded that, for the managers interviewed, the Program was an important strategy for the management of labor in health, even though there is a critical issue regarding the fleeting period these professionals remain in the Primary Health Care teams.
Article
The present study was conducted in September 2018, and had the goal of checking the current state of the teaching of speech therapy in Brazil through a characterization of its undergraduate courses. In order to do so, a documentary and descriptive research was conducted with a quantitative and qualitative approach. Data collection was made through the website of the Brazilian Ministry of Education. We analyzed 87 speech therapy undergraduate courses linked to public (27.6%) and private (72.4%) higher education institutions, totaling 7,044 slots offered annually, with an average of 3,681 credit hours, and a period of integralization ranging from eight to ten semesters. The courses were distributed among 23 Brazilian states, with a higher concentration in the Southern region of the country. Most courses were graded 3 regarding the indicators of quality proposed by the Ministry of Education. We concluded that the teaching of speech therapy in Brazil is fundamentally in-person, private, distributed throughout the country, with a low rate of students taking the slots, an aspect deduced by the small number of graduates compared with the amount of slots offered, higher credit hours in the public higher education institutions, concluded between eight and ten semesters, and it presents satisfactory quality indicators.
Article
Supervision promotes changes in the services under the perspective of psychosocial care. Its institutionalization took place in the fields of clinical practice, training and management in health, and it expresses contradictory forces that were established and that also establish these forces. The present study originated from a research that analyzed the clinical-institutional supervision process within two teams of the health care network of a municipality in the countryside of the Northeastern region of Brazil. The theoretical-methodological framework used was that of the institutional analysis, under a socioclinical perspective. The process took place throughout 12 meetings from March 2011 through February 2012, and was recorded on institutional journals. During this process we evidenced that: the analysis of the order, and especially of the demands, mobilized the supervision process; there were conflicts regarding the use of clinical cases and the development of unique therapeutic projects, as well as regarding the understanding of the supervision training process; there were rivalries and cooperation between the two teams regarding the development of care in municipal networks; challenges arose regarding the care of the crisis in the context of the regional networks under the perspective of psychosocial care. The supervision directive must be expanded and internalized, and constantly reviewed so it can be in line with the presuppositions of psychosocial care, and also to provide moments of experimentation on the part of the workers as groups-subjects.
Article
Teaching-service integration, understood through the combined work of students, teachers and workers in a practice setting, has as its goals excellency in professional training and quality of the work in health. The goal of the study is to analyze, through the perception of the students, the teaching-service integration, which takes place during the undergraduate Pharmacy studies. It is a quantitative study conducted in 2018, and characterized as a cross-sectional survey in which a structured questionnaire was applied. A total of 155 undergraduate Pharmacy students, enrolled in three different universities, a private university and two public ones, located in the metropolitan region of the city of Porto Alegre, in the state of Rio Grande do Sul, Brazil, participated in the study. The results found indicate the potentialities of the internships in public health settings for the training of Pharmacy professionals who are more confident regarding their future work at the Brazilian Unified Health System. The data obtained reveal the variable age of the students as a relevant factor for the acknowledgement of the competencies needed for the job. Such findings may contribute to the process of development or reformulation of the syllabi of the Pharmacy undergraduate courses, with the goal of training professionals who are critical, thoughtful and knowledgeable regarding the local health reality.
Article
To understand how the nursing team workers perceive themselves in the complex interrelationship in the care provided to the ill individual and their family member who acts as carer in the death/dying process. This qualitative research was conducted in a university hospital between March and June 2016 and inspired by the Leininger methodology. A total of 24 family members who were carers and 47 nursing team workers as general informants, 18 of which were key informants. Data collection was performed through semistructured interviews, whose focus was the self-perception of the team regarding the aforementioned process, contemplating the obstacles and the complexity of these interrelationships in the hospital setting. Through an analysis based on Edgar Morin’s theoretical framework of complexity, the work overload, the lack of competence on the part of the professional, and the lack of institutional support stand out as the main obstacles. Regarding the complexity of the relationships, questions related to the professional competence regarding the care, the needs of the family, the appreciation of the workers and its repercussion to the interrelationship with the ill individual and their relative that acts as carer stand out. We believe this study can cause the nursing professional to reflect upon and assess their daily practices in relation to the care provided to the individuals in their death/dying process and to their relatives that act as carers.
Article
The multiprofessional residencies in health meet the needs of the Brazilian Unified Health System and of the Ongoing Education Policy, and are a tool for the training and insertion of professionals in the health services. Due to the fact that it is a new intervention, we proposed an analysis to assess the degree of implementation of the program in two health care services connected to the Universidade Federal de Santa Catarina, with a documentary analysis and bibliographic reviews, with the development of the logical and theoretical models, and of the analysis and assessment matrix. The data collection, which took place between May and August 2018, was made through interviews with 16 actors from the program. The results of the assessment show favorable aspects regarding the organization of the political pedagogical process, the structuring of the follow-up agencies provided in the legislation, and the development of the selection process. As limiting aspects, we can mention the absence of financial resources to implement the activities of the residency students, low insertion of the tutors and preceptors in the learning process, few training initiatives for the actors, as well as absence of an evaluation by the National Committee of Multiprofessional Residencies in Health.
Article
Thise article analyzes the role of the institutional supporters as individuals responsible for the conduction of public policies. Thus, it aims to understand the way in which institutional relationships are developed from the basis of the Brazilian State, through the establishment of relational dynamics among public agents, especially in the confrontation of complex issues regarding Brazilian federative relationships. The study was conducted at the General Coordination for Primary Health Care Management of the Primary Health Care Department of the Brazilian Ministry of Health. The research was based on qualitative epistemology, with the development of a documentary research, observation, in-depth interviews and focus groups between November 2015 and June 2017. The results enabled the identification of two structuring elements of the work of the supporters - ties to and knowledge of the territory -, which subsidize the development of a typology of the strategy of action developed and operated by the supporters, namely: application, adaptation, and cooperation. We concluded that the advancement in the implementation of the institutional support strategy was fundamentally made possible due to the relational and in-person dynamics among the individuals, and its results indicate concrete possibilities regarding the advancement in the guarantee of the right to health, in spite of the difficulties and contradictions that characterize Brazilian federalism.
Article
The study that originated the present article, which was conducted between 2015 and 2017, has the goal of understanding the possible relationships in the productive, environmental and sanitary contexts in the municipality of Goiana, in the state of Pernambuco, Brazil, with the arrival of the Fiat Chrysler Automobiles multinational enterprise. We aimed at developing an explanatory matrix based on the Driving force-Pressure-State-Exposure-Effect-Action framework, with the systematization of indicators for the monitoring of changes in the territory that could affect the health of the local population and the environment due to the establishment of the automotive complex. In order to do so, we proposed descriptive components for each dimension of the matrix, and we performed a systematization of secondary data in different databanks. We noticed effects on the well-being within the local context due to the territorial exposure to an increase in violence, precarization and injuries related to work, environmental contamination and precarious sanitation. In order to face the complex and systematic problems identified, we propose actions that can subsidize strategies for the vigilance in environmental health and in the health of the worker. Through the framework, we can describe processes of vulnerabilization in the local territories, associating them with productive structuring forces and changes in the social reproduction situation.
Article
The study had the goal of identifying current changes in the training of medicine professionals that have been brought about by the demands of the More Doctors Program (‘Programa Mais Médicos,’ in Portuguese) in Brazil. The discussions were guided by formulations of the cultural studies in the field of the syllabus. We analyzed articles and research reports on the effects that connect work, learning and changes in the practices of the doctors who integrate the Program. The context of strengthening and development of the Unified Health System (‘Sistema Único de Saúde,’ in Portuguese), certain reforms and political agendas that affect the formal syllabus, and, recently, the implementation of the More Doctors Program itself, are actions that are identified as possibilities created and as spaces where new practices take place within a professional culture that is still biomedical/flexnerian. The results confirmed micro changes in the More Doctors Program that are treated as cultural effects and put into practice in the teaching-service integration, in which the approach of a more humanized work is observed.
Ensaio
The present theoretical study proposes a critical diagnosis of the relationships among work, education, and contemporary youths through a brief dialogue with the social thinking of Christian Laval and Pierre Dardot. Its main concern lies in the rise of new subjective arrangements within the context of neoliberalism. In order to think of these relationships, we have considered three conceptual traits derived from the works of the selected authors: the understanding of the crisis as a permanent way of life, the emphasis on the emotional aspects and on the performance/enjoyment device, and the reassignment of youth training to the territory of the common. Throughout the study, it is evidenced that an analytical, critical, and unorthodox framework, backed by a specific reinterpretation of Marx’s thinking combined with other contributions, as treated by Dardot and Laval, displays a significant heuristic potentiality to think about the concepts of work, education, and youth in the current Brazilian context.
Review
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