Nursing workloads in family health: implications for universal access.

OBJECTIVE: to identify the workloads of nursing professionals of the Family Health Strategy, considering its implications for the effectiveness of universal access. METHOD: qualitative study with nursing professionals of the Family Health Strategy of the South, Central West and North regions of Brazil, using methodological triangulation. For the analysis, resources of the Atlas.ti software and Thematic Content Analysis were associated; and the data were interpreted based on the labor process and workloads as theorical approaches. RESULTS: the way of working in the Family Health Strategy has predominantly resulted in an increase in the workloads of the nursing professionals, with emphasis on the work overload, excess of demand, problems in the physical infrastructure of the units and failures in the care network, which hinders its effectiveness as a preferred strategy to achieve universal access to health. On the other hand, teamwork, affinity for the work performed, bond with the user, and effectiveness of the assistance contributed to reduce their workloads. CONCLUSIONS: investments on elements that reduce the nursing workloads, such as changes in working conditions and management, can contribute to the effectiveness of the Family Health Strategy and achieving the goal of universal access to health.

The health care model: concepts and challenges for primary health care in Brazil.

This is a theoretical reflection aiming to highlight the conceptual debate about the health care model and the challenges for primay health care in Brazil. The study characterizes different concepts and terminologies relating to the expression 'care model' and shows that the Family Health Strategy has improved access to health care, and also including user reception and humanization perspectives in health practices. However, one still sees: a centralizing attitude in the treatment of pathologies, and care focused on the biological body; difficulties in implementing comprehensive care; and deficits in training of teams, and in working conditions and relations. The study concludes that the term 'care model' is interpreted as polysemic and that, although there are structuring proposals and policies for a model that can make progress in relation to the biomedical paradigm, the difficulties for its implementation are significant.

[A creative and sensitive way to research]. / A maneira criativa e sensível de pesquisar.

This experience report describes the application of Creative Sensitive Method in a qualitative exploratory-descriptive research. Its theoretical foundation and the way this method was applied objectively presented through the following stages: introduction, production, presentation, discussion and evaluation. Finally, one can argue that the method, among others pathways, is a good alternative methodology for generating data in collective spaces for application in qualitative research related to nursing or others health contexts.

[The implementation of interdisciplinarity in the work routine of the family health care team]. / A construção da interdisciplinaridade no trabalho da Equipe de Saúde da Família.

Interdisciplinarity in the work routine of professionals of a Residency Course on Family Health in Southern Brazil was investigated in a qualitative study involving 11 residents and 5 supervisors of seven professions. Through interviews, observations and focal groups the existence of interdisciplinarity in practice was analyzed, duly identifying favorable and unfavorable aspects for its implementation. Interdisciplinarity was expressed as a complex process and concrete action, which occurs in the dramatic implications of its usage, in a dialectical relationship with the political and institutional context. The study revealed that working in family health care renders the work more complex and that the professionals experience difficulties in sharing knowledge and making the transition between multidisciplinarity and interdisciplinarity. The study concludes that interdisciplinarity requires the integrated use of knowledge in the multi-professional practice, the crossing of disciplinary boundaries, the development of competencies to address the challenges of the work environment and personal attitude as a basic component for professional action.

[Necessary changes for advancing nursing as caring science]. / Transformações necessárias para o avanço da Enfermagem como ciência do cuidar.

The article aimed to reflect upon the challenges involved in strengthening Nursing as a caring science. It is founded on the sociological theory, connecting three approaches: the historical-dialectic materialism perspective about the working process in health care and nursing; the sociology of professions from a critical perspective; and the philosophy of science. The discussion is organized considering the aspects of Nursing as a discipline, work and health care profession. It sustains that knowledge production should be driven both by the purpose of Nursing work which is providing care to human beings with health needs and to advocate for the indispensable work conditions to a safe and responsible practice. It concludes that to strengthening Nursing it is necessary to produce knowledge to support nursing care and the political actions defending safe work conditions, the universal right to health as well safe and high quality care.

The discourse of ethics in nursing education: experience and reflections of Brazilian teachers - case study.

From a scenario of political and technological changes in work and health education, the purpose of this study was to understand the ethics discourse in nurses' education process in Brazilian nursing schools. A research was performed with a qualitative approach, characterized as a case study, involving six schools of a region in the south of Brazil. The data were collected by focal groups involving 50 teachers. The results were organized in three categories: (1) experience and motivation to teach ethics and bioethics, (2) indicators of change identified in global and local contexts and (3) challenges in the education of ethics, values and related themes. The teachers have highlighted complex elements related to scientific, educational and professional contexts, and pointed out the need for a critical perspective on the professional scenario and on their own situations as nurses and educators. The analyzed discourse brings to light the topic of ethics, seen as peculiar to the present day and in intimate connection with the daily routine of clinical, pedagogical and political professional practices. The findings suggest that the reflections on nurses' ethics education should not be limited to discussing content and pedagogical strategies but should be extended to include a commitment to the adoption of values in professional practice and to the process of the construction of a professional identity.

[Technological innovation and healthcare professionals' workloads: an ambiguous relationship]. / Inovação tecnológica e cargas de trabalho dos profissionais de saúde: uma relação ambígua.

This is an integrative review with the aim of tracing the scientific production concerning the influence of technological innovation in health care professionals' workloads. Fifty-seven (57) publications presented from 2004 to 2009 were selected from the LILACS and PubMed databases. In the selected studies field research using qualitative approaches and carried out in hospitals predominated. No study had the purpose to analyze the relationship between technological innovation and workloads. In studies involving technological innovation, publications concerning information and communication technologies and new forms of work organizations were highlighted studies concerning conditions which promote stress and Burnout predominated in the workloads theme. Results show an ambiguous relationship between technological innovation and workloads, which are either increased or diminished by innovations.

[Nursing workloads and working conditions: integrative review]. / Cargas de trabalho e condições de trabalho da enfermagem: revisão integrativa.

This study reviews theoretical production concerning workloads and working conditions for nurses. For that, an integrative review was carried out using scientific articles, theses and dissertations indexed in two Brazilian databases, Virtual Health Care Library (Biblioteca Virtual de Saúde) and Digital Database of Dissertations (Banco Digital de Teses), over the last ten years. From 132 identified studies, 27 were selected. Results indicate workloads as responsible for professional weariness, affecting the occurrence of work accidents and health problems. In order to adequate workloads studies indicate some strategies, such as having an adequate numbers of employees, continuing education, and better working conditions. The challenge is to continue research that reveal more precisely the relationships between workloads, working conditions, and health of the nursing team.

[Work relations in interdisciplinary teams: contributions towards new forms of work organization in health]. / Relações de trabalho em equipes interdisciplinares: contribuições para novas formas de organização do trabalho em saúde.

This is a qualitative study developed with the interdisciplinary health care teams of two public hospitals in Brazil. One team gave palliative care to cancer patients and the other gave care to the elderly. The study contributes to thinking about work relationships in the health care sector upon analyzing the contribution of these experiences for the constitution of new forms of health care work organization. The results reveal that the interdisciplinary perspective of performance in health care makes better work relationships possible among professionals and between professionals and patients/family, as well as approximates the professionals to the needs of the patient, beyond contributing to better quality care. We conclude that interdisciplinary practice approximates new forms of work organization and, upon favoring these links, reception, and access, contributes to the greater efficiency of the Brazilian National Health Care System.

[Work relationships among interdisciplinary teams: contributions for new methods of organization in health work]. / Relações de trabalho em equipes interdisciplinares: contribuições para a constituição de novas formas de organização do trabalho em saúde.

This is a qualitative study developed with the interdisciplinary health care teams of two public hospitals in Brazil. One team provides palliative care to cancer patients and the other provides care to the elderly. The study contributes to thinking about work relationships in the health care sector upon analyzing the contribution of these experiences for the constitution of new forms of health care work organization. The results reveal that the interdisciplinary perspective of performance in health care makes better work relationships possible among professionals and between professionals and patients/family, as well as approximates the professionals to the needs of the patient, beyond contributing to better quality care. We conclude that interdisciplinary practice approximates new forms of work organization and, upon favoring these links, reception, and access, contributes to the greater efficiency of the Brazilian National Health Care System.

[Healthcare rights: an invitation for reflection]. / Direito à saúde: um convite à reflexão.

This study focuses on changes and breaks in contemporary society relating to the right to healthcare as a universal value, in conformity with the guidelines provided by multilateral agencies and disseminated particularly since the 1990s. From the genesis of social rights and by tracing the interdependence between social and economic aspects of social citizenship in democratic capitalist countries, the study presents the two paradigms informing the approach to healthcare in the early 21st century: the full citizenship paradigm, according to which the right to healthcare is a universal value, and the paradigm of restricted social citizenship, according to which the right to healthcare is guided by the criterion of efficiency and economic rationalization. These propositions align with the health economy paradigm, which (i) defends focused resource allocation to attenuate poverty conditions, (ii) reduces the role of the state, (iii) recommends resource allocation to healthcare in association with social protection, and (iv) defines the market as the privileged regulator of healthcare actions.