O trabalho dos agentes comunitários de saúde à luz da teoria comunidades de prática / The work of community health workers in light of communities of practice theory

Resumo Analisou-se o trabalho dos Agentes Comunitários de Saúde (ACS), à luz da teoria das Comunidades de Prática (CdP). Estudo qualitativo transversal, realizado em quatro municípios do Ceará. Realizaram-se seis grupos focais e seis entrevistas com 45 ACS, respeitando os aspectos éticos. O corpus de dados foi analisado pela técnica de análise de conteúdo. Os resultados apontaram que a participação dos ACS na ESF é marcada pela vivência na comunidade, sendo o foco principal o acompanhamento dos grupos prioritários. As práticas os colocam diante das diversas complexidades sociais e familiares, gerando reflexões e construções de novos significados para si e o processo de trabalho. As CdP dos ACS se engajam e compartilham desafios e aprendizados singulares do trabalho, caracterizado pelo contato e relacionamento íntimo com as famílias do território, que revelam necessidades pouco percebidas pelos demais profissionais da ESF. Quanto aos processos de reificação, evidenciou-se o significado de ser ACS como aquele que escuta e acolhe, além do que, percebe as necessidades das famílias invisíveis aos serviços. Os ACS exercem melhor o papel de articulador da ESF nos territórios, quanto maior forem os espaços de diálogo entre eles, os demais membros da equipe e a gestão.

Abstract The work of Community Health Workers (ACS) was analyzed in light of Communities of Practice (CP) theory. This is a qualitative cross-sectional study carried out in four municipalities in Ceará. Six focus groups and six interviews were carried out with 45 Community Health Workers (ACS), observing ethical aspects. The data corpus was analyzed using the content analysis technique. The results show that ACS participation in the ESF is marked by experience in the community, and the main focus is monitoring priority groups. The practices put them before the diverse social and family complexities, generating reflections and building new meanings for themselves and their work process. The ACS CPs engage and share challenges and unique learning from work, characterized by close contact and relationships with the families of the territory, which reveals needs hardly perceived by other ESF professionals. The meaning of being ACS as one who listens, embraces, and perceives the needs of families invisible to services, is evident in the reification processes. The ACS better exercise their role as ESF articulators in the territories the greater the spaces for dialogue between them, the other team members, and management.

The application of the Diagnostic Therapeutic Care Pathway for the geriatric patient with anemia at the hospital of Cosenza, Italy: a management tool or a quality project?

BACKGROUND: Many studies in literature, indicate that the prognosis of hospitalized elderly patients is substantially related to the presence of concomitant diseases (multi-morbidity) along with physical, cognitive, biological and social functional impairments. These patients, therefore, require the expertise of a multi-professional and multi-disciplinary team operating in a Multi Dimensional Rating (MDR). MDR explores the multiple facets of the elderly and it is considered the tool of choice to define prognosis, especially in the case of compromised elderly patients with clinical or functional problems. MDR is satisfactory and it can be applied if it is included in a diagnostic therapeutic care pathway, which is a management tool that achieves best practices and efficiency in healthcare professionals that learn from each other. METHODS: Considering that about 80% of elderly patients has anemia, a condition often underestimated, it has been necessary to create a Diagnostic and Therapeutic Care Pathway (DTCP) with the goal to increase the level of medical awareness on this specific medical problem, and outline clear care paths for the patient. The DTCP in question was promoted by the Geriatric ward of Cosenza's Hospital by setting up a multidisciplinary working group and editing an algorithm. Indicators and standards were chosen to evaluate performance and procedures: all this has required several meetings and counseling sessions between the coordinator of DTCP and the Quality and Accreditation Operative Unit (OU). The verification of the path activities has been realized by examining the documented evidence produced. RESULTS: Preparing the indicators and standards for anemia, DTCP was a particularly challenging step of the work. DTCP has been correctly applied to more than 50% of cases, but was inapplicable to patients who either were very sick or had a very mild form of anemia. CONCLUSION: The analysis of this first phase shows that DTCP is both beneficial to the patient (framed and accompanied in her/his hospitalization and subsequent follow-up) and it facilitates the work of the physician. However, there are some limitations in its application because it is not always possible to measure indicators in every ward that participates in the DTCP.

Estudiando el proceso de configuración de multiscopic, una red on-line profesional de análisis de la práctica de educación física / Estudar o processo de configuração de multiscopic, uma análise profissional da rede on-line da prática da educação física / Studying the configuration process of multiscopic, a professional online network that analyses the physical education practice

Presentamos aquí algunos de los primeros resultados sobre el desarrollo de una red profesional en línea llamada MultiScopic (múltiples puntos de vista sobre un fenómeno), tratando de entender cuáles son las tensiones y limitaciones en torno al proceso de consolidación de una comunidad on-line de análisis de la práctica educativa. En este sentido, MultiScopic es una red social que involucra, entre otros, a maestros y profesores de Educación Física en activo y que ofrece un espacio, a través del intercambio, del diálogo, de la aplicación, reflexión y evaluación de diferentes prácticas pedagógicas, para compartir diferentes puntos de vista, intercambiar procedimientos de análisis y llevar a cabo una formación permanente reflexiva capaz de mejorar los procesos de enseñanza/aprendizaje. A la vista de los primeros resultados, concluimos que este proyecto permite generar significados compartidos en torno a la Educación Física y dotar al profesorado de procedimientos para el análisis y mejora de su práctica.

Apresentamos aqui alguns dos primeiros resultados sobre o desenvolvimento de uma rede profissional online chamada MultiScopic (múltiplos pontos de vista sobre um fenômeno), tentando entender quais são as tensões e limitações ao redor do processo de consolidação de uma comunidade online de análise da prática educativa. Nesse sentido, MultiScopic é uma rede social que envolve, entre outros, professores formados ou não em Educação Física, ativos e que oferece um espaço, através do intercâmbio, do diálogo, da aplicação, reflexão e avaliação de diferentes práticas pedagógicas, para dividir diferentes pontos de vista, intercambiar procedimentos de análise e levar a cabo uma formação permanente reflexiva capaz de melhorar os processos de ensino/aprendizagem. Tendo em vista os primeiros resultados, concluímos que esse projeto permite gerar significados compartilhados em torno da Educação Física e dotar o profesorado de procedimentos para a análise e melhora das suas práticas.

This article presents some of the initial results on the development of a professional online network called MultiScopic (multiple points of view of a phenomenon), in an attempt to understand what are the tensions and limitations surrounding the process of consolidation of an online analysis community in the educational practice. From this standpoint, MultiScopic is a social network that involves, among others, teachers and active Physical Educators and offers a space, through exchange, dialog, application, reflection and evaluation of different pedagogical practices, to share different points of view, exchange analysis procedures, and carry out a permanent reflexive formation, capable of improving the teaching-learning process. In light of the initial results, it can be concluded that this project generates shared meanings around Physical Education and provides educators with procedures for the analysis and the improvement their practice.