Educação permanente em saúde - espaços, sujeitos e tecnologias na reflexão sobre o processo de trabalho

Abstract

The urgency to transpose the line of irreversibility in the process of change in the brazilian tecno-assistential model incites us to face all the problems at the same time, in a short time period. One of the challenges is to transform the health care services network in a space where the reflection about the work can generate alternatives that respond to the population health care needs. In this sense, the Brazilian Health Ministry defined the National Policy for Permanent Education in Health and it has invested in strategies to face this challenge. The general objective of this study was to analyze the possibility of the development of the practice of permanent education in the micro environment where the health care services are provided by inserting the primary health professionals in a distance learning qualification process. The investigation in this work has also focused on other aspects of the qualification process: the potential to bring into focus for the students the reality of the area where they work; the criteria used to chose optional courses and its relation with theprofessional practice; the appropriation of work process organization tools; the reflection about the work process; the change in the practice and the establishment of new habits. The qualification process studied was the Curso de Especialização em Atenção Básica em Saúde da Família that, since 2008, has been offered by the Universidade Federal de Minas Gerais as a distance learning course as a strategy to support the consolidation of the Sistema Único de Saúde. This study consists in a research based on the philosophical materialism in which the analysis of the empirical data was made by means of documental analysis, questionnaire and narrative interview, characterized by a mixed (quantiqualitative) approach. The data collected in the narrative interview were subjected to content analysis following Bardin (1979). The subjects of the research were one hundred and twenty alumni that answered the questionnaire and fifteen that were interviewed (seven dentists, five nurses and three physicians). The criteria to be included in theinterview set were: to have been part of the family health-care strategy during the whole duration of the course, to be a resident of the city that is a head office of a Support Center for the Universidade Aberta do Brasil to which he/she was bound during the course. At all parts of this study, we took into consideration the Resolution 196, from 1996, of theConselho Nacional de Saúde. The qualitative data showed that: the optional courses were chosen as a result of the need to deepen the knowledge in that subject and the relation of the subject of the course and the priority problems of the students practices; 82.4% answered that they introduced work process organization tools in their practice and thesetools are categorized as: Planing, Health Diagnostic, Work Process Organization, Receptivity, Operative Group, Qualification and access to new knowledge, Team Formation and Team Work, Team Meeting, Risk classification and Information; 75.6% answered that they adopted tools related to the attention to the health of the users, with a registry of the changes that they introduced in the day to day work, during their course.Were described and interpreted, in the content analysis, five thematic categories: Interrogating an comprehending the possibility of theory to contribute with practice and practice to enrich theory; Reflecting about the work process: incorporation and application of knowledge; Difficulties and facilities lived in the implantation and implementation of anew model of health care; Commitment with the current Sistema Único de Saúde and the vision for the future: the SUS were I want to be; Some issues to be considered in an evaluation of the course. After the analysis it is possible to say that the Course potentialized the permanent education processes that already existed and generated newones; it strengthened the permanent education practice in professionals that already practiced it and aroused a positive attitude towards permanente education in other people because it introduced a refection about the work process with the activities proposed. There were indications of changes in the practice and the creation of new habits as a consequence of the professional involvement with the activities proposed. The course has the pedagogical intention that is translated into activities that generate space and time for reflection within the work process.The urgency to transpose the line of irreversibility in the process of change in the brazilian tecno-assistential model incites us to face all the problems at the same time, in a short time period. One of the challenges is to transform the health care services network in a spacewhere the reflection about the work can generate alternatives that respond to the population health care needs. In this sense, the Brazilian Health Ministry defined the National Policy for Permanent Education in Health and it has invested in strategies to face this challenge.The general objective of this study was to analyze the possibility of the development of the practice of permanent education in the micro environment where the health care services are provided by inserting the primary health professionals in a distance learning qualification process. The investigation in this work has also focused on other aspects ofthe qualification process: the potential to bring into focus for the students the reality of the area where they work; the criteria used to chose optional courses and its relation with the professional practice; the appropriation of work process organization tools; the reflection about the work process; the change in the practice and the establishment of new habits. Thequalification process studied was the Curso de Especialização em Atenção Básica em Saúde da Família that, since 2008, has been offered by the Universidade Federal de Minas Gerais as a distance learning course as a strategy to support the consolidation of the Sistema Único de Saúde. This study consists in a research based on the philosophicalmaterialism in which the analysis of the empirical data was made by means of documental analysis, questionnaire and narrative interview, characterized by a mixed (quantiqualitative) approach. The data collected in the narrative interview were subjected to content analysis following Bardin (1979). The subjects of the research were one hundredand twenty alumni that answered the questionnaire and fifteen that were interviewed (seven dentists, five nurses and three physicians). The criteria to be included in the interview set were: to have been part of the family health-care strategy during the whole duration of the course, to be a resident of the city that is a head office of a Support Center for the Universidade Aberta do Brasil to which he/she was bound during the course. At all parts of this study, we took into consideration the Resolution 196, from 1996, of the Conselho Nacional de Saúde. The qualitative data showed that: the optional courses were chosen as a result of the need to deepen the knowledge in that subject and the relation of the subject of the course and the priority problems of the students practices; 82.4%answered that they introduced work process organization tools in their practice and these tools are categorized as: Planing, Health Diagnostic, Work Process Organization, Receptivity, Operative Group, Qualification and access to new knowledge, Team Formation and Team Work, Team Meeting, Risk classification and Information; 75.6% answered that they adopted tools related to the attention to the health of the users, with aregistry of the changes that they introduced in the day to day work, during their course. Were described and interpreted, in the content analysis, five thematic categories: Interrogating an comprehending the possibility of theory to contribute with practice and practice to enrich theory; Reflecting about the work process: incorporation and application of knowledge; Difficulties and facilities lived in the implantation and implementation of anew model of health care; Commitment with the current Sistema Único de Saúde and the vision for the future: the SUS were I want to be; Some issues to be considered in an evaluation of the course. After the analysis it is possible to say that the Course potentialized the permanent education processes that already existed and generated newones; it strengthened the permanent education practice in professionals that already practiced it and aroused a positive attitude towards permanente education in other people because it introduced a refection about the work process with the activities proposed. There were indications of changes in the practice and the creation of new habits as a consequence of the professional involvement with the activities proposed. The course has the pedagogical intention that is translated into activities that generate space and time for reflection within the work process.