Como avançar na humanização do cuidado oferecido por uma Unidade Básica de Saúde?: Uma Pesquisa Implicada

• Ano de defesa: 2011
• Autor(a) principal: Molina, Marcia Castagna [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Conflito organizacional; Gestão do cuidado; Micropolítica do trabalho em saúde; O trabalho de equipe em saúde; Humanização do cuidado; Humanização da assistência; Management of care; Micro politics of work on health; Organizational conflict; Team work on health; Humanization of care; Humanization of assistance
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9208

This study describes and analyses an intervention-research that I conducted in one of the Health Centers of the Municipal Health Secretariat of Campinas, Brazil, where I work as a district supporter. The empirical phase of the thesis began in December 2008 after I was asked to work on the “communication” in the team. The intervention took two main steps, aiming at reaching that goal. First there were four “communication workshops”, which involved 69 employees of the unit. After the workshops meetings were held with the employees chosen as communication facilitators by the groups to work on the material produced and to manage the proposals for solving the problems that were presented. The work went on for the following six months and the highlights were the monthly general meetings. All the employees were invited for the meetings, their agendas were cleared and the unit had a group on duty just in case a patient might need it. That was a period when the workers proved intensive changes while searching for the reconstruction of relationships and ways of care. The second step consisted of “humanization workshops” based on interviews with the workers and the manager at the Health Center about the humanization and their evaluation about the care offered at the Heath Center. The methodological challenge was to move from my institutional role of power, authority and “externality” regarding the team of workers to a closer and inner insertion of micro political relationships, trying with them to bring up reflections and actions upon the humanization of their daily relationships and, at the same time, of their relationships with the patients as far as care is concerned. Therefore this was a participatory action-research, because during all the time I had to deal with the tense relationship between my position in the hierarchy of the formal authority of the organization and the rationality, interests and timing of the research itself as well as with the team.s dynamics and ways of working. The study presents and discusses the complex movement of internalization/externalization concerning the micro political field, which was investigated, modified and produced intensely together with the workers. Based on the tradition started by the action-research and consolidatedin the reflexive sociology, especially in Alberto Melucci.s writings, I was during all the time concerned with the production of a theoretical dialog with the authors that could in a more or less direct way contribute to clear the paths opened by investigation and especially by the knowledge gotten by the organizational actors who were modifying the relationships and approaches of providing care. I was concerned with an intervention that could provide at the same time the “object” and the theory to think over the “object” that was being produced. The thesis was the setting up of a map. The map consists of meridians and parallels that intersect all the time while rebuilding my interventions always keeping the dialog with the authors that contributed for a clearer understanding of the practical problems I faced. The meridians make the “verticality” of the map and define the “fields of observation and/or reflection”, as reference clippings. They are crossed by the parallels that make the “horizontality”. The meridians come up by means of the intervention in which they are produced and they are irregular regarding size and configuration. There are three meridians in the map: 1- my construction as epistemic subject: from being a supporter to being a researcher; 2- The Health Center of the intervention: a scenery of suffering and conflicts; 3- the intervention. The three meridians are crossed by five parallels: methodological reflections; theoretical reflections upon the problem of the research; reflections upon the care; reflections upon management and reflections upon the context. Though the parallels always preserve the same statement in the three meridians, they are different according to each respective specificity. I have always paid close attention to any vanishing line at each intersection of meridians and parallels in search for clues leading to other ways of thinking and doing which I had never experienced before.