[The influence of the institutions on local health councils]. / La influencia de las instituciones en los consejos locales de salud.

OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

Violence in the Nursing Workplace in the Context of Primary Health Care: A Qualitative Study.

Violence demands considerable attention due to its complexity and social consequences. The objective of this study was to analyze violence in the nursing professional workplace in the context of primary health care in Brazil. It is a qualitative study with theoretical and methodological reference to institutional analysis. It was carried out in basic health units in Brazil. Nursing professionals (N = 11) participated in semi-structured interviews and discussion groups, in addition to a research diary and participant observation. Data collection took place from October to December 2021. The results are presented in five categories: types of violence and aggressors from the perspective of nursing professionals; the causes of violence reported by professionals; strategies for the management of violence; professionals' proposals for preventing violence in health contexts; the consequences of violence in the workplace. Nursing professionals make up a large part of the workforce and have reported verbal, physical, moral, and psychological violence. The main causes are associated with user access to services. For the prevention of violence, professionals do not see themselves as protagonists of change. The consequences are the loss of quality of work and the health of professionals who requested sick leave and transfers. The study's findings can help in the development of public policies and educational and management actions.

The Work of Nurses in Primary Health Care: Crossings of the New Public Management.

The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.

Matrix support in children's mental health in Primary Health Care: institutional socio-clinical intervention research. / Apoio matricial em saúde mental infantojuvenil na Atenção Primária à Saúde: pesquisa intervenção socioclínica institucional.

OBJECTIVE: To analyze matrix support for Family Health Strategy teams in relation to Mental Health in Children and Adolescents. METHOD: This is a research-intervention with a qualitative approach, based on the Institutional Analysis framework, Socio-clinic, carried out with eighteen health workers from two Family Health Strategy and Psychosocial Care Center teams of a small municipality in the countryside of the state of São Paulo, through eleven reflection meetings. RESULTS: The following themes emerged: The dynamics of relations in the FHS territory; Matrix Support as a technological device: unveiling established practices. Subsequently, the results were discussed based on the principles of Institutional Socio-clinic. CONCLUSION: Matrix support in children's mental health, based on Institutional Socio-clinic, favored the deterritorialization of professionals, revealing how mental health care is provided for children and adolescents, and the crossings that occur in the production of this care as well as possible paths to be followed to improve health actions.

Homeless people: health aspects and experiences with health services.

OBJECTIVES: to analyze the understanding of homeless people living in a city in the countryside of São Paulo about what health is and about their experiences in health services. METHODS: a qualitative exploratory study developed through interviews with homeless people and a field diary. The data were organized by themes and the findings were compared to a collective health framework. RESULTS: the explored themes were: "Being healthy for the homeless population", "The search for health services" and "Being a user of health services from the perspective of homeless people". We present the interviewees' understanding of health and their experiences in healthcare services. Along this path, we outline aspects that show the network's weaknesses, permeated by prejudices and discrimination. FINAL CONSIDERATIONS: this population has conceptions about health and needs that need to be singularly taken into consideration to facilitate access and care.

Apoio matricial em saúde mental infantojuvenil na Atenção Primária à Saúde: pesquisa intervenção socioclínica institucional / Matriz de apoyo en salud mental infantil en Atención Primaria de Salud: investigación de intervención socio-clínica institucional / Matrix support in children's mental health in Primary Health Care: institutional socio-clinical intervention research

RESUMO Objetivo Analisar o apoio matricial para equipes da Estratégia Saúde da Família em relação à Saúde Mental em Crianças e Adolescentes. Método Pesquisa-intervenção de abordagem qualitativa, fundamentada pelo referencial da Análise Institucional, a socioclínica, realizada com dezoito trabalhadores de saúde de duas equipes da Estratégia Saúde da Família e do Centro de Atenção Psicossocial de um município de pequeno porte, localizado no interior do estado de São Paulo, por meio de onze encontros de reflexão. Resultados Foram apresentados a partir dos temas: A dinâmica das relações no território da ESF; O apoio matricial como dispositivo tecnológico: desvelando práticas instituídas. Posteriormente, foi realizada a discussão dos resultados a partir dos princípios da Socioclínica Institucional. Conclusão O apoio matricial em saúde mental infantojuvenil, pautado no referencial da Socioclínica Institucional, favoreceu a desterritorialização dos profissionais, revelando como se dá o cuidado em saúde mental para crianças e adolescentes e os atravessamentos que ocorrem na produção desse cuidado, assim como possíveis caminhos a serem trilhados para aprimorar as ações de saúde.

RESUMEN Objetivo Analizar la matriz de apoyo a los equipos de la Estrategia Salud de la Familia con relación a la Salud Mental en la Niñez y la Adolescencia. Método Investigación-intervención con enfoque cualitativo, con base en el marco de Análisis Institucional, el socioclínico, realizado con dieciocho trabajadores de salud de dos equipos de la Estrategia Salud de la Familia y del Centro de Atención Psicosocial de una pequeña ciudad, ubicada en el interior del estado de São Paulo, a través de once encuentros de reflexión. Resultados Se presentaron a partir de los temas: La dinámica de las relaciones en el territorio de la ESF; El soporte matricial como dispositivo tecnológico: revelando prácticas establecidas. Posteriormente, se discutieron los resultados con base en los principios de Socioclínicas Institucionales. Conclusión La matriz de apoyo en salud mental infantil, con base en el marco Socioclínico Institucional, favoreció la desterritorialización de los profesionales, revelando cómo se brinda la atención en salud mental a la niñez y adolescencia y los cruces que se dan en la producción de este cuidado, así como en lo posible caminos a seguir para mejorar las acciones de salud.

ABSTRACT Objective To analyze matrix support for Family Health Strategy teams in relation to Mental Health in Children and Adolescents. Method This is a research-intervention with a qualitative approach, based on the Institutional Analysis framework, Socio-clinic, carried out with eighteen health workers from two Family Health Strategy and Psychosocial Care Center teams of a small municipality in the countryside of the state of São Paulo, through eleven reflection meetings. Results The following themes emerged: The dynamics of relations in the FHS territory; Matrix Support as a technological device: unveiling established practices. Subsequently, the results were discussed based on the principles of Institutional Socio-clinic. Conclusion Matrix support in children's mental health, based on Institutional Socio-clinic, favored the deterritorialization of professionals, revealing how mental health care is provided for children and adolescents, and the crossings that occur in the production of this care as well as possible paths to be followed to improve health actions.

Homeless people: health aspects and experiences with health services / Personas sin hogar: aspectos de salud y experiencias con los servicios de salud / Pessoas em situação de rua: aspectos sobre a saúde e experiências com serviços sanitários

ABSTRACT Objectives: to analyze the understanding of homeless people living in a city in the countryside of São Paulo about what health is and about their experiences in health services. Methods: a qualitative exploratory study developed through interviews with homeless people and a field diary. The data were organized by themes and the findings were compared to a collective health framework. Results: the explored themes were: "Being healthy for the homeless population", "The search for health services" and "Being a user of health services from the perspective of homeless people". We present the interviewees' understanding of health and their experiences in healthcare services. Along this path, we outline aspects that show the network's weaknesses, permeated by prejudices and discrimination. Final Considerations: this population has conceptions about health and needs that need to be singularly taken into consideration to facilitate access and care.

RESUMEN Objetivos: analizar la comprensión de las personas sin hogar residentes en una ciudad del interior de São Paulo, sobre lo que es la salud y sus experiencias en los servicios de salud. Métodos: estudio exploratorio cualitativo desarrollado con entrevistas a personas sin hogar y diario de campo. Los datos se organizaron por temas, y los hallazgos se compararon con un marco de salud colectiva. Resultados: los temas explorados fueron: "Tener salud para la población sin hogar", "La búsqueda de servicios de salud" y "Ser atendido en los servicios de salud desde la perspectiva de las personas sin hogar". Presentamos la comprensión de la salud de los entrevistados y las experiencias vividas en los servicios. Trazamos aspectos que demarcan las debilidades de la red, permeados por prejuicios y discriminaciones. Consideraciones Finales: esta población tiene concepciones sobre la salud y necesidades que deben ser consideradas de manera singular para facilitar el acceso y la atención.

RESUMO Objetivos: analisar o entendimento das pessoas em situação de rua, que vivem em município do interior paulista, sobre o que é saúde e sobre suas experiências em serviços sanitários. Métodos: estudo qualitativo exploratório desenvolvido com entrevistas com pessoas em situação de rua e diário de campo. Os dados foram organizados por temas e os achados foram confrontados com referencial da saúde coletiva. Resultados: os temas explorados foram: "O ter saúde para a população em situação de rua", "A busca por serviços de saúde" e "Ser atendido em serviços de saúde sob a ótica de pessoas em situação de rua". Neles apresentamos a compreensão da saúde dos entrevistados e experiências vivenciadas em serviços. Nesse caminho, delineamos aspectos que demarcam fragilidades da rede, perpassadas por preconceitos e discriminação. Considerações Finais: essa população tem concepções sobre a saúde e necessidades que precisam ser consideradas singularmente para facilitar acesso e cuidado.

Acolhimento: percepção de enfermeiros em uma unidade de urgência e emergência / User embracement: the nurses' perception in a urgency and emergency unit

Objetivos: identificar a percepção dos enfermeiros sobre o acolhimento e analisarsua articulação com os fundamentos da Política Nacional de Humanização (PNH). Método:pesquisa qualitativa, com 14 enfermeiros que atuam no Pronto-Socorro Adulto do Hospital dasClínicas da Universidade Federal do Triângulo Mineiro. Os dados foram coletados emdezembro de 2015, por meio de entrevista semiestruturada e analisados conforme análise deconteúdo. Resultados: emergiram as categorias: o acolhimento como atendimento inicial, emque o acolhimento é descrito como ação na entrada do usuário no serviço; acolhimento comvistas à humanização, demonstrando entendimento e aplicação de acordo com a PNH;dificuldades para desenvolver o acolhimento devido à sobrecarga de trabalho, a falta de fluxo ede infraestrutura. Conclusões: os enfermeiros demonstraram compreender o significado deacolhimento. Porém, existem pontos frágeis na aplicabilidade, merecendo atenção dos gerentesde saúde para efetivar que os princípios da PNH sejam garantidos.

Aim: to identify nurse’s perception about the user´s adjustment and to analyzeits articulation with the fundamentals of the National Humanization Policy (PNH). Method:qualitative research, with 14 nurses working in the Adult Emergency Department of theHospital das Clínicas of the Federal University of Triângulo Mineiro. Datas were collected inDecember 2015, through a semi-structured interview and analyzed according to contentanalysis. Results: the following categories emerged: the user embracement as initial service,where it is described as action on the user's entry into the service; humanization,demonstrating understanding and application according to the PNH; difficulties indeveloping the user embracement due to overwork, lack of flow and infrastructure.Conclusions: the nurses demonstrated to understand the meaning of the user embracement.However, there are weak aspects in the applicability, which deserves the attention of healthmanagers to ensure that the principles of PNH are guaranteed

Objetivos: identificar la percepción de los enfermeros sobre el acogimiento yanalizar su articulación con los fundamentos de la Política Nacional de Humanización (PNH).Método: investigación cualitativa, realizada con 14 enfermeros que actúan en el Puesto dePrimeros Auxilios para adultos del Hospital de las Clínicas, de la Universidade Federal doTriângulo Mineiro. Los datos fueron recogidos en diciembre de 2015, por medio de unaentrevista semiestructurada y analizados a partir del análisis de contenido. Resultados: fueronidentificadas las categorías: acogimiento como atención inicial, en que el acogimiento secaracteriza por la entrada del usuario en el servicio; acogimiento como forma dehumanización, demostrando entendimiento y aplicación de acuerdo con la PNH; dificultadespara desarrollar el acogimiento debido a la sobrecarga de trabajo, la falta de flujo y de lainfraestructura. Conclusiones: los enfermeros demostraron comprender el significado deacogimiento. Sin embargo, hay puntos frágiles en la aplicabilidad que merecen la atención delos administradores de salud para que los principios de la PNH estén garantizados.

Experimentações no apoio matricial em saúde mental para crianças e adolescentes na atenção básica: a busca pela aprendizagem coletiva / Experimentations on matrix support in mental health for children and adolescents in basic healthcare: the search for collective learning

Esta dissertação parte da problemática da desarticulação entre as equipes de atenção básica e as equipes do Centro de Atenção Psicossocial (CAPS) com relação às crianças e adolescentes que necessitam de cuidados em saúde mental. Utiliza o Apoio Matricial (AM) como um dispositivo para desencadear processos de análise coletiva entre profissionais de saúde do campo da Atenção à Saúde Mental para Crianças e Adolescentes (SMCA) e aproximar os serviços de atenção primária e secundária. O objetivo geral deste estudo foi experienciar o Apoio Matricial em Saúde Mental com equipes da Estratégia Saúde da Família (ESF) em relação à saúde mental de crianças e adolescentes, segundo o referencial da Análise Institucional. Um dos objetivos específicos foi promover a discussão sobre o cuidado em saúde mental para esta população em articulação com o CAPS. Trata-se de uma pesquisa de abordagem qualitativa, apoiada nos conceitos da Socioclínica Institucional. A produção de dados ocorreu por meio de encontros de reflexão com trabalhadores de duas equipes da ESF e do CAPS de um município de pequeno porte do interior do Estado de São Paulo. Ao todo, participaram da pesquisa 18 profissionais, sendo distribuídos em dois grupos: A (8 participantes) e B (10 participantes), ambos com a participação de um profissional do CAPS. Foram realizados seis encontros de reflexão com o grupo A e cinco com o grupo B. Os encontros foram gravados em mídia digital e transcritos na íntegra. Além disso, a pesquisadora também realizou anotações em diário de campo. O material produzido foi analisado a partir dos princípios da Socioclínica Institucional e os resultados apresentados de acordo com os mesmos: análise da encomenda e das demandas; participação dos sujeitos no dispositivo; trabalho dos analisadores; análise das transformações que ocorrem à medida que o trabalho avança; aplicação de modalidades de restituição; intenção da produção de conhecimentos; atenção aos contextos e às interferências institucionais e trabalho das implicações primárias e secundárias, sendo também considerada a conexão existente entre eles. Dessa forma, apresentamos como resultado e discussão as reflexões realizadas com os profissionais participantes do dispositivo AM acerca do cuidado voltado à SMCA em suas áreas de abrangência, atentando para a problematização sobre o conceito de saúde mental e a identificação do cuidado pautado por diagnósticos psiquiátricos; solicitação da presença de psicólogos na ESF para suprir a demanda de usuários que têm algum tipo de sofrimento mental; o uso das tecnologias leves, como a escuta e os atravessamentos da divisão do trabalho, moldando o entendimento de que a prática de escutar é apenas trabalho do psicólogo; a pouca articulação entre as equipes da ESF e do CAPS com interferência de outros estabelecimentos na condução da coordenação do cuidado intersticial das crianças e adolescentes e, por fim, as relações estabelecidas entre a pesquisadora e o grupo, propiciando algumas transformações durante a pesquisa. Ressalta-se que as reflexões ocorridas promoveram a análise da prática realizada pela articulação dos trabalhadores com vistas à construção de um conhecimento coletivo. Essas considerações contribuem para processos e estudos acerca do Apoio Matricial em SMCA

This dissertation starts from the problematic of the disarticulation between the basic healthcare teams and the Center for Psychosocial Healthcare teams (CPH) and the Family Healthcare Support teams regarding children and adolescents who need mental healthcare. It uses the Matrix Support (MS) as a device to trigger processes of collective analysis among health professionals in the field of Mental Health Care for Children and Adolescents (MHCCA) and to rapproch primary and secondary healthcare services. The general aim of this study was to experience the Matrix Support in Mental Healthcare with Family Health Strategy (FHS) teams in relation to the mental healthcare of children and adolescents, according to the Institutional Analysis framework. And one of the specific aims was to promote the discussion on mental healthcare for this population in articulation with CPH. It is a qualitative research based on the concepts of Institutional Socioclinic. The data were produced through reflection meetings with workers from two FHS and CPH teams from a small municipality in the intern part of the State of São Paulo. In all, 18 professionals participated in the study, distributed in two groups, A (8 participants) and B (10 participants), both with the participation of a CPH professionals. Six reflection meetings were held with group A and five with group B. The meetings were recorded in digital media and transcribed in full, the researcher also made notes in field journal. The material produced was analyzed based on the principles of Institutional Socioclinic, and the results were presented according to them: order analysis and demand analysis; participation of the subjects in the device; search for analyzers; analysis of the transformations that occur as the work progresses; use of several types of data restitution; intention of knowledge production; attention to institutional contexts and interference; primary and secondary implications, and the connection between them was also considered. Thus, we present as a result and discussion the reflections carried out with the professionals participating in the MS device about healthcare for MHCCA in its areas of coverage, paying attention to the problematization of the concept of mental health and the identification of care based on psychiatric diagnoses; solicitation of the presence of psychologists in the FHS to supply demand of the users that have some type of mental suffering; the use of light technologies such as listening and the crossings of the division of labor, shaping the understanding that the practice of listening is responsibility of the psychologist; the lack of articulation between the FHS and CPH teams with interference from other institutions in the coordination of the interstitial care of children and adolescents and, finally, the relations established between the researcher and the group, providing some changes in those involved during the research. It should be emphasized that the reflections that occurred promoted the analysis of the practice carried out by the articulation of the workers with in order to construct collective knowledge. This contributes to processes and studies about Matrix Support in MHCCA