Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology.

Objective: To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods: This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results: Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions: The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

Interprofessional education in Brazilian nursing undergraduate course syllabi.

The objective of this study was to analyze aspects related to interprofessional education in healthcare through the assessment of the syllabi of undergraduate nursing programs in Brazil. An observational, descriptive study was conducted in two phases. The first phase involved identification of programs, and the second phase involved documental analysis of the syllabi through a script created for this purpose. One thousand two hundred and twenty nursing undergraduate programs were identified; 229 were included in the sample for the document analysis. In 2.6% of the programs, the term "interprofessional" was identified in the purpose of the programs. Seventeen percent of the programs valued interprofessional education, and 8% assessed interprofessional learning. Recognizing (9.2%) and respecting (6.6%) the attributes and roles of different professionals were the least identified interprofessional values in the syllabi. Interprofessional education was not institutionalized/stated in the documents, even though the documents indicated use of interprofessional relationships in training scenarios, especially in primary care, and in activities not included in the formal curriculum.

[Interprofessional health education in the Region of the Americas from a nursing perspectiveEducação interprofissional em saúde na Região das Américas na perspectiva da enfermagem]. / Educación interprofesional en salud en la Región de las Américas desde la perspectiva de la enfermería.

This study presents a reflective analysis of the implementation of interprofessional education in undergraduate nursing courses, considering as an example the curricula of undergraduate nursing careers in Brazil. Despite investments to advance interprofessional education, its practice is not institutionalized in the curricula of undergraduate courses. These findings represent a limitation for the implementation of interprofessional education in nursing courses, and the case of Brazil allows to learn lessons for the education of nursing professionals in other countries of the Region of the Americas. Recommendations are provided for training, management and intersectoral articulation of health and education services, with emphasis on primary health care and the Sustainable Development Goals, aimed at educational institutions wishing to implement interprofessional education.

Neste estudo, foi realizada uma análise reflexiva sobre a implementação da educação interprofissional em cursos de graduação em enfermagem, considerando como exemplo os currículos dos cursos de graduação em enfermagem no Brasil. Apesar dos investimentos para avançar a educação interprofissional, sua prática não está institucionalizada nos currículos de graduação. Esses achados representam uma limitação para a implementação da educação interprofissional em cursos de enfermagem, e o caso do Brasil fornece lições para a formação de profissionais de enfermagem em outros países da Região das Américas. Medidas de treinamento, gestão e articulação intersetorial de serviços de saúde e educação, com ênfase nos cuidados primários de saúde e nos Objetivos de Desenvolvimento Sustentável, são recomendadas para instituições educacionais que desejam implementar a educação interprofissional.

[Managers' perspective on continuous health education in a region of São Paulo State]. / Perspectiva dos gestores de uma região do estado de SãoPaulo sobre educação permanente em saúde.

OBJECTIVE: Analysing the concepts of Continuous Health Education - CHE (EPS - in Portuguese), operated by municipal managers and translated into official documents. METHOD: Qualitative research with the use of official documents and semi-structured interviews with the Municipal Health Secretaries or Coordinators of Primary Health Care in the Northeast Region of São Paulo State, and thematic analysis of empirical material. RESULTS: Results indicate difficulties in the municipalities problematizing their management practices, services and health care; EPS tools presented are insufficient and unsatisfactory for amending the array of problems raised and are still far from the routine of Primary Care services. CONCLUSION: Despite efforts to implement EPS actions for the strengthening of primary care, the process appears to be incipient.

[Supervision of Community Health Agents in the Family Health Strategy: the perspective of nurses]. / Supervisão dos Agentes Comunitários de Saúde na Estratégia Saúde da Família: a ótica dos enfermeiros.

OBJECTIVE: Analyzing the conceptions of supervision of nurses in the Family Health Strategy (ESF - Estratégia Saúde da Família) in relation to community health workers (ACS - Agente Comunitário de Saúde), taking for reference the work process and the power relations. METHOD: A qualitative study, in which 18 interviews were carried out with nurses from the ESF in the countryside of the state of Goiás. Following transcription, the data were subjected to thematic content analysis and the following categories were identified: Supervision with that sees it all and Supervision is participating and working together. RESULTS: Among the findings, it is clear the character of control and monitoring that is carried out primarily through printed instruments and home visits, which constitute vertical and impositive relations, and suffer influence of the local health management. Another finding is the supervision as acting together and with the educational perspective. CONCLUSION: The supervision carried out does not provide the changes intended by the ESF.

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.

[Cooperative interventions and the Interaction of Community Health agents within the family health team]. / Articulação das ações e interação dos Agentes Comunitários de Saúde na equipe de Saúde da Família.

This qualitative study examines the social relationships between the Community Health Agents (CHAs) and the Family Health team (FH), highlighting cooperative interventions and interactions among workers. A total of 23 participant observations and 11 semi-structured interviews were conducted with an FH team in a city in the interior of São Paulo, Brazil. The results revealed that CHAs function as a link in the development of operational actions to expedite teamwork. These professionals, while creating bonds, articulate connections of teamwork and interact with other workers, developing common care plans and bringing the team and community together, as well as adapting care interventions to meet the real needs of people. In communication practice, when talking about themselves they talk about the community itself because they are the community's representatives and spokespersons on the team. The conclusion is that the CHA may be a strategic worker if his/her actions include more political and social dimensions of work in healthcare.

[Cartographic notes on the work in the Family Health Strategy: relationships between workers and the population]. / Notas cartográficas do trabalho na Estratégia Saúde da Família: relações entre trabalhadores e população.

The objective of this intervention study was to map instituted and instituting movements present in the work of the Family Health Strategy in the development of their care practices. The theoretical framework is based on institutional analysis, using the schizoanalytic approach. Group meetings were carried out with the staff to discuss how they provided collective care in continuing health education. The study subjects were professionals from the team and students who were engaged in academic activity in the service. The average attendance was twelve people per meeting, and there were a total of eight meetings from March to July 2010. Data were grouped into two immanent strata: the relationships of the team and the relationship with clients. The strata point to the intersection of education and legal institutions and the social and technical division of labor. Collective thinking in groups appeared to be effective in denaturalizing established processes and interrogating places, knowledge and practices.

The research and association between teaching and care in the consolidation of the Brazilian National Health System. / A pesquisa e a articulação ensino-serviço na consolidação do Sistema Único de Saúde.

This article comprises the authors' reflections about theory and experiences about the connection between research, teaching and health care services for the consolidation of the Brazilian National Health System (SUS - Sistema Único de Saúde). The research in collective health nursing face the challenge of breaking with the traditional forms that separate those who research, teach, learn and provide care. The movement for changing the process of caring and teaching occurs through an investigative and reflexive production. Therefore, the studies for the consolidation of the SUS call for an intense connection between teaching-service and knowledge production. It challenges us to create research projects together with the workers, which implies advancing the data collection to data production, and taking students to the activities and internship for the alliance and co-responsibilization of actions. We propose assuming the lack of knowledge to create instituting practices.

[Attributes mobilized by nurses in family health: reaching performances when developing managerial competence]. / Atributos mobilizados pela enfermeira na Saúde da Família: aproximação aos desempenhos na construção da competência gerencial.

This exploratory-descriptive study was performed using a qualitative approach with the purpose to identify and analyze the attributes mobilized in work situations that characterize the performance of nurses in managerial competence in Family Health based on the concepts of dialogic competence. Data collection was performed through participant observation of the work performed by Family Health nurses in four units associated with the University of São Paulo in Ribeirão Preto - SP/Brazil, considering a typical workweek, with a total of 160 hours of observation. Through content analysis, using the thematic analysis technique, we identified five themes related to: supervision, teamwork, social control, work organization and planning. Results show there is a group of attributes mobilized by nurses which remains centered on work organization for individual health care with rare incursions for a systemized planning process.

[Family discussion in the family health strategy: a working process under construction]. / Discussão de famílias na estratégia saúde da família: processo de trabalho em construção.

The objective was to follow the working process of a family health team in their regular meetings held to discuss family cases. This study used a qualitative approach, founded on the theoretical and methodological framework institutional schizoanalytic analysis. Seventeen meetings were followed, which counted with the participation of an average of 7 to 8 of the 17 workers participating in the study. The team held discussions on the families, and classified them according to the risk criteria, reviewed what had been accomplished in the meting and searched for action alternatives. There were disagreements when participants faced differences and difficulties to be heard by their colleagues, which were gradually overcome, and made it possible for the members to share care situations they had in common. The team made an effort to analyze the how they take care of the families and to get them to integrate. It was concluded that the meetings favor the production of care and the construction of group work as the team, while delivering care, deals with the subjectivities produced in their practice.

[Cervical cancer: integral care to the woman in health services]. / Câncer de colo uterino: atenção integral à mulher nos serviços de saúde.

This study aims to understand how the health services of the Brazilian Public Health System (BPHS) are organized to give an integral care to the woman with cervical cancer. This is a descriptive, qualitative research with 20 women. Semistructured interviews were coupled with participant observation in data collection. The thematic analysis revealed the theme: "The search for care: access to BPHS and use of health services in the search for integral care". In the use of health services, women have exposed their views on the received care, and on the potentialities and limits of integrality in this context. The conclusion is that the effectivation of health actions that aim at the integrality of care for women requires courage and the promotion of a dialogue between social actors as a way to build a health awareness that allows an ethical commitment pointing towards the necessary changes in care.

Follow-up of cancer patients by family health workers.

This descriptive and quantitative study identified and analyzed follow-up actions developed by workers of 13 Family Health Teams (FHT) for cancer patients in a city in the Southeast of Brazil. A questionnaire validated by seven experts was applied to 101 workers. The results indicated that 80.2% of workers were aware of the existence of cancer patients in the FHT scope area; 13.9% were aware of the total number of cancer patients; and 63.3% delivered care to these patients; home visits were carried out by 93.1%; and 69% discussed cases during FHT meetings. Emotional support was the most frequent action among those offered by workers to caregivers. As to the joint work developed within the service network, 46.5% reported that there are no counter-referrals. The conclusion is that follow-up is not systematized; there are needs and possibilities within the Family Health Strategy for workers to follow-up with cancer patients and their caregivers.

Assistance in family health from the perspective of users.

This descriptive exploratory study analyzed user satisfaction with the care received at a Family Health Unit in Ribeirão Preto, Brazil. In total, 40 users from families registered in the FHU were selected, using key informants and the snowball sampling technique, and interviewed. Thematic content analysis was used to analyze the empirical material. Interviewees were mostly female, over 50 years, resident in the catchment area of the unit for 10-30 years, had incomplete primary education and also did not perform work outside the home. The analysis identified three themes: access, team-user interaction and organization of work in the FHU. The subjects of this study expressed satisfaction with the accessibility provided together with the caring attention given to them, marked by a team-user interaction that takes place in a friendly and patience manner. Although not totally satisfied, the majority of users would recommend the health service to someone due to its quality.

[(Dis)satisfaction of users: duplication and simultaneous use of services in family health]. / (In)satisfação dos usuários: duplicação e uso simultâneo na utilização de serviços na Saúde da Família.

This descriptive and exploratory study was performed with the purpose to identify the pattern of use of health services: duplication and simultaneous use in a District Reference Unit (URD, acronym in Portuguese) and four Family Health Units (USF, acronym in Portuguese). Secondary data were collected in two stages: the first stage involved identifying the Service Files of the District Reference Unit for 15 days of the month of June 2006; and the second stage involved verifying 856 services delivered among the selected USF to users who were seen at the URD. It was found that there was duplication in the use of health services corresponding to 0.35% of the users seen at the group of services, as well as simultaneous use, corresponding to 3.27% of users. The duplication of health service use is considered to be an indirect indicator for the analysis of user satisfaction, i.e., service use duplication may be understood as an expression of user dissatisfaction.

[Special Requests Analysis Committee: a key initiative in the context of health judicialization]. / Comissão de Análise de Solicitações Especiais: uma iniciativa fundamental no contexto da judicialização da saúde.

OBJECTIVES: To describe and analyze the work of a Special Commission, which technically evaluates litigations in a municipality in the regional area of São Paulo, in Brazil. METHOD: Qualitative study, in which seven semi-structured interviews were carried out following the snowball technique. The discursive data was analyzed taking as reference some elements of the thematic analysis. RESULTS: The members of the Special Commission interviewed, answered questions related to four pre-established thematic axes: the work experience in the judicialization, the health-disease process, the responsibility of the health system regarding the user's well-being, and the right to health. In the first axis, they shared their work routine, exposed the tools they use to issue technical opinions, and recognized the relevance of the Commission to qualify the demands, rationalize public spending and approximate the areas of Health and Law. In the second axis, they highlighted the association between several constraints and determinants to be healthy or to develop a disease. In the third, they emphasized the relevance of integral care to promote well-being and reduce worsening. In the fourth, they affirmed that the right to health is not restricted to access to health care, but to the individual and collective elements that conform people, families and communities, and that the realization of the right to health is not a unilateral process. CONCLUSION: According to the empirical material, recognizing the different issues, perspectives, conditions and opinions related to the judicialization can help in its global comprehension and offer more just and rational possibilities for the realization of the right to health through the judicial process.

Nurses' work at Family Health Strategy: possibilities to operate health needs.

OBJECTIVES: to identify and analyze possibilities for recognizing health needs in the nurses' work at Family Health Strategy. METHODS: a qualitative study with interviews and observation of the nurses' work in the countryside of São Paulo. The empirical material was subjected to thematic content analysis and interpreted in the light of the health work process. RESULTS: two themes emerged: Possibilities utilized and Possibilities neglected to recognize health needs. Careful observation, welcoming, attention, listening, bonding and dialogue developed by nurses, in live work in action with users, touched on the possibilities, which, taken advantage of, were evidenced in care in spontaneous demand, scheduled consultation, examination gynecological and group activities. FINAL CONSIDERATIONS: nurses are able to recognize health needs, which can expand their clinical practice and interprofessionality in Family Health.

Preparing the care relationship: a welcoming tool in health units.

This study aimed to identify and analyze aspects regarding the preparation for the worker-user relationship in a primary health care unit in a city in the state of São Paulo-Brazil, from the perspective of welcoming. The health work process is the theoretical basis of the study; participant observation and semi-structured interviews were used as data collection techniques, and thematic analysis in the analysis stage. For the welcoming to be processed, there is a 'moment' of preparation for the worker, the physical environment and the relationships present at work so that users are welcomed, in which the users' needs are sometimes disregarded. Despite the difficulties in terms of resource availability, especially in the public sector, when preparing the service/user and worker/user relationships, one should consider the aspects associated to a more human, welcoming relationship, since it is during live work, in this intersection, that care quality is established.

[The work process in the reception of a primary care unit worker's view]. / O processo de trabalho na recepção de uma unidade básica de saúde: otica do trabalhador.

This qualitative study aimed at understanding the elements that constitute the work process in the reception room of a Primary Care Unit. The theoretical approach used was the work process in health. Data were collected through free observation and semi-structured interview. The Discourse of the Collective Subject and the Thematic Analysis were used for data organization and treatment. Results reveal fragmentation of the work process. The duties are taken as subject of the job, the needs of the users are limited to execution of procedures, and the main instruments are the norms and routines. The work purpose is care to the needy people. We concluded there is a need to develop analysis about the work.

[Nursing in Brazil in the context of the work force of the health: profile and legislation]. / A enfermagem no Brasil no contexto da força de trabalho em saúde: perfil e legislação.

This article approaches nursing as a social practice, grounded in the work category to address the nursing work force in Brazil. It recovers the historical arrangement of its profile associated to the most general organization of the health sector in the country. Workers' profile is related to the aim of the health work process. Authors understand that the moving forces in the health context are restricted, but its organized actors can give directions determined by the technical, ethical and political ambits. Readers are invited to reflect on which nursing profiles are supported and targeted to the multiple Brazils. The characteristics of generalist nursing workers are highlighted, evidencing that new power and knowledge arrangements will be necessary for this training. This can build other profiles and outlines to health work and nursing, more committed with the principles of the Unified Health System.