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.

The Feminine Condition and Women's Sexual and Reproductive Health in Brazil and France.

Introduction: Elements mark the reality of reading the female body in symbolic constructions and social symbols in the exercise of their reproductive health. The study aims to identify elements that characterize the female condition while analyzing the reproductive health of Brazilian and French women. Materials and Methods: A qualitative, multicenter, international study was conducted in Brazil and in France between 2016 and 2019. Data were produced through the use of semi-structured scripts. Focus group discussions and individual interviews were conducted with women who gave birth, hetero-female couples who lived the experience of gestation and birth of a baby, and professionals of maternal and childcare services or members of the associations concerned with the health of mothers and babies. It was guided by the theoretical-methodological framework of institutional analysis in line with the French Institutional Socioclinics. Results: Sexual and reproductive health in the realities researched in Brazil and France are sometimes close and sometimes far apart. In what involves the Brazilian health system, abortion is criminalized and often performed illegally. Furthermore, pregnancy, childbirth, and the postpartum period are highly medicalized. In addition, childbirth is not assured as an experience for a woman and her family. This aspect is confirmed by high numbers of cesarean sections performed or by maternal and infant mortality indicators. The French health system prioritizes vaginal deliveries and seems to assure more autonomy to women, but at the same time, it is worn out by the logic of profit, the efficiency of actions, and the rationalization of practices. In association with these, there are other intrinsic elements in the functioning of the institution that delineates the format of each country: notion of women's rights, violence against women, and discussion regarding the oppression markers of race, gender, sexuality, and social class. Conclusions: Both countries reveal aspects related to the social role of women's bodies. The established logic reflects in the decision to have children, motherhood, women's autonomy over their own bodies, and in the core values linked to the termination of pregnancy and the professional practices developed in prenatal care, childbirth, and postpartum.

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses.

OBJECTIVE: to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France. METHOD: a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries. RESULTS: the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health. CONCLUSION: the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses / Parto por cesárea: estudio socioclínico institucional de prácticas y discursos profesionales / O nascimento por cesariana: um estudo sócio-clínico institucional das práticas e discursos profissionais

Objective: to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France. Method: a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries. Results: the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health. Conclusion: the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

Objetivo: analizar cómo influyen los elementos sociales, históricos, económicos y profesionales en el proceso de institucionalización del parto por cesárea en Brasil y Francia. Método: estudio cualitativo basado en el marco teórico de la socioclínica institucional. Los datos se obtuvieron a través de grupos focales y entrevistas individuales, basados en encuestas semiestructuradas con profesionales de la salud, madres y padres y en un diario de investigación. El estudio contó con 83 participantes. El análisis se basó en el marco teórico y el análisis temático. Se realizó un análisis cruzado entre diferentes tipos de datos, servicios, grupos y entre países. Resultados: los participantes fueron caracterizados por educación, empleo, nivel de formación y lugar de trabajo. Los países estudiados tienen una estructura sanitaria y educativa peculiar y se caracterizan por una construcción socio-histórico-económica basada en el patriarcado. La Nueva Gestión Pública influye en ambos contextos y precariza la asistencia sanitaria. Las dimensiones técnicas y organizativas refuerzan una división intelectual y social del trabajo y del conocimiento en salud. Conclusión: el proceso de institucionalización del parto en los países está marcado por aspectos sociales, económicos y profesionales. Las prácticas y los discursos de los profesionales en su proceso de trabajo influyen en la realización o no, de la cesárea.

Objetivo: analisar como os elementos sociais, históricos, econômicos e profissionais influenciam o processo de institucionalização do nascimento por cesariana, no Brasil e na França. Método: estudo qualitativo fundamentado no referencial teórico da sócio-clínica institucional. Os dados foram produzidos por meio da realização de grupos focais e entrevista individual, apoiados em roteiros semiestruturados, com profissionais da saúde, mães e pais e diário de pesquisa. O estudo contou com 83 participantes. A análise foi feita com base no referencial teórico e análise temática. Desenvolveu-se análise cruzada entre os diferentes tipos de dados, serviços, grupos e entre países. Resultados: os participantes foram caracterizados em relação à escolaridade, emprego, nível de formação e lugar de trabalho. Os países pesquisados têm sua estrutura sanitária e educativa peculiar e são marcados por uma construção sócio-histórica-econômica delineada pelo patriarcado. A Nova Gestão Pública influencia ambos os contextos e torna os cuidados de saúde precarizados. As dimensões técnicas e organizacionais reforçam uma divisão intelectual e social do trabalho e do saber em saúde. Conclusão: o processo de institucionalização do nascimento nos países é marcado por aspectos sociais, econômicos e profissionais. Práticas e discursos dos profissionais em seu processo de trabalho influenciam a ocorrência, ou não, da cesariana.

[Analysis of researchers' implication in a research-intervention in the Stork Network: a tool for institutional analysis]. / A análise de implicação de pesquisadores em uma pesquisa-intervenção na Rede Cegonha: ferramenta da análise institucional.

This qualitative study is based on institutional analysis as the methodological theoretical reference with the objective of analyzing researchers' implication during a research-intervention and the interferences caused by this analysis. The study involved researchers from courses in medicine, nursing, and dentistry at two universities and workers from a Regional Health Department in follow-up on the implementation of the Stork Network in São Paulo State, Brazil. The researchers worked together in the intervention and in analysis workshops, supported by an external institutional analysis. Two institutions stood out in the analysis: the research, established mainly with characteristics of neutrality, and management, with Taylorist characteristics. Differences between researchers and difficulties in identifying actions proper to network management and research were some of the interferences that were identified. The study concludes that implication analysis is a powerful tool for such studies.

[Socianalytical device: intervention instrument and data collection in qualitative research in nursing]. / Dispositif socianalytique: instrument d'intervention et de collecte de données en recherche qualitative en soins infirmiers.

The aims of this paper is to describe and to analyze the use of a socioanalytical device as a data collection too as well as a space of professional practice and work relations analysis, with nurses from a School Hospital of the Minas Gerais Federal University, Brazil. The qualitative approach was chosen to develop an intervention research with Institutional Analysis as theoretical and methodological framework. In the first stage of data collection, an exploratory research was carried out through a questionnaire and, in the second phase, a socianalytical device was built in 5 meetings that took place during two months. For the nurses, the analysis device has enabled personal and professional growth; to review positions; to exchange experience and to reflect on their own problems through the experience of other colleagues. We conclude that the socioanalytical device was a space for discussion, for analysis of professional practice and was the methodological strategy for data collection in this research. It has allowed the creation and recreation of forms of intervention, the production of knowledge and has improved quality of health work.

A análise de implicação de pesquisadores em uma pesquisa-intervenção na Rede Cegonha: ferramenta da análise institucional / Analysis of researchers' implication in a research-intervention in the Stork Network: a tool for institutional analysis / El análisis de implicación de investigadores en una investigación-intervención en la Red Cegonha: herramienta de análisis institucional

Resumo: Estudo qualitativo baseado no referencial teórico metodológico da análise institucional, com o objetivo de analisar a implicação dos pesquisadores durante o processo de uma pesquisa-intervenção e as interferências que esta análise provocou. A pesquisa envolveu pesquisadores de duas universidades oriundos de cursos de medicina, enfermagem e odontologia, e trabalhadores de um Departamento Regional de Saúde no acompanhamento da implantação da Rede Cegonha no interior de São Paulo. Os pesquisadores trabalharam juntos na intervenção e em oficinas de análise. Contaram com um analista institucional externo, que auxiliou o grupo na análise de implicação. Duas instituições se destacaram na análise: a pesquisa, em cujo instituído predominam características de neutralidade, e a gestão, com características tayloristas. As diferenças entre os pesquisadores, as dificuldades em identificar ações próprias da gestão da rede e da pesquisa foram algumas das interferências identificadas. Conclui-se que a análise de implicação é uma ferramenta potente para pesquisas dessa natureza.

Abstract: This qualitative study is based on institutional analysis as the methodological theoretical reference with the objective of analyzing researchers' implication during a research-intervention and the interferences caused by this analysis. The study involved researchers from courses in medicine, nursing, and dentistry at two universities and workers from a Regional Health Department in follow-up on the implementation of the Stork Network in São Paulo State, Brazil. The researchers worked together in the intervention and in analysis workshops, supported by an external institutional analysis. Two institutions stood out in the analysis: the research, established mainly with characteristics of neutrality, and management, with Taylorist characteristics. Differences between researchers and difficulties in identifying actions proper to network management and research were some of the interferences that were identified. The study concludes that implication analysis is a powerful tool for such studies.

Resumen: Estudio cualitativo basado en el referencial teórico metodológico del análisis institucional, con el objetivo de analizar la implicación de los investigadores durante el proceso de una investigación-intervención y las interferencias que este análisis provocó. La pesquisa involucró a investigadores de dos universidades, procedentes de cursos de medicina, enfermería y odontología, y trabajadores de un Departamento Regional de Salud en el seguimiento de la implantación de la Red Cegonha en el interior de Sao Paulo. Los investigadores trabajaron juntos en la intervención y en oficinas de análisis. Contaron con un analista institucional externo, que auxilió al grupo en el análisis de implicación. Dos instituciones se destacaron en el análisis: la investigación, en cuya institución predominan características de neutralidad, y la gestión, con características tayloristas. Las diferencias entre los investigadores, las dificultades en identificar acciones propias de la gestión de la red y de la investigación fueron algunas de las interferencias identificadas. Se concluye que el análisis de implicación es una herramienta potente para investigaciones de esta naturaleza.

Uma pesquisa socioclínica na França: notas sobre a análise institucional / Socio-clinical research in France: notes on institutional analysis

Esse texto tem por objetivo apresentar e discutir o processo de produção de uma pesquisa socioclínica sobre a parentalidade, desenvolvida na França, em Gennevilliers, durante 2011 e 2012. Baseou-se no referencial teórico da análise institucional, linha socioclinica. Os dispositivos para a produção dos dados da pesquisa foram observação participante, grupos de discussão com profissionais e pais, entrevista em domicílio, entrevistas informais e sessões de restituição. O processo de montagem e desenvolvimento desse tipo de pesquisa indica uma permanente tensão a ser explorada entre a intencionalidade dos demandantes e dos pesquisadores, o que faz a análise de implicação indispensável.(AU)

This study aims to present and discuss the process of producing a socioclinical research on parenting, developed in Gennevilliers, France during 2011 and 2012. The theoretical framework was based on institutional analysis, socio-clinical perspective. The devices for the production of research data include participant observation, discussion groups with professionals and parents, household interview, informal interviews and restitution sessions. The development of this kind of research indicates a constant tension to be explored between the intentionality of claimants and researchers which makes the analysis of implication indispensable.(AU)

Uma pesquisa sócio clínica na França: notas sobre a análise institucional / Socio-clinical research in France: notes on institutional analysis

Esse texto tem por objetivo apresentar e discutir o processo de produção de uma pesquisa socioclínica sobre a parentalidade, desenvolvida na França, em Gennevilliers, durante 2011 e 2012. Baseou-se no referencial teórico da análise institucional, linha socioclinica. Os dispositivos para a produção dos dados da pesquisa foram observação participante, grupos de discussão com profissionais e pais, entrevista em domicílio, entrevistas informais e sessões de restituição. O processo de montagem e desenvolvimento desse tipo de pesquisa indica uma permanente tensão a ser explorada entre a intencionalidade dos demandantes e dos pesquisadores, o que faz a análise de implicação indispensável.

This study aims to present and discuss the process of producing a socioclinical research on parenting, developed in Gennevilliers, France during 2011 and 2012. The theoretical framework was based on institutional analysis, socio-clinical perspective. The devices for the production of research data include participant observation, discussion groups with professionals and parents, household interview, informal interviews and restitution sessions. The development of this kind of research indicates a constant tension to be explored between the intentionality of claimants and researchers which makes the analysis of implication indispensable.

Analyser ses implications dans l´institution scientifique: une voie alternative / Analisar as implicações na instituição científica: uma via alternativa / Analysing the involvements on the scientific institution: one alternative

L’article interroge la possibilité, pour l’activité de recherche, de trouver une alternative en dehors de l’institution scientifique. La production des résultats de recherche est un travail institutionnel qui suppose le maniement de diverses techniques mais également d’agir sur l’institution. Le chercheur est impliqué dans l’institution, c'est-à-dire qu’il entretient avec elle des relations qui sont aussi bien idéologiques, organisationnelles que libidinales. En conséquence, c’est en analysant ses implications dans l’institution scientifique que le chercheur peut trouver une ligne de fuite afin de tenter d’échapper à la pensée instituée.René Lourau a proposé cette voie, l’article montre de quelle manière.(AU)

O artigo interroga a possibilidade, para a atividade de pesquisa, de encontrar uma alternativa fora da instituição científica. A produção de resultados de pesquisa é um trabalho institucional que supõe o manejo de diversas técnicas, mas igualmente supõe um agir sobre a instituição. O pesquisador está implicado na instituição, ou seja, mantém com ela relações que são tanto ideológicas e organizacionais como libidinais. Conseqüentemente, é mediante a análise de suas implicações na instituição científica que o pesquisador pode encontrar uma linha de fuga, na tentativa de escapar ao pensamento instituído. René Lourau propôs esta via, e o artigo mostra de que maneira.(AU)

The article asks the possibility for the research activity to find an alternative outside the scientific institution. The production of search results is an institutional work that involves the management of different techniques, but also implies acting on the institution. The researcher is involved in the institution, i.e. maintains relationships with it that are both ideological and organizational as libidinous. Therefore, it is through the analysis of his involvement in scientific institution that the researcher can find a line of escape, in an attempt to bolt from the instituted thought. René Lourau proposed this path, and the article shows in which way.(AU)

Analyser ses implications dans l´institution scientifique: une voie alternative / Analisar as implicações na instituição científica: uma via alternativa / Analysing the involvements on the scientific institution: one alternative

L’article interroge la possibilité, pour l’activité de recherche, de trouver une alternative en dehors de l’institution scientifique. La production des résultats de recherche est un travail institutionnel qui suppose le maniement de diverses techniques mais également d’agir sur l’institution. Le chercheur est impliqué dans l’institution, c'est-à-dire qu’il entretient avec elle des relations qui sont aussi bien idéologiques, organisationnelles que libidinales. En conséquence, c’est en analysant ses implications dans l’institution scientifique que le chercheur peut trouver une ligne de fuite afin de tenter d’échapper à la pensée instituée.René Lourau a proposé cette voie, l’article montre de quelle manière.

O artigo interroga a possibilidade, para a atividade de pesquisa, de encontrar uma alternativa fora da instituição científica. A produção de resultados de pesquisa é um trabalho institucional que supõe o manejo de diversas técnicas, mas igualmente supõe um agir sobre a instituição. O pesquisador está implicado na instituição, ou seja, mantém com ela relações que são tanto ideológicas e organizacionais como libidinais. Conseqüentemente, é mediante a análise de suas implicações na instituição científica que o pesquisador pode encontrar uma linha de fuga, na tentativa de escapar ao pensamento instituído. René Lourau propôs esta via, e o artigo mostra de que maneira.

The article asks the possibility for the research activity to find an alternative outside the scientific institution. The production of search results is an institutional work that involves the management of different techniques, but also implies acting on the institution. The researcher is involved in the institution, i.e. maintains relationships with it that are both ideological and organizational as libidinous. Therefore, it is through the analysis of his involvement in scientific institution that the researcher can find a line of escape, in an attempt to bolt from the instituted thought. René Lourau proposed this path, and the article shows in which way.

Implicação, sobreimplicação e implicação profissional / Implication, over implication and professional implication

O artigo busca discutir um dos conceitos básicos da Análise Institucional, a implicação. Para tanto, traz também outros conceitos que dela derivam e/ou modulam: sobreimplicação e implicação profissional. Trazendo exemplos presentes em diferentes espaços, na escola, na universidade, no hospital analisa a tendência da 'universitarização' das profissões, onde os profissionais são convocados a trabalhar suas dificuldades práticas pelo discurso, ao modo do fazer universitário, como se a análise discursiva da prática permitisse fazer evoluir a própria prática.(AU)

This article debates one of the basic concepts of Institutional Analysis: implication. For that purpose, brings two other concepts that stem from it: over implication and professional implication. Both rather important for the implications analyses process. Pointing out that implication analyses is a collective work, the text board the devices that those analyses can construct. Bringing examples of different spaces, in the school, in the university, in the hospital, it is analysed the tendency to give a universitarian form to the professions, when professionals are called to work their practical difficulties, doing it through the discourse, as used in the universities, as if the discursive analyses of the practice allowed the evolution of their practice.(AU)

Implicação, sobreimplicação e implicação profissional / Implication, over implication and professional implication

O artigo busca discutir um dos conceitos básicos da Análise Institucional, a implicação. Para tanto, traz também outros conceitos que dela derivam e/ou modulam: sobreimplicação e implicação profissional. Trazendo exemplos presentes em diferentes espaços, na escola, na universidade, no hospital analisa a tendência da "universitarização" das profissões, onde os profissionais são convocados a trabalhar suas dificuldades práticas pelo discurso, ao modo do fazer universitário, como se a análise discursiva da prática permitisse fazer evoluir a própria prática.(AU)

This article debates one of the basic concepts of Institutional Analysis: implication. For that purpose, brings two other concepts that stem from it: over implication and professional implication. Both rather important for the implications analyses process. Pointing out that implication analyses is a collective work, the text board the devices that those analyses can construct. Bringing examples of different spaces, in the school, in the university, in the hospital, it is analysed the tendency to give a universitarian form to the professions, when professionals are called to work their practical difficulties, doing it through the discourse, as used in the universities, as if the discursive analyses of the practice allowed the evolution of their practice.(AU)

Trabalhos socioanalíticos concernentes à violência na educação / Social analytical work on violence in educational establishments

O artigo visa a comentar as modalidades de demanda mais frequentes, na França, de trabalhos em Análise Institucional, ligados à questão da violência em estabelecimentos educacionais. Considerando que este termo constitui-se em uma categoria classificatória, utilizada por profissionais e pesquisadores para qualificar fenômenos nomeados diferentemente em outras épocas, o autor discute as possíveis modalidades de intervenção a estas situações problemas, levando em conta dispositivos e modalidades de intervenção. Enfim, o artigo pretende abordar a dimensão clínica destes trabalhos, assim como a de produção de conhecimento.

The article comments on the most frequent modalities of demand - in France - of investigations related to violence in educational establishments carried out within the perspective of "Institutional Analysis". Considering that violence is a notion used as a classifying category by researchers and other professionals to quality phenomena that were understood in different ways at different at times, the author discusses the possible modalities of intervention in situations of violence, taking into consideration specific devices. Finally, the article points out the clinical dimension of such investigations and their commitment do knowledge production.

Entrevista com Gilles Monceau / Interview with Gilles Monceau

Esta entrevista foi realizada por ocasião do 1° Seminário Internacional de Análise Institucional, organizado pelo Mestrado de Psicologia, do Departamento de Psicologia da UFF, em setembro de 2002.

Trabalhos socioanalíticos concernentes à violência na Educação / Social analytical work on violence in educational establishments

O artigo visa a comentar as modalidades de demanda mais frequentes, na França, de trabalhos em Análise Institucional, ligados à questão da violência em estabelecimentos educacionais. Considerando que este termo constitui-se em uma categoria classificatória, utilizada por profissionais e pesquisadores para qualificar fenômenos nomeados diferentemente em outras épocas, o autor discute as possíveis modalidades de intervenção a estas situações problemas, levando em conta dispositivos e modalidades de intervenção. Enfim, o artigo pretende abordar a dimensão clínica destes trabalhos, assim como a de produção de conhecimento.(AU)

The article comments on the most frequent modalities of demand - in France - of investigations related to violence in educational establishments carried out within the perspective of 'Institutional Analysis'. Considering that violence is a notion used as a classifying category by researchers and other professionals to quality phenomena that were understood in different ways at different at times, the author discusses the possible modalities of intervention in situations of violence, taking into consideration specific devices. Finally, the article points out the clinical dimension of such investigations and their commitment do knowledge production.(AU)

Entrevista com Gilles Monceau

Esta entrevista foi realizada por ocasião do 1° Seminário Internacional de Análise Institucional, organizado pelo Mestrado de Psicologia, do Departamento de Psicologia da UFF, em setembro de 2002.(AU)