Institutional analysis in scientific health production: an integrative literature review.

OBJECTIVE: To analyze the use of the Institutional Analysis theoretical-methodological framework and of the central concept of institution in its three moments - instituted, instituting and institutionalizing in health studies. METHOD: Integrative review conducted in databases of PubMed/Medline, LILACS, Scopus, and CINAHL including original research articles published between 2012 and 2017. RESULTS: Analysis of 26 publications. A plurality of study objects was found, and the most common were related to collective health, namely: mental health, violence, family-team relationship, family health, primary care, health of women, children and adolescents, oral health, continuing education, micropolitics of health work, health surveillance, HIV, law, pedagogical practices, school education and Autism. Nursing and psychology were the areas that most opted for Institutional Analysis. The polysemy of the institution concept was confirmed in the findings, indicating the richness of modes and uses of the concepts. CONCLUSION: Institutional Analysis presents tool-concepts to perform analyzes of health practices consistent with the Unified Health System.

Institutional analysis in scientific health production: an integrative literature review / El análisis institucional en la producción científica en salud: una revisión integradora de literatura / A análise institucional na produção científica em saúde: uma revisão integrativa de literatura

Abstract Objective: To analyze the use of the Institutional Analysis theoretical-methodological framework and of the central concept of institution in its three moments - instituted, instituting and institutionalizing in health studies. Method: Integrative review conducted in databases of PubMed/Medline, LILACS, Scopus, and CINAHL including original research articles published between 2012 and 2017. Results: Analysis of 26 publications. A plurality of study objects was found, and the most common were related to collective health, namely: mental health, violence, family-team relationship, family health, primary care, health of women, children and adolescents, oral health, continuing education, micropolitics of health work, health surveillance, HIV, law, pedagogical practices, school education and Autism. Nursing and psychology were the areas that most opted for Institutional Analysis. The polysemy of the institution concept was confirmed in the findings, indicating the richness of modes and uses of the concepts. Conclusion: Institutional Analysis presents tool-concepts to perform analyzes of health practices consistent with the Unified Health System.

Resumen Objetivo: Analizar, en los estudios del área sanitaria, la utilización del marco de referencia teórico metodológico del Análisis Institucional y del concepto central de institución en sus tres momentos - instituido, instituyente e institucionalización. Método: Revisión integradora llevada a cabo en las bases de datos PubMed/Medline, LILACS, Scopus, CINAHL, incluyéndose en la búsqueda artículos originales de investigación, publicados entre 2012 y 2017. Resultados: Fueron analizadas 26 publicaciones. Se encontró una pluralidad de objetos de estudio, siendo los más comunes los relacionados con la salud colectiva: salud mental, violencia, relación familia-equipo, salude de la familia, atención primaria, salud de la mujer, infancia y adolescencia, salud bucal, educación permanente, micropolítica del trabajo en salud, vigilancia en salud, VIH, derecho, prácticas pedagógicas, educación escolar y Autismo. La enfermería y la psicología fueron las áreas que más optaron por el Análisis Institucional. La polisemia del concepto de institución se confirma en los hallazgos, señalando una riqueza en los modos y usos de los conceptos. Conclusión: El Análisis Institucional presenta conceptos herramienta capaces de operar análisis de prácticas en salud acordes con el Sistema Único de Salud.

Resumo Objetivo: Analisar, nos estudos da área da saúde, a utilização do referencial teórico-metodológico da Análise Institucional e do conceito central de instituição em seus três momentos - instituído, instituinte e institucionalização. Método: Revisão integrativa realizada nas bases PubMed/Medline, LILACS, Scopus, CINAHL, sendo incluídos na busca artigos originais de pesquisa, publicados entre 2012 e 2017. Resultados: Foram analisadas 26 publicações. Encontrou-se uma pluralidade de objetos de estudo, sendo mais comuns os relacionados à saúde coletiva: saúde mental, violência, relação família-equipe, saúde da família, atenção primária, saúde da mulher, infância e adolescência, saúde bucal, educação permanente, micropolítica do trabalho em saúde, vigilância em saúde, HIV, direito, práticas pedagógicas, educação escolar e Autismo. A enfermagem e a psicologia foram as áreas que mais optaram pela Análise Institucional. A polissemia do conceito de instituição se confirma nos achados, indicando uma riqueza nos modos e usos dos conceitos. Conclusão: A Análise Institucional apresenta conceitos-ferramenta capazes de operar análises de práticas em saúde condizentes com o Sistema Único de Saúde.

Dificuldades e facilidades do enfermeiro da Saúde da Família no processo de trabalho / Difficulties and facilities of the Family Health nurse in the work process

Resumo Introdução Os cuidados primários à saúde são discutidos internacionalmente desde 1978 com a Declaração de Alma-Ata. Quinze anos depois, nasceu no Brasil a Saúde da Família, em que se destaca o enfermeiro como um dos principais profissionais com atribuições no processo de trabalho que garante a prestação qualificada da assistência. Objetivo Analisar as dificuldades e as facilidades do processo de trabalho dos enfermeiros das Unidades Básicas de Estratégia Saúde da Família. Método Trata-se de um estudo de natureza descritiva, transversal e abordagem qualitativa, cujos dados foram obtidos a partir de entrevista semiestruturada. Os dados coletados em um período de três meses foram analisados por meio da análise temática. Resultados A análise revelou quatro núcleos de sentido relacionados à dificuldade: alta demanda espontânea, recursos humanos escassos, sobrecarga de atividades e educação permanente reduzida. Para as facilidades, foram identificados dois núcleos de sentido: formação holística e campo rico para pesquisas. Conclusão Os resultados forneceram subsídios para que os gestores de saúde implementem estratégias em prol do processo de trabalho dos enfermeiros, o que, consequentemente, refletirá em benefícios ao indivíduo, à família, à comunidade e a toda equipe de saúde.

Abstract Background Primary health care has been discussed internationally since 1978 with the Alma Ata Declaration. Fifteen years later the Family Health is born in Brazil, which the nurse is the one of the main professionals with attributions in the work process that ensures the qualified provision of the assistance. Objective To analyze the difficulties and facilities of the work process of nurses of the Basic Family Health Strategy Units. Method This is a descriptive, cross-sectional and qualitative study, the data being obtained from a semi-structured interview. The data collected over a period of three months were analyzed through the thematic analysis. Results The analysis revealed four sense nuclei related to the difficulty: high spontaneous demand, scarce human resources, activities overload and reduced permanent education. For the facilities were identified two nuclei of sense: holistic formation and rich field for research. Conclusion The results provide support for health managers to implement strategies for the nurses' work process, which will consequently reflect benefits to the individual, family, community and all health team.

Acupuncture in Brazil's Unified Health System - an analysis based on different health management tools. / Acupuntura no Sistema Único de Saúde ­ uma análise nos diferentes instrumentos de gestão.

The integration of Integrative and Complementary Practices into public health systems has been the subject of national and international debate. In Brazil, the National Policy on Integrative and Complementary Practices guides the integration of acupuncture into the Unified Health System (UHS). This article explored the availability and/or accessibility of acupuncture in the UHS in 26 municipalities in the XIII Health Region of the State of São Paulo between 2001 and 2011, based on the analysis of Municipal Health Plans, Annual Management Reports and complementary data obtained from Information Systems. The data was analyzed using a framework for policy analysis based on: context, process, content and actors. Results show that the legislative framework provides a favorable environment; however public funding for these activities is particularly limited. Only government actors participated in the decision-making processes; the plans and reports contained inconsistencies both in structure and in the references made to acupuncture; the process showed that the policy helped to describe the organization of the provision of acupuncture services. The study concludes that the integration of acupuncture and use of health management and planning tools is limited in the 26 municipalities and that this precludes monitoring and maintains these practices on the periphery of the system.

Acupuntura no Sistema Único de Saúde - uma análise nos diferentes instrumentos de gestão / Acupuncture in Brazil´s Unified Health System - an analysis based on different health management tools

Resumo A inserção de Práticas Integrativas e Complementares nos sistemas públicos de saúde tem sido muito discutida nacional e internacionalmente. No Brasil a Política Nacional de Práticas Integrativas e Complementares norteia a inclusão da acupuntura no Sistema Único de Saúde. Este artigo analisou a implantação da acupuntura no SUS de 26 municípios do Departamento Regional de Saúde XIII/São Paulo, entre 2001 e 2011, a partir dos Planos Municipais de Saúde, Relatórios Anuais de Gestão e Sistemas de Informação. Os registros referentes à acupuntura foram analisados nas categorias contexto, atores, conteúdo e processo de implantação da prática. Os resultados mostraram um contexto favorável no âmbito legislativo e desfavorável no financiamento; somente atores institucionais; o conteúdo continha incoerências na estrutura dos documentos e nos registros da acupuntura; o processo mostrou que a política auxiliou a descrever a organização para a oferta da acupuntura. Conclui-se que a acupuntura e os instrumentos de gestão e planejamento em saúde têm incorporação incipiente nos 26 municípios, o que obsta o monitoramento e mantém essas práticas na periferia do sistema.

Abstract The integration of Integrative and Complementary Practices into public health systems has been the subject of national and international debate. In Brazil, the National Policy on Integrative and Complementary Practices guides the integration of acupuncture into the Unified Health System (UHS). This article explored the availability and/or accessibility of acupuncture in the UHS in 26 municipalities in the XIII Health Region of the State of São Paulo between 2001 and 2011, based on the analysis of Municipal Health Plans, Annual Management Reports and complementary data obtained from Information Systems. The data was analyzed using a framework for policy analysis based on: context, process, content and actors. Results show that the legislative framework provides a favorable environment; however public funding for these activities is particularly limited. Only government actors participated in the decision-making processes; the plans and reports contained inconsistencies both in structure and in the references made to acupuncture; the process showed that the policy helped to describe the organization of the provision of acupuncture services. The study concludes that the integration of acupuncture and use of health management and planning tools is limited in the 26 municipalities and that this precludes monitoring and maintains these practices on the periphery of the system.