Uma experiência de integração ensino-serviço e a mudança de práticas profissionais: com a palavra, os profissionais de saúde

Implementation of pharmaceutical care for older adults in the brazilian public health system: a case study and realistic evaluation

BACKGROUND

Pharmaceutical care services have been recognized as the most highly regarded professional pharmacy practice model that allows the identification, intervention, and resolution of drug related problems. This practice provides significant clinical outcomes and can reduce direct and indirect costs for health systems. However, its implementation can be complex and challenging, needing study experiences that aims at overcoming obstacles, especially in free and universal healthcare systems. The objective of this study is to evaluate the implementation of Ambulatory Care Pharmacy services for older adults at Paulista Institute of Geriatrics and Gerontology (IPGG), which is recognized in the city of São Paulo for offering pharmaceutical care services for over 10 years continuously. This initiative and process is independent of external academic interventions or educational institutions. It is hoped that the results may also contribute to advancing the implementation of pharmaceutical care service in similar health systems.

DESIGN

This is a case study using multiple sources of data. Qualitative and quantitative data were collected from institutional documents, by participant observation and interviews. Initial themes were identified by content analysis and analyzed under the context-mechanism-outcome configurations (CMO Configurations) in realistic evaluation.

SETTING

Geriatrics and Gerontology Institute of São Paulo (known as IPGG).

PARTICIPANTS

Eleven health professionals and three pharmaceutical care service users.

RESULTS

Three CMO configurations were identified and accepted: "Scenario Construction mediated by educational processes", "Contribution to complex needs resolution", and "Organizational Visibility". The CMO (Context-Mechanism-Outcomes) configuration "Logistic activities discourage clinical pharmaceutical services implantation" was denied due to the influence of accepted CMOs.

CONCLUSIONS

Educational processes which value transdisciplinary knowledge exchanges provide resources required to overcome important obstacles present during pharmaceutical care implementation. Thus, providing and seeking knowledge to build and offer context-consistent clinical health services as well as fulfilling organizational environment requirements can be the key to implement pharmaceutical care service.

Training physiotherapists in primary care: reflections on teaching-service integration

Abstract Introduction: Teaching-service integration contributes to the quality training of healthcare professionals. Objective: This study aimed to analyze the relationship between practicing physiotherapists, teachers and students in physiotherapy training in primary care, from the perspective of the professionals. Method: This is a qualitative study that used a semi-structured interview for data collection and discourse analysis as a methodological framework to analyze the interviews. Interviewees were nineteen physiotherapists who work at basic health units (BHUs) in a large municipality in Paraná state, Brazil. Results: Only six of the nineteen physiotherapists receive or have received students in the workplace. Higher education institutions that offer degrees in physical therapy have yet to harness the full potential of practical physiotherapy training in primary care in the municipality studied. The professionals who received or have received students in the workplace highlighted shortcomings in teaching-service integration, such as the lack of collaboration with teachers in terms of planning and student assessment. Conclusion: There is a need for closer ties between managers, health care professionals, teachers and students in order to improve teaching-service integration and provide physiotherapy training that complies with curriculum guidelines and the principles and policies of the National Health System (SUS).

VER-SUS project: Influences on the training and performance of nurses

OBJECTIVE

To analyze the influences of the Vivências e Estágios na Realidade do Sistema Único de Saúde (Brazilian Unified Health System), in the training and performance of nurses.

METHOD

A qualitative study was carried out with 14 nurses who participated in the VER-SUS project in Rio Grande do Sul State. The data were collected through a semi-structured interview technique. The data were analyzed, interpreted and discussed, through the technique of Content Analysis.

RESULTS

The categories "VER-SUS Influences on Nursing Training for SUS" and "VER-SUS Contributions for Nurses Performance in the SUS" were highlighted.

FINAL CONSIDERATIONS

It was possible to identify the influences of the VER-SUS project in the training and performance of the nursing professionals, pointing out the revision of the Pedagogical Projects of Course and the preparation of the teachers, as a way to carry out the training with emphasis in the Brazilian Unified Health System.

Integração ensino-serviço-comunidade nos cenários de práticas na formação interdisciplinar em Saúde: uma experiência do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) no sul da Bahia, Brasil

A proposta do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) da Universidade Federal do Sul da Bahia (UFSB) focaliza as relações entre saberes e práticas acadêmicas, profissionais e populares, desenvolvendo uma postura crítica e reflexiva na formulação de problemas com base nas demandas concretas da comunidade, por meio do trabalho em equipe, fortalecendo a articulação entre universidade e Rede de Atenção à Saúde. O objetivo foi relatar a experiência do PET-Saúde em um curso de Bacharelado Interdisciplinar em Saúde na UFSB, em Porto Seguro, sul da Bahia, no período entre maio de 2016 e março de 2017. Valoriza-se aqui a importância do processo ensino-aprendizagem vinculado aos cenários das práticas na formação em saúde. A experiência relatada esteve orientada pelos princípios da pesquisa-ação na elaboração do diagnóstico participativo da situação de saúde do território para mudanças no contexto social e sanitário e debate da relevância social do ensino na formação para o exercício profissional.

Laboratório de mudança: método para compreensão da crise entre universidade pública e sociedade

Resumo O objetivo deste artigo é analisar se um método de intervenção formativa contribui para que os profissionais de atividades colaborativas formem uma compreensão histórica dos problemas enfrentados em crises interinstitucionais e criem soluções para essas situações. Apresentamos o método Laboratório de Mudança (LM), inspirado na Teoria da Atividade Histórico-Cultural (TAHC). Ele é ilustrado com um caso empírico de intervenção na qual foi identificada a gênese histórica e as contradições que levaram à crise entre uma universidade pública e um centro de saúde escola. Para o estudo foram utilizados dados obtidos a partir de registros efetuados ao longo da intervenção, entre 2013 e 2015, assim como entrevistas e comentários dos participantes. Como resultado, eles analisaram historicamente suas atividades e desenharam novos cenários de colaboração futura, visando uma solução para a crise, no âmbito de possíveis relações acadêmico-pedagógicas vinculadas ao Sistema Único de Saúde (SUS). A análise sugere a existência de contradições nos objetos das atividades de assistência à saúde e educação que podem estar no cerne da relação problemática entre outras instituições semelhantes que precisam desenvolver atividades colaborativamente. O LM, enquanto metodologia de intervenção formativa, integra diagnóstico, aprendizagem, protagonismo dos participantes e criação de soluções como parte de um mesmo processo.

Professional training in physiotherapy: barriers to the diversification of practical learning scenarios and for teaching-service integration

Abstract Introduction: Professional training in health, at present, aims to develop competencies and skills for a performance according the principles of the Unified Health System (SUS, in Portuguese). In this sense, the Ministries of Health and Education have set up devices for training reorientation that prioritize teaching-service integration and diversification of learning scenarios. Objective: To describe barriers to the diversification of practical learning scenarios and for teaching-service integration in a physiotherapy course from the perspective of teachers and students. Methods: This is a qualitative research developed according to the case study method, with the participation of 16 students and 11 teachers-physiotherapists. During the data collection three focus groups were established, two with students and one with professors, besides individual interviews with both the course coordinator and the pedagogical articulator of the National Program for the Reorientation of Professional Health Training of the assessed course. Data were analyzed through thematic content analysis. Results: Among the identified barriers there are students’ low participation in public health services; saturation of public health services for students to carry out practical activities; low number of physiotherapists in Primary Care; indirect relationship of Clinical School with SUS. Conclusion: In order to improve the teaching-service interaction and to diversify the learning scenarios it is necessary to prioritize an integrated planning of actions to overcome identified barriers, including the participation of both the university managers and health services.

Reorientation of nurses' training: analysis of the protagonists

Objective

To analyse the changes that occur in nursing education from the perspective of the Pro-Health programme and its impact on the professional practice of the graduate students of this programme.

Methods

This is a collective study conducted in southern Brazil. The cases were nursing courses contemplated with the Pro-Health programme. Interviews were conducted with health workers, professors, students, and graduates of the cases, followed by observation of the theory and practice activities of the basic care units, and document analysis of the political-educational project of the courses, in 2015. The data were organised and analysed using analytical questions.

Results

The programme reflects on the reorientation of the curriculum, on the encouragement and strengthening of permanent education, and on the integration of teaching and service.

Conclusions

The programme is recognised for its effects on the education and work process of the graduates. However, local policies should be created to ensure the sustainability of teaching and service integration.

PET-Health as inducer of professional education to Unified Health System

PET-Health is configured as a program developed by health courses guided by the principle Unified Health System (SUS), with the preceptorship of a professional from health public service. The aim of the research was to compare the performance between PET-Health undergraduate of Dentistry, Medical and Nursing courses by the results of National Student Performance Exam (ENADE) in 2010 with those who did not participate in the program. The study population consisted of 49,758 students, which 761 participated in PET-Health. To analyze the performance of students in 2010 were considered the mean scores in general education, expertise skill and public health. Students who participated in PET-Health had superior performance in all means (55.48) when compared to those who did not (50.96). The shared investment between the Ministries of Health and Education in PET-Health, strategy involving students, professionals from public services and professor, contribute to the reorientation of health training, producing a great relationship between public health services and university.