Integration research, education and health services: background, strategies and initiatives

Este artigo objetiva identificar e analisar experiên-cias nacionais e internacionais que postulem a integração ensino, pesquisa e serviços de saúde. A partir da vivência no Sistema Municipal de Saúde Escola de Fortaleza, que busca a referida integração, interessava-nos conhecer outras experiências que postulassem a mesma. Nesse sentido, mediante uma revisão da literatura científica em bases bibliográficas on-line, associada à pesquisa documental de experiências contemplando essa integração, identificamos informações caracterizadas pela aproximação entre ensino, pesquisa e serviços de saúde. Foram selecionadas oito experiências no continente americano, sendo uma canadense; uma cubana; duas latino-americanas e quatro brasileiras, que são apresentadas neste artigo. Integrar ensino e pesquisa, utilizando a face assistencial do sistema de saúde como um recurso pedagógico, evidencia-se como um objetivo aglutinador em vários países das Américas. Analisando-se as oito experiências apresentadas, observa-se que em seis delas a integração ensino, pesquisa e serviços já aparece como estratégia de formação e de educação permanente. Não obstante, a aproximação entre essas três funções persiste como um campo de disputas, de convergências e divergências, portanto, como espaço de conflitos entre distintos interesses, efetivando-se lentamente. Assim, novos investimentos precisam ser feitos no sentido de desvelar as dinâmicas e os processos em construção que facilitem e impulsionem a integração do ensino, da pesquisa e da assistência em saúde, que demandam práticas interprofissionais, interinstitucionais e intersetoriais, de forma a superar a crise de conhecimentos e de valores da saúde no mundo.This article aims to identify and analyze national and international experiences of integration in teaching, research and health services. From the experience in Municipal System of Health - School of Fortaleza, which integrates teaching, survey and assistance, interested us to know other experiences that take for granted such integration. In this sense, through a review of scientific literature, in bibliographic databases online, associated with a documentary research experiments that showed the same integration, we identified information indicating the existence of links between education, research and services. We selected eight experiments on the American continent, one in Canada, one in Cuba, two in Latin America and four in Brazil, which are presented in this article. Integrating teaching and research, using the face of the health system of care as an educational resource, it is clear as a unifying purpose in several countries of the Americas. Analyzing the 08 (eight) experiments presented, it is observed that in 06 (six) of them the integrate teaching, research and services already appears as a strategy for training and continuing education. However, the rapprochement between the functions of teaching, research and health services remains a battleground of convergence and divergence, therefore, as a space for conflict between different interests, making effective slowly. Thus, new investments must be made to uncover the dynamics and processes in construction to facilitate and foster the integration of teaching, research and health care, which requires inter practices, interagency and intersectoral

Interprofissionalidade strategy in family health: conditions of possibility for integration of knowledge and interprofessional collaboration

O princÃpio da interprofissionalidade à critÃrio fundamental que orienta equipes multiprofissionais na EstratÃgia SaÃde da FamÃlia. A aÃÃo profissional, no entanto, parece ser marcada por uma lÃgica caracterizada pela delimitaÃÃo estreita de territÃrios de cada categoria, conformando um quadro de disputa entre as lÃgicas contraditÃrias da profissionalizaÃÃo e da interprofissionalidade. Esta à compreendida como a sÃntese de um processo de integraÃÃo de saberes e de colaboraÃÃo interprofissional, processos estes mediados pelos afetos. Considerando haver obstÃculos diversos para a efetivaÃÃo da interprofissionalidade, a pesquisa objetiva compreender a dinÃmica das relaÃÃes interprofissionais na produÃÃo do cuidado na EstratÃgia SaÃde da FamÃla, explorando a existÃncia de condiÃÃes de possibilidade para a construÃÃo da interprofissionalidade na AtenÃÃo PrimÃria à SaÃde no Brasil. Trata-se de estudo de caso, de natureza qualitativa, inspirado na HermenÃutica. O cenÃrio de estudo à um Centro de SaÃde da FamÃlia, numa capital brasileira. A recolha das informaÃÃes foi procedida no perÃodo de marÃo a agosto de 2011, com realizaÃÃo de entrevistas abertas, observaÃÃo das atividades desenvolvidas pelas equipes e realizaÃÃo de oficinas de produÃÃo de conhecimento, envolvendo 23 profissionais da ESF, NÃcleos de Apoio à SaÃde da Familia e residentes de Medicina e de SaÃde da FamÃlia e Comunidade. Foram identificadas condiÃÃes de possibilidades da interprofissionalidade na ESF, sintetizadas em trÃs dimensÃes: organizacional, coletiva e subjetiva. Incluem-se na dimensÃo organizacional dispositivos e arranjos institucionais, suportes para as atividades interprofissionais, quais sejam: a estruturaÃÃo de uma âRede de SaÃde â Escolaâ, transformando todas as unidades de saÃde de um municÃpio em espaÃos de ensino, pesquisa e assistÃncia; a âEducaÃÃo Permanente Interprofissionalâ que contribua para ultrapassar a lÃgica da profissionalizaÃÃo ainda hegemÃnica na formaÃÃo dos trabalhadores da saÃde; bem como a âAbordagem Centrada na FamÃliaâ, em contraposiÃÃo à tendÃncia de organizar os serviÃos de saÃde com base em interesses corporativos. A segunda dimensÃo enfoca aspectos relacionados à organizaÃÃo dos profissionais como grupo de trabalho, ou seja, a organizaÃÃo do coletivo em comunidade de prÃtica, caracterizada pela pactuaÃÃo de um projeto em comum, engajamento mÃtuo e repertÃrios compartilhados. Mesmo tendo sido os profissionais da saÃde formados hegemonicamente para a lÃgica da profissionalizaÃÃo, envolvendo luta por status e reserva de mercado de trabalho, a participaÃÃo numa equipe da ESF, constituida como comunidade de prÃtica, possibilita a aprendizagem de outros valores, favorecendo a integraÃÃo de saberes e a colaboraÃÃo interprofissional, embora nÃo livre de conflitos. A terceira dimensÃo privilegia aspectos subjetivos, como a identificaÃÃo dos profissionais com o modelo assistencial da ESF, saber lidar com frustraÃÃes e a afetividade. Consideramos ser possÃvel a interprofissionalidade, desde que sejam disponibilizadas condiÃÃes organizacionais e coletivas, mobilizadoras de aspectos subjetivos dos profissionais. A oferta das condiÃÃes de possibilidade, no plano organizacional, à indispensÃvel, mas nÃo suficiente para a integraÃÃo de saberes e a colaboraÃÃo interprofissional. Sem a mobilizaÃÃo dos afetos, dos desejos e dos micropoderes de cada sujeito, nÃo hà interprofissionalidade possÃvel.The principle of interprofessional learning and practice is a fundamental criterion that guides multidisciplinary teams in the Family Health Strategy (FHS).The professional action however, seems to be marked by a logic characterized by the narrow boundaries of the territories of each category as a scene of contention between the contradictory logics of professionalization and interprofessional practice. This is understood as the synthesis of a process of integration of knowledge and interprofessional collaboration (COLET, 2002). These processes are mediated by affects. Considering that there are several obstacles to the realization of the interprofessional learning and practice, the research aims to understand the dynamics of inter-relationships in the production of care in the familyÂs health strategy, exploiting the existence of conditions of possibility for the construction of interprofessional learning and practice. This is a qualitative case study inspired by hermeneutics. The scenario is a study of the Family Health Center, in a Brazilian capital. The gathering of the information was provided from March to August 20122, with open interviews, observation of activities in the FHS and workshops for knowledge production, involving 23 professionals. Conditions were identified in the possibilities of interprofessional FHS, combined in the following groups: Organizational, collective, and subjective. Included in the organizational dimension are devices and institutional arrangements, cross-media activities for the structuring of a âHealth-Education systemsâ, transforming all health facilities of a municipality into areas of teaching, research, and assistance. The âinterprofessional continuing educationâ helps to overcome the hegemonic logic of professionalism, sill found in the training of healthcare workers and user-centered approach, in contrast to the trend of organizing health service base on corporate interests. The second dimension focuses on aspects related to the organization of professionals working as a group, or the organizations of the collective community practice, characterized by agreeing on a common project, mutual engagement and shared repertoire. Even though health professionals trained to the hegemonic logic of professionalization, involving a struggle to preserve status and labor market participation in the ESF team, the way they are formed as a community of practice, enables the learning of other values, knowledge and practice, favoring the integration of interprofessional collaboration and knowledge, though not free of conflict. The third dimension includes subjective aspects such as the identification of professionals of the ESF health care model, dealing with frustration and affection. We consider that the interprofessional learning and practice is possible, if subjected to the organizational and collective conditions, mobilizing subjective aspects of professionals. The offering conditions of possibility in the organizational level are essential but not sufficient for integration of knowledge and interprofessional collaboration. Without the mobilization of emotions, desires and micro powers of each subject, inter-professional learning and practice is not possible

Inter-professional collaboration in an Intensive Care Unit: Challenges and opportunities

Objective: to understand the relationship between health professionals in an intensive care unit, to explore the inter-professional collaboration. Methods: it is a qualitative study, inspired by the Hermeneutics Phenomenology of Paul Ricoeur, for the production of knowledge. Interviews were conducted with 36 intensive care professionals of a tertiary public hospital. Results: the professionals are satisfied with the work, and there is a commitment to provide quality care despite organizational boundaries such as precarious employment relationships and turnover of professionals. The inter-professional collaboration is an indispensable factor for assistance, but in practice is not effective most of the times by the absence of provisions for the integration of the team, leadership presence, as well as the overcrowding of services that overwhelm health workers. Conclusion: while recognizing the need for inter-professional collaboration, professionals do their work even in a very individualized way, with no strategies to boost this cooperation

Colaboração interprofissional em uma Unidade de Terapia Intensiva: desafios e possibilidades

Objective: to understand the relationship between health professionals in an intensive care unit, to explore the inter-professional collaboration. Methods: it is a qualitative study, inspired by the Hermeneutics Phenomenology of Paul Ricoeur, for the production of knowledge. Interviews were conducted with 36 intensive care professionals of a tertiary public hospital. Results: the professionals are satisfied with the work, and there is a commitment to provide quality care despite organizational boundaries such as precarious employment relationships and turnover of professionals. The inter-professional collaboration is an indispensable factor for assistance, but in practice is not effective most of the times by the absence of provisions for the integration of the team, leadership presence, as well as the overcrowding of services that overwhelm health workers. Conclusion: while recognizing the need for inter-professional collaboration, professionals do their work even in a very individualized way, with no strategies to boost this cooperation

Integração ensino, pesquisa e serviços em saúde: antecedentes, estratégias e iniciativas Integration research, education and health services: background, strategies and initiatives

Este artigo objetiva identificar e analisar experiên-cias nacionais e internacionais que postulem a integração ensino, pesquisa e serviços de saúde. A partir da vivência no Sistema Municipal de Saúde Escola de Fortaleza, que busca a referida integração, interessava-nos conhecer outras experiências que postulassem a mesma. Nesse sentido, mediante uma revisão da literatura científica em bases bibliográficas on-line, associada à pesquisa documental de experiências contemplando essa integração, identificamos informações caracterizadas pela aproximação entre ensino, pesquisa e serviços de saúde. Foram selecionadas oito experiências no continente americano, sendo uma canadense; uma cubana; duas latino-americanas e quatro brasileiras, que são apresentadas neste artigo. Integrar ensino e pesquisa, utilizando a face assistencial do sistema de saúde como um recurso pedagógico, evidencia-se como um objetivo aglutinador em vários países das Américas. Analisando-se as oito experiências apresentadas, observa-se que em seis delas a integração ensino, pesquisa e serviços já aparece como estratégia de formação e de educação permanente. Não obstante, a aproximação entre essas três funções persiste como um campo de disputas, de convergências e divergências, portanto, como espaço de conflitos entre distintos interesses, efetivando-se lentamente. Assim, novos investimentos precisam ser feitos no sentido de desvelar as dinâmicas e os processos em construção que facilitem e impulsionem a integração do ensino, da pesquisa e da assistência em saúde, que demandam práticas interprofissionais, interinstitucionais e intersetoriais, de forma a superar a crise de conhecimentos e de valores da saúde no mundo.<br>This article aims to identify and analyze national and international experiences of integration in teaching, research and health services. From the experience in Municipal System of Health - School of Fortaleza, which integrates teaching, survey and assistance, interested us to know other experiences that take for granted such integration. In this sense, through a review of scientific literature, in bibliographic databases online, associated with a documentary research experiments that showed the same integration, we identified information indicating the existence of links between education, research and services. We selected eight experiments on the American continent, one in Canada, one in Cuba, two in Latin America and four in Brazil, which are presented in this article. Integrating teaching and research, using the face of the health system of care as an educational resource, it is clear as a unifying purpose in several countries of the Americas. Analyzing the 08 (eight) experiments presented, it is observed that in 06 (six) of them the integrate teaching, research and services already appears as a strategy for training and continuing education. However, the rapprochement between the functions of teaching, research and health services remains a battleground of convergence and divergence, therefore, as a space for conflict between different interests, making effective slowly. Thus, new investments must be made to uncover the dynamics and processes in construction to facilitate and foster the integration of teaching, research and health care, which requires inter practices, interagency and intersectoral

Comunidade de prática enquanto modo coletivo de aprendizagem e desenvolvimento de práticas e saberes na estratégia saúde da família: um estudo teórico - doi: 10.5020/18061230.2012.s104

Objective: Present and discuss the contribution of the concept of Community of Practice (CP), while collective space of learning and development of knowledge and practice in multidisciplinary teams of Family Health Strategy. Methods: Theoretical study through nonsystematic literature reviews the theme of “Communities of Practice” in the work of social researchers Jean Lave and Etienne Wenger, who developed this concept, completed with studies on the same topic from the research in online databases. Results: A CP is characterized by a group of people who forged and got engaged in a common project, sharing a repertoire, which allowed communication between them. Several effects are attributed to the experience of working together in a CP, such as the socialization of knowledge, the interprofessional collaboration and the development of an environment conducive to reflective practice, which facilitates the conflict mediation. The theory of CP requires a major change in the conception of learning. Unlike theories that consider learning as resulting mainly from the internal process of the person, as the cognitive, the CP’s theory conceives learning through the angle of social participation. The inter-relationship developed by the CP influences the learning process, negotiation of meaning and identity formation, which results from the fact of belonging to the community and from the meaning attributed to the collaborative. Conclusion: The formation of Community of Practice in Family Health Strategy can be a device to facilitate the construction of interdisciplinary projects, expressed by the integration of knowledge and interprofessional collaboration.Apresentar e discutir a contribuição do conceito de Comunidade de Prática (CP), enquanto espaço coletivo de aprendizagem, desenvolvimento de saberes e práticas no interior de equipes multiprofissionais da Estratégia de Saúde da Família (ESF). Métodos: Estudo teórico, através de revisão bibliográfica não sistemática sobre a temática das “Comunidades de Prática” na obra dos pesquisadores sociais, Jean Lave e Etienne Wenger, formuladores deste conceito, complementando com estudos sobre a mesma temática, oriundos da busca em bases de dados online. Resultados: Uma CP se caracteriza por um conjunto de pessoas que pactuam um projeto em comum, engajam-se mutuamente neste, compartilhando um repertório que permite a comunicação entre eles. Vários efeitos são atribuídos à experiência de trabalho em comum no âmbito de uma CP, como a socialização de conhecimentos, a colaboração interprofissional e o desenvolvimento de um ambiente propício à prática reflexiva, que facilita a mediação de conflitos. A teoria das CP pressupõe uma mudança importante na concepção de aprendizagem. Diferentemente de teorias que consideram a aprendizagem como resultante, principalmente, de processos internos da pessoa, como a cognitiva, a teoria da CP concebe a aprendizagem sobre o ângulo de uma participação social. As interrelações desenvolvidas no interior das CP influenciam os processos de aprendizagem, de negociação de sentido e de formação de identidades, que resulta do fato de pertencer à comunidade e do significado atribuído ao trabalho compartilhado. Conclusões. A formação de CP na ESF pode ser um dispositivo para facilitar a construção de projetos interprofissionais, expresso pela integração de saberes e colaboração interprofissional

Community of practice as a collective way of learning and development of practices and knowledge of the family health strategy: a theoretical study

Objective: Present and discuss the contribution of the concept of Community of Practice (CP), while collective space of learning and development of knowledge and practice in multidisciplinary teams of Family Health Strategy. Methods: Theoretical study through nonsystematic literature reviews the theme of “Communities of Practice” in the work of social researchers Jean Lave and Etienne Wenger, who developed this concept, completed with studies on the same topic from the research in online databases. Results: A CP is characterized by a group of people who forged and got engaged in a common project, sharing a repertoire, which allowed communication between them. Several effects are attributed to the experienceof working together in a CP, such as the socialization of knowledge, the interprofessional collaboration and the development of an environment conducive to reflective practice, which facilitates the conflict mediation. The theory of CP requires a major change in theconception of learning. Unlike theories that consider learning as resulting mainly from the internal process of the person, as the cognitive, the CP’s theory conceives learning through the angle of social participation. The inter-relationship developed by the CP influences the learning process, negotiation of meaning and identity formation, which results from the fact of belonging to the community and from the meaning attributed to the collaborative. Conclusion: The formation of Community of Practice in Family Health Strategy can be adevice to facilitate the construction of interdisciplinary projects, expressed by the integration of knowledge and interprofessional collaboration