This is a double titled thesis that aims to analyze the process of institutionalization of cesarean deliveries in Brazil and France from the perspective of institutional social-clinical. The theoretical-methodological framework, in its dialectical character between institute and instituinte, unfolds in the process of institutionalization. Therefore, birth is understood as an analyzer of "maternal and child health" and "health education" institutions. The present research comes from a larger study on births in Canada, France and Brazil. In this thesis, data were produced between 2016 and 2019, in Brazil and France, through focus groups, individual interviews with maternal and child health professionals (and the Brazilian Maternal and Child Death Surveillance Committee), with mothers and fathers who lived the experience of childbirth and the research journal. The focus groups were composed of professionals from traditional and alternative services, parents from different social backgrounds. There were 3 meetings making a total of 12 meetings. The ethical aspects regarding research with human beings were respected. A cross-analysis was carried out between the different types of data, between services, between groups and between countries, on a continuous basis, based on the materials produced. The polished thematic axes were: Birth by cesarean section: an analyzer of the female condition in face of medicalization, of professional practices and discourses, and of the institutionalization of birth. These were arranged in analytical frameworks and organized by group of interviewees and scenarios studied. Afterwards, horizontal summaries of the interviews were carried out, by groups interviewed. The analysis was also produced during the time of restitution to the participants and was based on the thematic analysis approach of the authors Mucchielli and Paille. Brazil and France demarcate distinct processes. Brazil is the champion in surgical deliveries without indication. France, on the other hand, presents another reality, in which births are mostly vaginal. It was possible to learn that although each of the countries studied has its peculiar sanitary and educational structure, they are marked by a sociohistorical-economic construction outlined by the patriarchy and female subjugation. The marks of New Public Management are present in both contexts and reveal a precariousness of offers and actions supported by a discourse of economic fragility. In terms of education and health, in any of the countries, pregnancy is understood as a physiological process and developed with numerous interventions on the female body. There is an appreciation of the technical and organizational dimensions pointed out by an intellectual and social division of work and knowledge in health. The practices and discourses of professionals (in their work process) influence the occurrence (or not) of cesarean delivery. The progression or regression of this is related to the degree of implementation of medical actions in health actions. In this way, in Brazil there is a struggle between the institutionalization of cesarean delivery in comparison with its deinstitutionalization. In France, in relation to cesarean sections, there is a discussion on "active cesarean section". Would this be the movement of institutionalization of cesarean delivery in this country?Keywords: cesarean section; childbirth; health education; health; education

https://tel.archives-ouvertes.fr/tel-02458149/document

The institutionalization of birth by cesariana in Brazil and France : educational and health components

Objective: to analyze university teaching in nursing from an institutional dialectic approach. Method: a qualitative research based on Institutional Socioclinics. Eighteen nursing professors from four regions of Brazil and from six public institutions of higher education participated. For data production, interviews, observations, documentary analyses, individual and collective restitution and use of the research diary were performed. Data was organized for analysis by transcription/translation, recomposition/rearrangement, and final reconstruction/narration. Data analysis was produced from analyzers, based on Socioclinics, Institutional Analysis current of thought, and on the qualitative mode of analysis by questioning and writing. Results: two main analyzers made the institution ‘teaching in higher education and the nursing professor’ emerge: time-money relation and resistance. Teaching time, increasingly associated with money, in managerialist logic, has formatted the nursing professors as passive subjects in the production of knowledge, induced by the evaluation model of the Coordination for the Improvement of Higher Level Personnel and its link to the progression in the university career. In this model, the nursing professor is driven to devote more to research than to teaching. This interferes with teaching conceptions and practices, which are more influenced by managerialism and less grounded in pedagogical theories. Resistance against this model has not yet encountered coping mechanisms. Conclusion: from the analysis produced with the participants, the choices of the nursing professor are so much more grounded in managerialism and so much less based on pedagogical references, especially those arising from dialectical theories. In this sense, resistance is transformed into a movement of adaptation.

http://www.scielo.br/pdf/tce/v29/1980-265X-tce-29-e20180407.pdf

Nursing professor in higher education: time, money and resistance in the management vision

Resumo Este estudo tem como objetivo investigar a formação de profissionais de saúde em programas de Residência Multiprofissional em Saúde (RMS) direcionados à atenção básica no Brasil. Trata-se de uma revisão sistemática da literatura conduzida nas bases de dados SciELO, BVS e PubMed no ano de 2019, registrada sob número CRD42019134350. A busca ocorreu utilizando descritores relacionados à RMS e à atenção básica, sendo incluídas pesquisas empíricas sobre o tema sem alto risco de viés. Dos 700 registros recuperados no processo de busca, 13 artigos foram incluídos na revisão. Todos os estudos apresentaram abordagem qualitativa, predominando estudos realizados no estado de São Paulo e com baixo risco de viés (69%). Os principais resultados foram categorizados em: contribuição de dispositivos para a formação pelo trabalho; estratégias balizadoras da formação; potencialidades da residência para a formação em saúde; e dificuldades experienciadas no processo de formação. A formação nos programas estudados tem proporcionado um novo perfil de profissional de saúde, apesar das limitações vivenciadas no processo. Torna-se necessário investimento na qualificação dos atores envolvidos na formação, uma vez que essa foi uma das principais dificuldades relatadas.

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Formação na Residência Multiprofissional em Atenção Básica: revisão sistemática da literatura

The scope of this study is to investigate how the training of health professionals has been provided in Multi-professional Primary Health Care Residency Programs in Brazil. A systematic review was conducted on Scielo, BVS and PubMed databases in 2019, under registration number CRD42019134350. The search was carried out using key words related to Multi-Professional Residency Programs and Primary Health Care, including empirical research on the theme with a low-level risk of bias. Of the 700 studies identified, 13 articles were included in this review. All the studies adopted a qualitative approach predominantly performed in São Paulo with a low risk of bias (69%). The main results were categorized as: Contribution of measures for occupational training; Definition of professional training strategies; Potential of Multi-Professional Primary Health Care Residency Programs for health professional training and difficulties experienced during the training process. Professional training on programs studied has provided a new profile of health providers, despite limitations in the training process. Investments in the qualification of the personnel involved in training were perceived as being necessary, since it was one of the main weaknesses reported.

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[Training in Multi-Professional Primary Health Care Residency Programs: a systematic review of the literature].

Objective: to analyze the institutionalization of preceptorship in health in a general hospital of the Duque de Caxias city. Method: socio-institutional clinical study with qualitative approach. Data will be collected in a public health facility, located in the city of Duque de Caxias/RJ. The subject will be health professionals, that are or were preceptors in the unit. The project was approved by the Research Ethics Committee, on 06/06/2014 opinion 679,754. Expected results: to develop guidelines for a training protocol for health professionals who act as preceptors. Conclusion: the collective reflection of the higher education institution preceptorship in a hospital unit can motivate personal and professional transformation of those involved in vocational training and thus improving the quality of care to our population. Descriptors: Preceptorship; Health Educators; Hospital Service Education. RESUMO Objetivo: analisar a institucionalização da preceptoria em saúde em uma unidade hospitalar geral do Município de Duque de Caxias. Método: estudo sócio-clínico institucional, com abordagem metodológica qualitativa. Os dados serão coletados em um estabelecimento público de saúde, localizado no município de Duque de Caxias/RJ. Os sujeitos serão os profissionais de saúde, que exercem ou exerceram função de preceptor na unidade. O projeto foi aprovado pelo Comitê de Ética em Pesquisa em 06/06/2014, com Parecer 679.754. Resultados esperados: elaborar diretrizes para um protocolo de capacitação para profissionais da saúde que atuem como preceptores. Conclusão: a reflexão coletiva da instituição preceptoria de ensino superior em uma unidade hospitalar poderá motivar a transformação pessoal e profissional dos sujeitos envolvidos na formação profissional e, consequentemente, na melhoria da qualidade da assistência prestada à nossa população. Descritores: Preceptoria; Educadores em Saúde; Serviço Hospitalar de Educação. RESUMEN Objetivo: analizar la institucionalización de la preceptoría en salud en una unidad hospitalaria general del Municipio de Duque de Caxias. Método: estudio socio-clínico institucional con enfoque metodológico cualitativo. Los datos serán recogidos en un establecimiento público de salud, localizado en la ciudad de Duque de Caxias/RJ. Los sujetos serán los profesionales de salud, que ejercen o ejercieron función de preceptor en la unidad. El proyecto fue aprobado por el Comité de Ética en Investigación, en 06/06/2014 con parecer 679.754. Resultados esperados: elaborar directrices para un protocolo de capacitación para profesionales de la salud que actúen como preceptores. Conclusión: la reflexión colectiva de la institución preceptoría de enseñanza superior en una unidad hospitalaria se puede motivar la transformación personal y profesional de los sujetos envueltos en la formación profesional y consecuentemente en la mejoría de la calidad de la asistencia prestada a nuestra población. Descriptores: Preceptoría; Educadores en Salud; Servicio Hospitalario de Educación. 1 Nurse, Study Center of the Municipal Hospital Dr. Moacyr Rodrigues do Carmo/HMMRC, Master degree student, Graduate Program – Master degree in Health Training, Fluminense Federal University /UFF. E-mail: marcellemmartins@ig.com.br; 2 Enfermeira. Nurse, Ph.d. Professor in Collective Health, Collective Health Institute, Fluminense Federal University/UFF. E-mail: luciamourao@hotmail.com NOTE PREVIEW ARTICLE Sanches MMM, Mourão LC. Hospital preceptorship: health professional... English/Portuguese J Nurs UFPE on line., Recife, 9(8):8928-31, Aug., 2015 8929 ISSN: 1981-8963 DOI: 10.5205/reuol.7696-67533-1-SP-1.0908201522 The training of health professionals from undergraduate to graduate is located at the confluence of the remarkable transformations in the health area as those resulting from the restructuring of higher education. This context refers to the problems experienced by these workers in relation to inadequate personnel policies. There is little opportunity for teacher training and continuing education, which would translate into an everyday exercise to discuss their practices in collective work. Health professionals working as preceptors of undergraduate students have a special role, since they are expected to promote the articulation of theoretical knowledge with practice in their acting area. The preceptor has the function to help graduates and newly graduates in building solutions to the problems that they face in their health practice, and articulate the knowledge and values of the school and work. The preceptors are often references/models for the students, and their actions should help in forming an ethical position by students. The main function of the preceptor is to teach medical practice, through formal instruction and with certain objectives and goals. Thus, among their salient features, there must be knowledge and ability to perform clinical procedures. In this sense, the preceptor is concerned primarily with the clinical competence or the teaching-learning aspects of professional development, favoring the acquisition of skills and competencies for new graduates in real clinical situations in the work environment. It is important to remember also that formal evaluations are also part of the duties of preceptorship. In the city of Duque de Caxias, the fellow academic program was created in 2011 in partnership with the federal government and is offered in the areas of nursing, medicine, social work, nutrition and pharmacy, in the hospital unit of the city and in units of PSF. The program is governed by Ordinance number 025/SMS/2009 of 23 July 2009, for higher, technical and medium educational students internships, within the units of the Municipal Health Network, but there is no specific paragraph addressing the preceptorship during the internship. From the above, our object of study is the practice of health professionals in developing preceptorship actions in health education, in a hospital unit. To interrogate the institutionalization of this practice we developed the following research questions: What is the role of health professionals who develop preceptorship activities in a public health establishment? How do health professionals, crowded in a general hospital, carry out activities preceptorship? What effects the practice of preceptorship exerted by health professionals from a general hospital produce in health education? It starts from the assumption that from the collective reflection of the higher education institution preceptorship in a hospital can motivate personal and professional transformation of those involved in vocational training in health and consequently to improve the quality of care provided to our population. This study aims to analyze the institutionalization of preceptorship in health in a general hospital of the Duque de Caxias city. Socio-institutional clinical study with qualitative approach that considers the analysis of the implications of the subjects in the production of knowledge. Data will be collected in a public health institution, located in Duque de Caxias City in the state of Rio de Janeiro, in a mid-size municipal hospital, providing services to various health specialties. Opened in 2008, the hospital has emergency 24h, and general surgeon, vascular surgeon, medical clinic, adult ICU, referenced dressings, maternity, medical rescuer, orthopedics, minor surgery, psychiatry, urology and neonatal ICU. The number of patients is voluntary, which means that there is a high number of daily visits to the residents of the city and vicinity. The hospital is a reference in outpatient vascular surgery, urology, plastic surgery and orthopedic postoperative, assisting also the population of Belford Roxo and São João de Meriti. For its sectors ́ diversity, it offers great opportunity to education and has as remarkable feature the presence of academics from various higher and mid-level professional categories. Academics are accompanied by sector professionals who act as preceptors, accompanying students in the developed activities, but there is no specific training for these professionals related to preceptorship. The subjects of the research will be health professionals, contractors or servants, who are or were preceptors in the unit. It is noteworthy that the guidelines and regulatory standards for research involving human beings will be met, determined in METHOD INTRODUCTION Sanches MMM, Mourão LC. Hospital preceptorship: health professional... English/Portuguese J Nurs UFPE on line., Recife, 9(8):8928-31, Aug., 2015 8930 ISSN: 1981-8963 DOI: 10.5205/reuol.7696-67533-1-SP-1.0908201522 Resolution number 466/2012 which deals with research and testing in humans, the National Health Council, and requested institutional authorization for referral to the Ethics Committee in Research. The project was approved by the Ethics Committee in Research of the Faculty of Medicine of the Fluminense Federal University UUF, under number 679,754. After approval, data collection will start with presentation of the objectives and the Consent Form (TCLE) to be signed by the subjects. Data will be collected through semistructured interview technique with key informants previously selected, in which the investigator has a previous list of questions or topics to be filled or answered as well as other questions may be included in its accomplishment. A workshop between the preceptors and researchers which through the interaction of its participants, promoting the reflection on the practices of professionals and structured recommendations for the improvement of the exercise of preceptorship in vocational training in health services will be held. The findings of this study will be analyzed based on the introduction of concepts, in their moments instituting, instituted and institutionalization; of involvement and analyzer designed for Institutional French Analysis. The registration of all the steps of the research will be don

https://periodicos.ufpe.br/revistas/revistaenfermagem/article/download/10680/11729

Preceptoria hospitalar: a prática do profissional de saúde como analisador da instituição formação em saúde

RESUMO Objetivo: refletir acerca das contribuicoes e limites da Socioclinica Institucional como aporte teorico metodologico em pesquisas em enfermagem e em saude. Metodo: estudo de reflexao desenvolvido a partir do delineamento das modalidades de conducao da abordagem Socioclinica Institucional: intervencao socioanalitica, analise institucional das praticas profissionais, pesquisa-acao e investigacao socioanalitica. Resultado: a Socioclinica Institucional e uma continuidade do aporte teorico metodologico da Socioanalise Louraudiana, corrente da analise institucional, linha francesa. Propoe oito principios norteadores: analise da encomenda e demanda; participacao dos sujeitos no dispositivo; trabalho dos analisadores; analise das transformacoes que ocorrem a medida que o trabalho avanca; aplicacao de modalidades de restituicao; trabalho das implicacoes primarias e secundarias; intencao de producao de conhecimentos e atencao aos contextos; e interferencias institucionais. As contribuicoes estao relacionadas com a logica de transformar para conhecer, producao coletiva do conhecimento e troca de saberes e aprenderes entre participantes e pesquisadores. Os desafios estao relacionados ao rompimento da logica dominante nas pesquisas e da inclusao da diferenca de saberes e poderes na producao de conhecimento. Conclusao: a Socioclinica Institucional pode articular transformacao de praticas e producao de conhecimento. O referencial oferta importante suporte no campo de producao de conhecimento da enfermagem e da saude por valorizar, em todo processo da pesquisa, a subjetividade dos envolvidos, bem como as instituicoes que atravessam as praticas e as relacoes.

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A socioclínica institucional como referencial teórico e metodológico para a pesquisa em enfermagem e saúde

Objectives: to analyze the understanding of homeless people living in a city in the countryside of Sao Paulo about what health is and about their experiences in health services. Methods: a qualitative exploratory study developed through interviews with homeless people and a field diary. The data were organized by themes and the findings were compared to a collective health framework. Results: the explored themes were: “Being healthy for the homeless population”, “The search for health services” and “Being a user of health services from the perspective of homeless people”. We present the interviewees’ understanding of health and their experiences in healthcare services. Along this path, we outline aspects that show the network’s weaknesses, permeated by prejudices and discrimination. Final Considerations: this population has conceptions about health and needs that need to be singularly taken into consideration to facilitate access and care.

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Homeless people: health aspects and experiences with health services

RESUMO Objetivo Analisar o apoio matricial para equipes da Estrategia Saude da Familia em relacao a Saude Mental em Criancas e Adolescentes. Metodo Pesquisa-intervencao de abordagem qualitativa, fundamentada pelo referencial da Analise Institucional, a socioclinica, realizada com dezoito trabalhadores de saude de duas equipes da Estrategia Saude da Familia e do Centro de Atencao Psicossocial de um municipio de pequeno porte, localizado no interior do estado de Sao Paulo, por meio de onze encontros de reflexao. Resultados Foram apresentados a partir dos temas: A dinâmica das relacoes no territorio da ESF; O apoio matricial como dispositivo tecnologico: desvelando praticas instituidas. Posteriormente, foi realizada a discussao dos resultados a partir dos principios da Socioclinica Institucional. Conclusao O apoio matricial em saude mental infantojuvenil, pautado no referencial da Socioclinica Institucional, favoreceu a desterritorializacao dos profissionais, revelando como se da o cuidado em saude mental para criancas e adolescentes e os atravessamentos que ocorrem na producao desse cuidado, assim como possiveis caminhos a serem trilhados para aprimorar as acoes de saude.

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Poliana Silva de Oliveira

Papers

A socioclínica institucional como referencial teórico e metodológico para a pesquisa em enfermagem e saúde

Homeless people: health aspects and experiences with health services

Apoio matricial em saúde mental infantojuvenil na Atenção Primária à Saúde: pesquisa intervenção socioclínica institucional