Avaliação da estrutura e processo de trabalho dos centros de atenção psicossocial

Objective: Evaluate the work structure and process in Psychos ocial Care Centers (CAPS) and the professionals profile, the satisfaction, conditions and work overload. Methods: Cross - sectional study conducted in five CAPS in Campina Grande city. The study sample consisted of five coordinators, 42 graduate professional s, 26 mid - level (technical and auxiliary nurses, and caregivers), and the medical records pertaining to 413 users followed up. Data were collected using validated questionnaires (CAPSUL - rating CAPS in southern Brazil) and adapted to the study, between July and October 2014. The questionnaires were double entered and submitted to validation in the sub - program “Validate Epi Info 3.5.4” , used along with the “SPSS 17.0” for processing the statistical analyzes. Measures of central tendency and dispersion were ap plied to the descriptive analyzes; “Fisher's” exact test to check the CAPS impact on hospital admissions and the “Bonferroni” adjusted to verify the diagnoses according to sex. 5% significance level was adopted. The study was approved by the Ethics Committ ee of the Rio Grande do Norte Federal University (UFRN), protocol 719.435, of 05.30.2014. Results: From the structure analysis were identified contextual factors that influenced the work process of CAPS professionals, such as: deficiencies with regard to h uman resources; forms of health professionals employment and qualifications; temporary contract existence. As to process dimension, it was found that the home visits performance by health professionals shows to be ineffective, given its insufficiency and i rregularity, which can be explained by the high demand, reduced staff and transportation lack. It was low coverage of items inherent to Therapeutic Individual Project, as the income generation program, insertion at work and home visit. The reference and co unter reference flow are still not satisfactorily organized. There was statistically significant difference for the diagnosis, with a predominance of mood disorders related to stress among women and those related to alcohol and other drugs among men (p <0. 05). There was an association between the degree of health professionals satisfaction and working conditions, overload and factors related to the content and working conditions, the security measures, comfort and CAPS appearance, contact between the teams and users, families treatment by the teams, temporary employment relationship. Conclusion: The data collected indicate the need for the CAPS organization through increased investments in the sector in order to enhance the infrastructure as potentiating el ement of practices with a view to changing the care model for mental health proposed by the Psychiatric Reform. It is hoped therefore that this research will contribute to better planning in CAPS unit management, with another tool to improve the dimensions involving the structure and the professional work process and improve this mental health care model.

O trabalho em equipe na atenção primária à saúde: situação de Portugal e do Brasil

Introdução: Na Atenção Primária à Saúde, nos contextos internacional e nacional, o trabalho em equipe tem sido reconhecido como estratégia decisiva para a organização de processos que visam à integralidade do cuidado, além de possibilitar melhorias na satisfação dos usuários com os serviços de saúde. Neste sentido, o objetivo, deste estudo, é analisar o trabalho em equipe na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa em banco de dados secundários. Realizou-se três estudos: a) O trabalho em equipe na Atenção Primária à Saúde, em Portugal, pesquisa avaliativa, de natureza qualitativa, tipo estudo de caso descritivo, que representou um recorte dos resultados derivados da pesquisa integrada ao projeto “Implantação das Unidades de Saúde Familiar em Portugal”, que teve como procedimentos entrevistas semiestruturadas, roteiro de coleta de informações (check list) e análise documental. Foi realizada a estratégia de triangulação dos dados com análise de conteúdo; b) trabalho em equipe, acesso e qualidade na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 17202 profissionais e 65391 usuários. Utilizou-se entrevista estruturada, com análise estatística realizada pelas frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. c) satisfação dos usuários com o trabalho em equipe na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 65391 usuários. Realizou-se análise estatística das frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. Utilizou-se, ainda, o Teste X2 , com nível de significância de 5%; análise de regressão logística múltipla. O modelo final foi ajustado pelo teste de Hosmer/Lemeshow, o qual indicou um ajuste de 66%. Resultados: Sobre o trabalho em equipe na Atenção Primária à Saúde, em Portugal, destacou-se a formação das equipes de forma voluntária, por meio de afinidades pessoais, a existência de “carteira básica de serviços”, juntamente com x intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares), sistemas informatizados nas unidades de saúde. Os dados revelaram dificuldades quanto ao atendimento domiciliar. No Brasil, foi destaque o processo de trabalho, com avanços relacionados a realização de planejamento e programação das ações e o apoio da gestão. Existência de território definido e de prontuários familiares. É destaque a agenda compartilhada e pactuada entre os profissionais. As equipes realizam acolhimento e reuniões, cujos temas, discutidos, giram em torno do processo de trabalho e planejamento. Os desafios, enfrentados, estão relacionados ao agendamento dos usuários; ao número de pessoas sob a responsabilidade das equipes; à existência de população descoberta nas áreas adscritas à Unidade de Saúde; à incipiência na ação intersetorial e ao pouco envolvimento da comunidade pelas equipes. Quanto aos fatores associados à satisfação do usuário foi marcante: a faixa etária; a escolaridade; a raça; se a falta de material prejudica o atendimento e se a equipe consegue marcar consulta para outros profissionais. Conclusões: Constatou-se o trabalho em equipe como elemento central no processo de mudança na Atenção Primária à Saúde, tanto no contexto de Portugal quanto no do Brasil, o qual ampliou o acesso e a qualidade na oferta de serviços de saúde e obteve, ainda, o reconhecimento social, mesmo que, em ambas as realidades, não tenha avançado na coordenação do cuidado e no estímulo à participação social. Os fatores, associados com a satisfação do usuário, estão relacionados diretamente ao cuidado prestado e refletem a expectativa, por parte do usuário, de resolução concreta de suas necessidades.

Qualidade de vida no trabalho da Emater-RN: validação de um instrumento síntese de pesquisa e diagnóstico

The theoretical recital of the present study it is initiated of the evidence that the work occupies an important space in the man s life in way that the majority of the people works and passes great part of its time inside organizati ons. However, it is verified that the relation between man and work is becoming increasingly disagreement a time that the employees had started to complain work s routines, stress, not use all their potential and inadequate work s conditions. It can be observed by the way of Dejours (1994) studies. Thus, as contribution for the quality of work life s (QWL) studies the research developed here objectified to characterize the public employees quality of work life at EMATER -RN taking as reference an instrumen t of research synthesized from the typical academic literature of the subject. The synthesis of an ampler instrument is a necessity not taken care to the literature that treats on the subject but already perceived by some studies like Moraes et al (1990); Rodrigues (1989); Siqueira & Coleta (1989); Moraes et al (1992); Carvalho & Souza (2003); El -Aouar & Souza (2003) and Mourão, Kilimnick & Fernandes (2005); Adorno, Marques & Borges (2005) amongst others. These studies point out weak points of the existing models in the QWL s literature, as well as they recommend the elaboration of a model more flexible, that contemplates Brazilian cultural characteristics, and that contemplates the entire variable studied in the main existing models. For reach this objectiv e the adopted methodology was characterized as a case study with collected data in qualitative and quantitative way. Questionnaires and comments had been used as sources of evidences. These evidences had been tabulated through of statistical package SPSS ( Statistical Package for Social Science), in which the main technique of multivariate analysis used were the factorial analysis. As for the gotten results, it was verified the grouping of the quality of work life s indicators in 11 factors which are: Work s execution, Individual accomplishment, Work s equity, Relation individual and organization, Work s organization, Adequacy of the remuneration, Relation between head and subordinate, Effectiveness of the communication and the learning, Relation between work and personal life, Participation and Effectiveness of the work processes. Whatever to the characterization of the EMATER -RN s quality of work life it was clearly that to the measure that the satisfaction s evaluation with the QWL in the organization walks to intrinsic factors for extrinsic factors this level of satisfaction goes diminishing what points to the importance to improve these extrinsic factors in the institution. In summary it is possible to conclude that the organization studied has offered a significant set of referring variable to the quality of work life of the individual

Layout, conforto e satisfação dos usuários em escritórios: uma avaliação pós-ocupação no edifício da sede administrativa do INPE-CRN

This research aimed to identify the link between the layout of workspaces in offices and the design strategies for environmental comfort. Strategies surveyed were focused on the thermal, visual and luminic comfort. In this research, visual comfort is related to issues of visual integration within and between the interior and exterior of the building. This is a case study conducted at the administrative headquarters of Centro Regional Nordeste do Instituto de Pesquisas Espaciais (INPE-CRN), located in Natal/RN. The methodological strategy used was the Post-Occupancy Evaluation, which combined the survey data on the building (layout of workspaces, bioclimatic strategies adopted in the design, use of these strategies) with some techniques aimed at acquiring qualitative information related to users. The workspace layout is primordial to satisfaction and productivity of workers. Issues such as concentration, communication, privacy, personal identity, density and space efficiency, barriers (access, visual and even ventilation and lighting), among others, are associated with the layout. The environmental comfort is one of the essential elements to maintaining life quality in workplace. Moreover, it is an important factor in user`s perception of the space in which he or she are inserted. Both layout and environmental comfort issues should be collected and analyzed in the establishment phase of the programming step. That way, it is possible to get adequate answers to these questions in subsequent project phases. It was found that changes in the program that occurred over time, especially concerning persons (number and characteristics), resulted in changes in layout, generating high density and inflexible environments. It turns difficult to adjust the furniture to the occupants` requirement, including comfort needs. However, the presence of strategies for environmental quality provides comfort to spaces, ensuring that, even in situations not considered optimal, users perceive the environment in a positive way. It was found that the relationship between environmental comfort and layout takes the following forms: in changing the perception of comfort, depending on the layout of the arrangements; adjustments in layout, due to needs for comfort; and the elevation of user satisfaction and environmental quality due to the presence of strategies comfort even in situations of inadequate layout