Lima M A, de Almeida M C
Departamento de Assistência e Orientação Profissional da Escola de Enfermagem, Universidade Federal do Rio Grande do Sul.
Rev Gaucha Enferm. 1999 Jan;20(1 Suppl):86-101.
The subject of this research study is the technological and social organization of health work in hospital, considering the position of nursing practice within production of care. The aim is to analyze the work process at a University Hospital to apprehend the configuration of practices, knowledges, social relations and technologies that are operated by agents in intervention on the body of an ill person. Using a dialectical approach, empirical data were collected by direct observation of the work process in a medical in-patient unit and by semi-structured interviews with professionals. It was found that the production of care is developed based on collective work, that is structured by the division in parts and fragmentation of the actions of the different agents, in order to produce a diagnosis and therapy. The agents articulate their actions around the medical act which takes up a central position in the production of care. The importance of broadening the clinical model to contemplate the social and subjective dimension of the health/disease process is pointed out in a therapeutical project shared by different health care team professionals. It is proposed to change the work process associated with the construction of new management models in health care institutions.
本研究的主题是医院卫生工作的技术与社会组织，同时考虑护理实践在护理生产中的地位。目的是分析一所大学医院的工作流程，以了解由干预病人身体的行动者所操作的实践、知识、社会关系和技术的构成。采用辩证方法，通过直接观察内科住院部的工作流程以及对专业人员进行半结构化访谈来收集实证数据。研究发现，护理生产是基于集体工作开展的，集体工作由不同行动者行动的分工和碎片化构成，以便进行诊断和治疗。行动者围绕在护理生产中占据核心地位的医疗行为来协调他们的行动。不同医疗团队专业人员共同参与的一个治疗项目指出了拓宽临床模式以考虑健康/疾病过程的社会和主观维度的重要性。建议改变与医疗机构新管理模式构建相关的工作流程。
