Azevedo Creuza da Silva, Miranda Lilian, Sá Marilene de Castilho, Grabois Victor, Matta Gustavo, Cunha Marcela
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2018 Jun 25;34(6):e00043817. doi: 10.1590/0102-331X00043817.
The article presents partial results of a study at Hospital Edgar Santos, Universidade Federal da Bahia (HUPES), Brazil, analyzing the service's experience with improvement in quality of care within a context of hospital accreditation. The article focuses on the hematology service and specifically its quality of care and intersubjective processes. The study adopted a qualitative approach, using interviews and observation. From the theoretical point of view, the work of Campos, Cecílio, and Merhy acknowledge healthcare's complex nature and micropolitical and intersubjective dimension and the capacity of health professionals to produce meanings and practice creativity. To understand the health professionals' processes of psychosocial linkage and subjective mobilization, we drew on concepts from the French school of psychosociology (Enriquez) and Dejours' psychodynamics of work. The analysis was organized along three lines: psychosocial linkage and the imaginary of self-management; bonding and affect: singularity of the subject's care and clinical case; real work and the healthcare team. One of the main conclusions is the building of a self-management imaginary, expressed in shared projects, expectations, and some forms of interpreting and operating reality, based on affectively invested representations of autonomy and unity. Alongside technical elements such as protocols, the article highlights professional judgment, proper to the intersubjective dimension, fostering the singularity of care. In our view, the real work in the patient care scene is traversed by adjustments that demonstrate team cooperation.
本文介绍了巴西巴伊亚联邦大学埃德加·桑托斯医院（HUPES）一项研究的部分结果，该研究分析了医院在认证背景下改善护理质量的服务经验。本文重点关注血液学服务，特别是其护理质量和主体间过程。该研究采用定性方法，运用访谈和观察。从理论角度来看，坎波斯、塞西利奥和梅尔希的著作承认医疗保健的复杂性质、微观政治和主体间维度，以及卫生专业人员产生意义和实践创造力的能力。为了理解卫生专业人员的心理社会联系和主观动员过程，我们借鉴了法国心理社会学派（恩里克斯）的概念和德茹尔的工作心理动力学。分析沿着三条线展开：心理社会联系与自我管理的想象；联系与情感：主体护理和临床病例的独特性；实际工作与医疗团队。主要结论之一是构建一种自我管理的想象，体现在共同的项目、期望以及一些解释和操作现实的形式中，这些基于对自主性和统一性的情感投入表征。除了协议等技术要素外，本文还强调了主体间维度特有的专业判断，促进了护理的独特性。在我们看来，患者护理场景中的实际工作通过展示团队合作的调整得以推进。
