Arco de Maguerez: problematizando acerca das estratégias que potencializam as atividades de trabalho realizadas por uma equipe de consultório na rua
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2024-02-22
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Universidade Estadual Paulista (Unesp)
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Introdução: o Consultório na Rua surgiu de uma necessidade frente à grande população em situação de rua, com objetivo de ampliar o acesso desses indivíduos aos serviços de saúde, oferecendo de modo mais oportuno atenção integral à saúde para esse grupo populacional. No município de Bauru, o Consultório na Rua é um serviço relativamente novo, que foi implantado no mês de fevereiro de 2018 e que ainda não é conhecido nem reconhecido por grande parte dos profissionais de saúde do município que compõem os equipamentos da Rede de Atenção à Saúde e pela população em geral. Diante da escassez na literatura referente às práticas de atendimento pelas equipes de Consultório na Rua, torna-se fundamental potencializar e divulgar os trabalhos desenvolvidos por essas equipes, tanto entre os serviços de saúde que integram a Rede de Atenção à Saúde quanto à população geral. Objetivos: elaborar estratégias para aprimorar a realidade de trabalho de uma equipe de Consultório na Rua a partir da problematização apoiada no Arco de Maguerez. Método: estudo descritivo, de natureza participativa, que utilizou a problematização fundamentada no Arco de Charles Maguerez. Participaram da pesquisa todos os profissionais com atuação na equipe de Consultório na Rua do Município de Bauru/São Paulo. A coleta de dados foi realizada entre dezembro de 2022 e junho de 2023, por meio do levantamento de características sociodemográficas e clínicas dos usuários em acompanhamento no serviço, bem como das atividades realizadas e de Oficina de Trabalho com utilização da problematização fundamentada no Arco de Charles Maguerez, composto por cinco etapas: observação da realidade, pontos-chave, teorização, hipóteses de solução e aplicação à realidade. A escolha pela problematização, como Referencial Teórico norteou o planejamento e execução da oficina de trabalho, direcionada a identificar a realidade de trabalho da equipe de Consultório na Rua e a constituir um espaço educativo, de reflexão e integração teórico-prática no exercício do processo de trabalho de saúde. Os dados quantitativos foram organizados em planilhas confeccionadas no Software Excel com análise descritiva. A pesquisa teve aprovação do Comitê de Ética em Pesquisa. Resultados: a equipe do Consultório na Rua é composta por sete profissionais que realizam atendimentos em vias públicas, praças, albergues e instituições do município de Bauru, contemplando 1113 pacientes cadastrados, desde o início das atividades do serviço, com 469 prontuários ativos de pacientes em sua grande maioria do sexo masculino (77%), faixa etária entre 31 e 40 anos, em uso de tabaco (71%), álcool (24%), entre outras drogas (29%). Dentre as atividades realizadas pela equipe, destacam-se as ações de educação em saúde, atendimentos no território, aplicação de medicação, coleta de exames e consultas; sendo que no ano de 2022 foram realizados 2233 atendimentos e realizados 2494 procedimentos, sobretudo realizados pela equipe de enfermagem. Na etapa da observação da realidade, foi levantada a falta de conhecimento sobre o trabalho, acesso limitado aos serviços da Rede de Atenção à Saúde, falta de mapeamento territorial, indisponibilidade de itens essenciais e ausência de protocolos de atendimento. Na etapa de pontos-chave, foi revelada uma confusão e desconhecimento sobre o escopo do trabalho de uma equipe de Consultório na Rua, não foram identificados os efeitos de suas ações no cuidado às pessoas em situação de rua, as ações individuais são bem compreendidas, mas as atividades coletivas e intersetoriais são limitadas, destacando a necessidade de diálogo sobre os marcos teóricos e as possibilidades de práticas no Consultório na Rua. Na etapa de teorização, foi realizada análise científica das informações coletadas para contribuir para a solução do problema. Uma enfermeira experiente conduziu uma discussão intitulada "Consultório na Rua: marcos teóricos, conceituais e possibilidades de práticas", permitindo uma discussão ativa sobre o trabalho das equipes de Consultório na Rua. Na etapa de hipóteses de solução houve uma discussão crítica na busca de melhorar o atendimento aos pacientes, com desejo de mudar a rotina e implementar novas ações, como atividades coletivas de educação em saúde e aumentar a divulgação da equipe. A experiência na Oficina de Trabalho reforçou a união da equipe e a vontade de fazer a diferença, e como proposta a construção coletiva de um Plano de Ação. Na etapa de aplicação à realidade, foram construídos dois produtos técnicos: 1) Fluxograma de atendimento à pessoa em situação de rua no município de Bauru, com objetivo de ampliar a divulgação do papel da equipe do Consultório na Rua entre os serviços que compõem a Rede de Atenção à Saúde. 2) Plano de ação para potencializar as atividades desenvolvidas pela equipe do Consultório na Rua, apresentado no formato de quadro contendo 13 objetivos e 22 ações estratégicas. Conclusão: o processo de trabalho da equipe multiprofissional do Consultório na Rua difere de qualquer outro serviço existente na Rede de Atenção à Saúde, devido sua característica singular em cuidar do usuário no seu ambiente de permanência. A problematização realizada neste estudo por meio do Arco de Maguerez permitiu com êxito a reflexão entre os profissionais da equipe de Consultório na Rua de Bauru para o seu engajamento nessa singular atividade, bem como potencializar suas ações com a proposição de estratégias de atendimento. A capacitação, o planejamento, construção e aprimoramento de estratégias e do trabalho intersetorial para o atendimento dessa população devem ser continuados e permanentes.
Introduction: the Street Clinic arose from a need in the face of the large homeless population, in order to expand the access of these individuals to health services, offering more timely comprehensive health care for this population group. In the municipality of Bauru, the Street Clinic is a relatively new service, which was implemented in February 2018 and is not yet known or recognized by most of the health professionals in the municipality that make up the equipment of the Health Care Network and the general population. Given the scarcity in the literature regarding the care practices by the Street Clinic teams, it is essential to enhance and disseminate the work developed by these teams, both among the health services that make up the Health Care Network and the general population. Objectives: to develop strategies to improve the reality of work of a team of Office in the Street from the problematization supported by the Arch of Maguerez. Method: a descriptive study of participatory nature, which used the problematization based on the Arch of Charles Maguerez. The participants were all professionals working in the Office on the Street from the Municipality of Bauru/São Paulo. Data collection was performed between December 2022 and June 2023, through the survey of sociodemographic and clinical characteristics of users in follow-up in the service, as well as the activities carried out and the Workshop with the use of problematization based on the Arc of Charles Maguerez, composed of five stages: observation of reality, key points, theorization, hypotheses of solution and application to reality. The choice for problematization, as Theoretical Reference guided the planning and execution of the workshop, aimed at identifying the reality of work of the Office team on the street and to constitute an educational space, reflection and theoretical integration practice in the exercise of the health work process. The quantitative data were organized in spreadsheets made in Excel Software with descriptive analysis. The research was approved by the Research Ethics Committee. Results: the team of the Office in the Street is composed of seven professionals who perform care in public roads, squares, hostels and institutions of the municipality of Bauru, contemplating 1113 registered patients, since the beginning of the service activities, with 469 active medical records of patients in their vast majority of males (77%), aged between 31 and 40 years, in tobacco use (71%), alcohol (24%), among other drugs (29%). Among the activities carried out by the team, health education actions, assistance in the territory, application of medication, collection of exams and consultations stand out; and in 2022, 2233 consultations were provided and 2494 procedures were carried out, mainly carried out by the nursing team. In the observation stage of reality was raised the lack of knowledge about the work, limited access to Health Care Network services, lack of territorial mapping, unavailability of essential items and absence of service protocols. In the stage of key points was revealed a confusion and ignorance about the scope of work of a team of Office on the Street, were not identified the effects of their actions in the care of people in street situation, individual actions are well understood, but collective and intersectoral activities are limited, highlighting the need for dialogue on theoretical frameworks and the possibilities of practices in the Office on the Street. In the theorization stage, a scientific analysis of the information collected was performed to contribute to the solution of the problem. An experienced nurse conducted a discussion entitled "Office on the Street: theoretical frameworks, conceptual and practical possibilities", allowing an active discussion about the work of the Office teams on the Street. In the hypotheses of solution stage there was a critical discussion in the search to improve patient care, with a desire to change the routine and implement new actions, such as collective health education activities and increase the dissemination of the team. The experience in the Workshop reinforced the union of the team and the will to make a difference, and as a proposal the collective construction of an Action Plan. In the stage of application to reality were built two technical products: 1) A flowchart of care to the person in street situation in the city of Bauru, in order to expand the role of the team of the Office on the Street among the services that make up the Health Care Network. 2) Action plan to enhance the activities developed by the team of Office on the Street, presented in the frame format containing 13 objectives and 22 strategic actions. Conclusion: the work process of the multiprofessional team of the Office on the Street differs from any other service existing in the Health Care Network, due to its unique characteristic in caring for the user in his environment of permanence. The problematization carried out in this study through the Arch of Maguerez successfully allowed the reflection among the professionals of the Office team in Bauru Street for their engagement in this singular activity, actions with the proposition of service strategies. Training, planning, construction and improvement of strategies and intersectoral work for the care of this population should be continued and permanent.
Introduction: the Street Clinic arose from a need in the face of the large homeless population, in order to expand the access of these individuals to health services, offering more timely comprehensive health care for this population group. In the municipality of Bauru, the Street Clinic is a relatively new service, which was implemented in February 2018 and is not yet known or recognized by most of the health professionals in the municipality that make up the equipment of the Health Care Network and the general population. Given the scarcity in the literature regarding the care practices by the Street Clinic teams, it is essential to enhance and disseminate the work developed by these teams, both among the health services that make up the Health Care Network and the general population. Objectives: to develop strategies to improve the reality of work of a team of Office in the Street from the problematization supported by the Arch of Maguerez. Method: a descriptive study of participatory nature, which used the problematization based on the Arch of Charles Maguerez. The participants were all professionals working in the Office on the Street from the Municipality of Bauru/São Paulo. Data collection was performed between December 2022 and June 2023, through the survey of sociodemographic and clinical characteristics of users in follow-up in the service, as well as the activities carried out and the Workshop with the use of problematization based on the Arc of Charles Maguerez, composed of five stages: observation of reality, key points, theorization, hypotheses of solution and application to reality. The choice for problematization, as Theoretical Reference guided the planning and execution of the workshop, aimed at identifying the reality of work of the Office team on the street and to constitute an educational space, reflection and theoretical integration practice in the exercise of the health work process. The quantitative data were organized in spreadsheets made in Excel Software with descriptive analysis. The research was approved by the Research Ethics Committee. Results: the team of the Office in the Street is composed of seven professionals who perform care in public roads, squares, hostels and institutions of the municipality of Bauru, contemplating 1113 registered patients, since the beginning of the service activities, with 469 active medical records of patients in their vast majority of males (77%), aged between 31 and 40 years, in tobacco use (71%), alcohol (24%), among other drugs (29%). Among the activities carried out by the team, health education actions, assistance in the territory, application of medication, collection of exams and consultations stand out; and in 2022, 2233 consultations were provided and 2494 procedures were carried out, mainly carried out by the nursing team. In the observation stage of reality was raised the lack of knowledge about the work, limited access to Health Care Network services, lack of territorial mapping, unavailability of essential items and absence of service protocols. In the stage of key points was revealed a confusion and ignorance about the scope of work of a team of Office on the Street, were not identified the effects of their actions in the care of people in street situation, individual actions are well understood, but collective and intersectoral activities are limited, highlighting the need for dialogue on theoretical frameworks and the possibilities of practices in the Office on the Street. In the theorization stage, a scientific analysis of the information collected was performed to contribute to the solution of the problem. An experienced nurse conducted a discussion entitled "Office on the Street: theoretical frameworks, conceptual and practical possibilities", allowing an active discussion about the work of the Office teams on the Street. In the hypotheses of solution stage there was a critical discussion in the search to improve patient care, with a desire to change the routine and implement new actions, such as collective health education activities and increase the dissemination of the team. The experience in the Workshop reinforced the union of the team and the will to make a difference, and as a proposal the collective construction of an Action Plan. In the stage of application to reality were built two technical products: 1) A flowchart of care to the person in street situation in the city of Bauru, in order to expand the role of the team of the Office on the Street among the services that make up the Health Care Network. 2) Action plan to enhance the activities developed by the team of Office on the Street, presented in the frame format containing 13 objectives and 22 strategic actions. Conclusion: the work process of the multiprofessional team of the Office on the Street differs from any other service existing in the Health Care Network, due to its unique characteristic in caring for the user in his environment of permanence. The problematization carried out in this study through the Arch of Maguerez successfully allowed the reflection among the professionals of the Office team in Bauru Street for their engagement in this singular activity, actions with the proposition of service strategies. Training, planning, construction and improvement of strategies and intersectoral work for the care of this population should be continued and permanent.
Descrição
Palavras-chave
População em situação de rua, Fluxo de trabalho, Equipe multiprofissional, Política de saúde, Homeless persons, Workflow, Patient care, Health policy
Como citar
SANTOS, Ângela Domingues dos. Arco de Maguerez: problematizando acerca das estratégias que potencializam as atividades de trabalho realizadas por uma equipe de Consultório na Rua. Orientador(a): Rúbia de Aguiar Alencar. Coorientador(a): Lucas Cardoso dos Santos. 2024. Dissertação (Enfermagem Profissional) - Faculdade de Medicina de Botucatu , Universidade Estadual Paulista (Unesp), Botucatu, 2024.