Aprender a interagir: tensões e lições da educação permanente em saúde na atenção domiciliar na Secretaria de Estado de Saúde do Amazonas

Abstract

The proposal of permanent health education takes place in a micro-political territory as a living body of work in development, in the daily actions of individuals, in the connection amongst themselves and the scenarios they find themselves. Public health in action involves many aspects: management, politics, teaching and care. To understand the proposal of permanent education developed in the Amazonian context we propose this investigation involving the dimensions of learning, and searched in education, for contributions to answer the research problem. Objectives: a) Understand the process of permanent education in health of the Homecare Attention Services in the municipality of Manaus in the state of Amazonas, from the perspective of healthcare professionals and caretakers; b) develop an action plan to evaluate the necessities of the permanent healthcare education in the Homecare Attention Services; c) Plan a health educational intervention for the Homecare Attention Services from the necessities that were identified. We conducted the search in the psychological cultural history, in the pedagogical dialogic and the concepts that support the Policy of Permanent Education in Health, primarily the psychological elements for the construction of theoretical references. The action-research was chosen due to the fact it is considered a social research with qualitative hallmarks, as well as its coherence with assumptions of permanent education and other references. The first phase of the research consisted of 9 participants, 5 were home healthcare professionals and 4 were caretakers that work in Homecare Attention, that participated in the semi-structured individualized interviews. The second phase, was a Discussion Group that was intentionally created with 6 healthcare professionals of home healthcare services that participated in three meetings. The recorded and transcribed narratives of these two phases were submitted to analysis under the Discourse of the Collective Individual, methodological process that main objective is to expose social representations and it initiates with the supposition that it is possible for a collective to speak as if they were an individual. The main results point to the lack of knowledge of the permanent health education as a policy, as a concept and as a driving method of developmental and performance transformations in health, with strong possibility of the same challenges being present in other services managed by the public healthcare services office. Although, there is an initial movement to strengthen the policy and its assumptions demonstrated by local management at homecare services, with the objective to increase the participation and involvement of a larger number of people in the decision making process and in communication. There is the challenge of establishing significant gatherings to generate change in the personnel and in the organization due to the breakdown in communication. The planning in educational health proposed and developed by the group revealed a multidisciplinary team acting in a disciplined manner, but at the same time, the team recognizes and rejects this reality with a strong will to overcome. The final considerations point to data that healthcare professionals and caretakers of the home services were pushed to reflect critically on the difficulty and scope of their daily activities, at the same time reporting the alleged capillarity of the permanent health education as an established policy is still a monumental challenge, and the person that works in healthcare to see themselves as an educator.