Social determinants of health and community health agent work

Patient safety culture in primary health care: Medical office survey on patient safety culture in a Brazilian family health strategy setting

Study objectives

To assess the patient safety culture in Primary Health Care (PHC) setting after the transition to the Family Health Strategy (FHS) model in a Brazilian metropolitan area and compare the results between the categories of health care professionals.

Methods

A cross-sectional study including 246 workers from primary health care services in Federal District, Brazil. Data collection took place from October to December 2019 through the Medical Office Survey on Patient Safety Culture (MOSPSC) application. Patient safety culture was considered positive when the score was above 60%. For comparisons between the categories of health care professionals’, the ANOVA and Kruskal-Wallis test were used for composite percent positive scores, and Pearson’s chi-square or Fishers exact test for frequency and percentage of positive responses.

Results

The overall MOSPSC composite percent positive score was 49.9%. Among the 12 dimensions, only three showed a positive patient safety culture: Teamwork (73.1%), Organizational learning (62.9%), and Patient care tracking/follow-up (60.1%). The percentage of positive responses on overall quality assessment (78.1%) and overall patient safety assessment (78.0%) showed a positive evaluation. There was no significant difference in the composite percent positive score of overall MOSPSC (p = 0.135) and the percentage of positive responses on overall patient safety assessment (p = 0.156) between the categories of health care professionals. Overall quality assessment showed a significant difference between job roles (p < 0.001), in which nursing /health care technicians showed a significantly lower score than other job roles.

Conclusion

The patient safety culture assessment showed a weakness in the patient safety in the PHC services. The MOSPSC and nine of its dimensions presented a negative safety culture assessment, regardless of the high scores in the overall patient safety and quality assessments.

Community Health Agents and child health care: implications for continuing education

ABSTRACT Objective: To understand the main situations faced by community health agents in relation to children’s health in the light of permanent education actions. Method: This is a research of qualitative approach, which used the Arc of Maguerez. Ten community health agents from a Primary Health Care Unit participated in the study. The following steps were addressed: observation of reality; identification of key points, and theorization. The speeches were recorded, transcribed, and their textual content was processed in the IRAMUTEQ software, using the Descending Hierarchical Classification. Results: Five classes were formed, which composed three thematic blocks named as follows: child’s social vulnerability in the territory; handling the child’s health record, and vaccination schedule. Conclusion: Unveiling situations that influence the work of community health agents is essential for continuing education, as this favors assumptions applicable to daily work with resoluteness in child health.

Nursing actions promoting adherence to tuberculosis treatment: scoping review

OBJECTIVE

To analyze actions promoting adherence to tuberculosis treatment that are being carried out by nurses in different countries.

METHOD

Scoping review with selection of articles on the subject in LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases.

RESULTS

Forty studies, published between 2009 and 2020, allowed the identification of nursing actions in two thematic categories. In the category "Nursing care: TB patients' specific needs to promote adherence to treatment", actions involving clinical aspects, professionals' knowledge and skills, educational and relational processes were identified. In the category "The role of nursing in coping with the social determinants of health to promote adherence to treatment", interventions related to the strengthening of family and community support, the inclusion of socioeconomic issues in care plans, and respect for cultural differences were highlighted.

CONCLUSION

Nursing work directed to the adherence to disease treatment requires the development of technical, ethical and, above all, political skills, aiming to increase the success of the actions carried out by these professionals.

Continuing education in healthcare as a strategy for occupational safety in the context of the COVID-19 pandemic: reflections on the role of community healthcare agents in construction of care

Community healthcare agents are strategic professionals in delivery of Primary Healthcare activities. This article reflects on the role of continuing education in healthcare as a strategic element in ensuring the occupational health of community healthcare agents faced with combating and managing coronavirus 19 disease (COVID-19). In the current scenario, the work of community healthcare agents is undergoing daily reconstruction of professional practice in order to keep pace with the living territories to which they are assigned. Continuing education in healthcare enables construction of feasible scenarios that make problem solving possible, involving a constant reflective analytical perception of professional practices, permitting (re)construction of social skills such as the capacity to mobilize and motivate other actors to participate in political action. Through problematization, identification of needs, and questioning, continuing education in healthcare leads to (de)construction of the working practices of the very actors who are delivering care. Furthermore, continuing education in healthcare reaffirms the importance of the social, technical, and political training of community healthcare agents, thereby confirming their right to dignified and quality work. In a pandemic scenario, an agenda focused on continuing education in healthcare is essential to the continuity of care delivery to communities, facilitating expansion of access to the right to health.