Gentileza no cuidado em saúde: concepções e práticas de gestores, trabalhadores e usuários de unidade de atenção primária

Abstract

The aim was to analyze the conceptions and practices of health workers, managers, and users of Primary Health Care regarding kindness in health care and its relationship with incivility and patient safety. This is a convergent, qualitative research study, grounded in the theoretical framework of the Ethics of Alterity, the construct of Kindness in Health Care, and the principles of the National Humanization Policy. It was conducted in a Primary Health Care Unit in Fortaleza-CE, between November 2025 and May 2026. Data collection methods were triangulated, employing semi-structured interviews, systematic observation, and focus groups. A total of 37 people participated in the study: two managers, 19 health professionals, and 16 users. Categorical Thematic Content Analysis was adopted, using the MAXQDA® software. The findings were presented in tables, figures, and code maps. The study was approved by the Research Ethics Committee (Opinion No. 7,814,388/2025). As a result, four central categories were identified: 1. “Courtesy and Incivility in Primary Health Care: conceptions and practices,” which highlighted how courtesy and incivility are conceived and practiced in the daily routine of Primary Health Care, encompassing attributes of courtesy and conceptions about the concept of incivility as a normalized practice and its impacts. The second category, “The Work Ecosystem in the Family Health Strategy: conditioning factors and interpersonal relationships,” helps to explain the institutional conditioning factors of courtesy and incivility, in addition to addressing the role of the territory and its vulnerability. Participants demonstrated that interpersonal relationships and the production of care in Primary Health Care cannot be understood in isolation from the conditions under which health work is carried out. Category 3, "The Care Encounter in Primary Health Care: Bonding, Subjectivity, and Burnout," addressed the professional-user relationship, encompassing conflicts of expectations, reactive behavior, rupture of bonds, and satisfaction with the service; in addition to emphasizing the emotional cost of caregiving. Category 4 addressed the "Impacts of Kindness on the Quality of Care and Promotion Strategies," including the promotion of practices based on kindness and the construction of more welcoming, humanized, and safe environments. Finally, a Kind Care Program was proposed, with objectives, structuring axes, tools, indicators, and an implementation schedule. It is concluded that the routine of Primary Care is marked by strong tension in the relationship between professionals and users, where episodes of incivility are very present and generate an emotional cost for those who work there. All of this is shaped by structural conditions, organizational climate, and the vulnerability of the territory. In response to this pain, the study mapped the attributes of kindness and their impacts as tools for transforming this ecosystem.