O processo de trabalho em um serviço de assistência especializada em HIV/AIDS (SAE): a constituição do núcleo e campo dos saberes e suas distintas articulações

Abstract

This study examines the work process in a Specialized HIV/AIDS Care Service (SAE) in Fortaleza, Ceará, Brazil. Its general objective was to characterize the work process developed by the healthcare team, and specifically, to identify the perception of different professional categories regarding their work; to verify the degree of articulation and integration between the categories of workers and its impact on work performance; to understand how the articulation between specific and collective professional knowledge and practice of the workers involved in this process occurs in the HIV/AIDS work process; to discuss the social work space of nursing and to identify the facilitating and hindering factors of the work from the perspective of the different categories of workers. It is a qualitative study, based on the historical-structural theoretical framework. Direct observations of the work process, field notes, and semi-structured interviews were used to collect data. Fieldwork was conducted from February to July 2001. The study subjects were 20 workers from the SAE (Specialized Care Service). According to the results, it was possible to affirm that the workforce is predominantly female, the team is mostly composed of young workers with considerable experience in the specialty who hold more than one job. The users are characterized by belonging to the low economic class. We identified a service with deficient physical and human resources. We found that the nursing category identifies and values ​​both activities that comprise its core function and the field of knowledge in HIV/AIDS, while the medical, social work, psychology, and nursing assistant categories have a strong tendency to value core activities. We can consider the SAE work team as a grouping team, in which fragmentation of actions occurs. In this service, we identified a predominance of the medical practice-centered care model, resulting in all other activities revolving around it. Medical practice reiterates the biomedical model of health and reveals ideological resistance to models of social reproduction of health, facing difficulties in carrying out work articulated with other practices. Nurses face concrete difficulties in expanding their social space and gaining recognition for their work in the SAE (Specialized Care Service). We conclude by confirming our assumption that nursing work in HIV/AIDS, in the service studied, operates on a new object, and this work is still under construction, like the other work carried out there. Nurses develop greater articulation of their work with psychologists and social workers and less articulation with doctors. This greater articulation seems to be explained by the similar conception these workers have about the purpose of work in HIV/AIDS and a shared perception of the existence of a field of activities that are shareable.