Autor/es
Descripción
ver mas
Colaborador
Zelaschi, María Constanza
Amable, Marcelo Jorge
Spatial Coverage
Temporal Coverage
2019-2021
Idioma
spa
Extent
350 p.
Derechos
info:eu-repo/semantics/openAccess
Atribución-NoComercial-SinDerivadas 2.0 Genérica (CC BY-NC-ND 2.0)
Formato
application/pdf
Identificador
Cobertura
1019697
Lomas de Zamora (inhabited place)
2019-2021
Abstract
The main purpose of production process in hospitals is the production of health care, and the different work processes converge on this through their tasks. The way in which those processes are linked to reach that purpose depends on the intersubjective relationship between workers, which reveals the centrality of the relational dimension, and thus the development of rules and agreements during the execution of the work process itself. Despite its centrality, the impact of regulation on intersubjective relationships and on the workers’ health remains poorly studied. Health work is usually thought of from an industrial logic, trying to produce standardized and rigid working methods. When standardized production invades the health work process, it does so at the expense of the professional's relationship with the users, with his or her own work team, and at the expense of the production of health care.
It is necessary to develop research that places at the center of the analysis the methods of generation of rules of the production of health care process. For the above reasons, the neonatal therapy unit arises as an area of work where the complexity of the regulation of the health care-producing process can be addressed. This complexity is due to the need of urgent interventions, the responsibility of monitoring the health status of newborns, the assistance to deliveries that cannot be foreseen; this will make the pace of work during the working day be fast and intense and will have an impact on decision making and on the development of rules and agreements. This workload falls especially on neonatology residents, who are students who have completed their medical degree training and hence enter the health system to obtain a specialization in a formal training program, and on nurses, whose role is to provide hygiene, comfort, and care and to be attentive to the needs of the baby and the family. Residents and nurses are closely linked by the interdependence resulting from their tasks, since both groups, from their respective functions, closely monitor the evolution of the babies in the hospital on a daily basis. In this way, the intersubjective relationships between them have an impact on the daily production of health care, and it is possible to investigate the way in which they produce and elaborate the rules and agreements necessary for the achievement of the final objective.
This thesis aims to investigate the way in which rules are elaborated and produced between resident physicians and nurses in a neonatal care unit of a public hospital and how they relate to the health of the workers. Among the specific objectives of the thesis, the first one is to identify the dimensions involved in the regulatory process between residents and nurses in terms of control and autonomy of their work processes; the second, to identify instances of cooperation and conflict in the regulatory process between the two occupational groups, and third, to identify the dimensions of regulation according to their role in protecting and/or deteriorating the health of resident physicians and nurses.
To address the problem of this research, we chose a qualitative methodology through interviews. The understanding of the regulation of the health care-producing process, according to the theoretical frameworks adopted, implies the observation of the organizational functioning on a case-by-case basis, since it is in the real activity carried out by the actors that the rules and agreements established can be evidenced. This is why the case study was the research strategy used.
The results obtained show how training and interest are the main drivers of the regulatory process. On the one hand, through the interviews conducted, the subjectivations that operate in each occupational group become evident: the perception of professional autonomy on the one hand and the discretionary will, in the case of nurses, on the other; and the responsible autonomy that subjectifies the work of the medical residents. As a result, the regulation between medical residents and nurses will present instances of conflict, related to the delay in the completion of tasks by the nurses and their work patterns in tension with those of the residents, and instances of cooperation related to the confidence that resident physicians have in nursing early warning. We regard the conclusions present here as original contributions to the knowledge of the regulatory process between medical residents and nurses, since they allow to ponder the limitations of autonomy related to disciplinary knowledge in order to think about the relational production of health care, the importance of spaces for deliberation to accommodate the care giving dimension, the need to rethink health management and the recognition that organizations give to workers so that they can mobilize their intelligence and the links that these processes have with the health of workers in terms of deterioration and/or protection.
It is necessary to develop research that places at the center of the analysis the methods of generation of rules of the production of health care process. For the above reasons, the neonatal therapy unit arises as an area of work where the complexity of the regulation of the health care-producing process can be addressed. This complexity is due to the need of urgent interventions, the responsibility of monitoring the health status of newborns, the assistance to deliveries that cannot be foreseen; this will make the pace of work during the working day be fast and intense and will have an impact on decision making and on the development of rules and agreements. This workload falls especially on neonatology residents, who are students who have completed their medical degree training and hence enter the health system to obtain a specialization in a formal training program, and on nurses, whose role is to provide hygiene, comfort, and care and to be attentive to the needs of the baby and the family. Residents and nurses are closely linked by the interdependence resulting from their tasks, since both groups, from their respective functions, closely monitor the evolution of the babies in the hospital on a daily basis. In this way, the intersubjective relationships between them have an impact on the daily production of health care, and it is possible to investigate the way in which they produce and elaborate the rules and agreements necessary for the achievement of the final objective.
This thesis aims to investigate the way in which rules are elaborated and produced between resident physicians and nurses in a neonatal care unit of a public hospital and how they relate to the health of the workers. Among the specific objectives of the thesis, the first one is to identify the dimensions involved in the regulatory process between residents and nurses in terms of control and autonomy of their work processes; the second, to identify instances of cooperation and conflict in the regulatory process between the two occupational groups, and third, to identify the dimensions of regulation according to their role in protecting and/or deteriorating the health of resident physicians and nurses.
To address the problem of this research, we chose a qualitative methodology through interviews. The understanding of the regulation of the health care-producing process, according to the theoretical frameworks adopted, implies the observation of the organizational functioning on a case-by-case basis, since it is in the real activity carried out by the actors that the rules and agreements established can be evidenced. This is why the case study was the research strategy used.
The results obtained show how training and interest are the main drivers of the regulatory process. On the one hand, through the interviews conducted, the subjectivations that operate in each occupational group become evident: the perception of professional autonomy on the one hand and the discretionary will, in the case of nurses, on the other; and the responsible autonomy that subjectifies the work of the medical residents. As a result, the regulation between medical residents and nurses will present instances of conflict, related to the delay in the completion of tasks by the nurses and their work patterns in tension with those of the residents, and instances of cooperation related to the confidence that resident physicians have in nursing early warning. We regard the conclusions present here as original contributions to the knowledge of the regulatory process between medical residents and nurses, since they allow to ponder the limitations of autonomy related to disciplinary knowledge in order to think about the relational production of health care, the importance of spaces for deliberation to accommodate the care giving dimension, the need to rethink health management and the recognition that organizations give to workers so that they can mobilize their intelligence and the links that these processes have with the health of workers in terms of deterioration and/or protection.
Título obtenido
Doctora de la Universidad de Buenos Aires en Ciencias Sociales
Institución otorgante
Universidad de Buenos Aires. Facultad de Ciencias Sociales