O "nós" e os "nós" do trabalho em equipe na atenção primária à saúde

Abstract

Introduction: In Brazil, the adoption of strategic programs has sought to legitimize and rescue Primary Health Care (PHC) in the country since the 1990s, promoting a change in the healthcare paradigm that aims to transform the traditional health care model into a collective, interprofessional, and subject-centered model. In this context, the Family Health Strategy (ESF) and the Support Center for Family Health and Primary Care (NASF-AB) have the mission of providing care through teamwork, due to the complexity of the health needs that are posed at the primary level of care, besides encouraging collaborative and interprofessional practices that influence the production of integral care. Objective: To analyze the perception of teamwork among PHC professionals in João Pessoa, State of Paraíba. Method: The research was developed from a multiple case study in João Pessoa, using the mixed method, and the units of analysis were the PHC professionals. The sample size for the quantitative component was calculated based on a 50% probability of occurrence of the event and a 5% sampling error, obtaining a minimum random sample of 318 professionals from the ESF and 119 from the NASF-AB teams. For the qualitative component, a nonprobabilistic sample was defined adopting the criterion of theoretical saturation. Three collection instruments were applied: a questionnaire for self-assessment of the work process, the Team Climate Inventory (TCI) and the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC), as well as guiding scripts for semistructured, face-to-face interviews with key informants from three health units, with and without orientation toward collaborative work. The quantitative data were analyzed by descriptive and inferential statistics, using the chi-square test to verify heterogeneity among variables and team types. For the treatment of qualitative data, Bardin's content analysis method was employed. Results and Discussion: The perception of teamwork identified in this study was that of collaboration, since the professionals indicated the need for interaction, union, mutual help, support, and interdependence for the production of care in PHC. The workers studied have expressive availability for interprofessional collaboration, with higher scores among the NASF-AB workers. About the potentialities for teamwork, we identified aspects such as: workers' satisfaction with the relationship with other team members; satisfaction with communication and clarity of roles in their teams; and appreciation of training practices and professional qualification. As weaknesses, there were elements that impact teamwork, such as: valorization of technical knowledge and individual practices, especially in ESF teams; management demands of goal achievement; shortage of materials and precarious infrastructure; and high demand for PHC assignments. Final Considerations: Teamwork aspects identified in the PHC of João Pessoa pose challenges to the work process of the ESF and NASF-AB, requiring the creation of continuing education strategies, greater articulation between teaching and service, and institutional investments to qualify the production of care through interprofessional collaborative practices at this level of care.