Recomendações e prescrições para cuidados de saúde no pós-alta: a investigação de um programa educativo a pacientes cardiopatas sob uma perspectiva interacional

Abstract

This dissertation resulted from the investigation of educational programs into good health practices that a private hospital located in the South of Brazil accomplishes with Acute Coronary Syndrome and Congestive Heart Failure patients. Conversation Analysis theoretical and methodological approach (SACKS, 1992; SACKS, SCHEGLOFF, JEFFERSON, 1974) has been adopted to analyze 25 interactions occurred between patients and medical doctors or other health providers – nurses, nutritionists, physiotherapists and psychologists – members of the multidisciplinary team responsible for the patients’ orientation. Interactions were audio and video recorded and transcribed according to Jefferson (1984). The present dissertation aimed to: (a) verify how the health professional responsible for accomplishing the educational program recommend or prescribe good health practices in the turn by turn of the interaction so as to discuss which ways of talking appear to be more (potentially) particularized or generalized in relation to patients` (not) displayed needs in the interaction and, from such discussion, to point out tendencies of (non) adherence to good practices recommended or prescribed by patients; (b) present an empirical trajectory representative of the educational program concerning the ways participants negotiate, in the interaction turn-by-turn, rights and obligation of knowing (epistemic domain) and saying (deontic domain) (HERITAGE, 2012; STEVANOVIC, 2011) what can (not) and/or must (not) be done in terms of good health practices so as to discuss the interaction and practical implication related to the negotiation around rights and obligations of recommending or prescribing good health practices; (c) discuss the ways of organizing provision of orientation to good health practices in the light of principle of integrality (BRASIL, 1998; MATTOS, 2005a). Regarding more or less particularized ways of talking concerning patients’ orientation needs, it has been verified that the professional members’ talk appear to be more particularized in situations in which they implement courses of action in such a way as to: (a) (try to) remove obstacles so that patients may accept professional members’ recommendations in favor of good health practices; (b) deviate from the action of providing information included in the manuals of good health practices of the programs and display knowledge regarding patients’ peculiar health conditions; (c) justify the indication of certain good health practice. In relation of the ways professional members and patients negotiate epistemic and deontic domains, it has been observed that: (a) non-medical members assume the position of someone who has rights and obligations of knowing and saying how patients must control their health conditions; (b) patients do not ratify these professionals’ rights and obligations of knowing and saying how they should proceed in the post-discharge; (c) medical doctors talk about good heath practices by list-formatting their turns at talk, which conflicts with patients’ expectations of discussing these topics in a minutely detailed way. In the third one, a comparing analysis between two interactions has been done. Finally, it has been verified that the way of organizing service of orientation to patients approximate integral assistance actions (AYRES, 2004) insofar as professional members produce talk capable of establish a demonstration sequence of orientation need from information solicitation concerning if and how the patient takes care of their health. The theoretical contribution of this dissertation may be translated into the proposal of including the aspect topic sequential organization mode in the description of the principle of recipiency-designed (SACKS, 1992; SACKS; SCHEGLOFF; JEFFERSON, 1974). The way topical sequences are organized in the interaction displays relevance to the degree of particularization interlocutors’ talk may reach. In terms of applicability, as providing recipient-designed recommendations or prescriptions to situated interlocutors’ needs implicates knowing if and how patients control their health conditions, we suggest that professional members depart from the action of soliciting information regarding patients’ successful and failed experiences and their difficulties in heath-caring so that interactional material may be generated and patients’ orientation may be done in a particularized way.