A construção da competência ética na atenção primária: o caso da enfermagem

Abstract

Introduction: The Brazilian Sanitarian Reform promoted the reorganization of the health assistance, setting the organization in motion to tend away from the centralization of the services, and putting the primary health care as the admission and the model for the reorientation of the Brazilian Health System. This movement influenced deeply the health work processes, raising new demands and ethic challenges. The nurses experiment new patterns in their work, needing to develop competences to deal with a more complex context, because they need to approach health also from social and subjective determinants. In this sense, ethical competence can help the professional to consider and develop skills to deal with the challenges of the health attendance and to contribute with the improvement of the quality of care. Objective: To recognize the process of constructing the ethical competence of primary care nurses and which are the possible sources contributing to this process according to their perceptions and experiences. Methodology: This is a qualitative research based on interpretative phenomenology. The data collection started with a questionnaire about nursing competences, followed by a qualitative interview about the perceptions and experiences as to ethical challenges and the competences needed to answer to them. The analysis of the questionnaire proceeded by a simple statistical estimate and the interpretation of the qualitative data followed steps of hermeneutics. The methodological instruments were applied to 10 nurses of a communitarian health service in Porto Alegre, RS, Brazil. Results: The process of construction of the ethical competence appear linked to three axles: values, education and experience. Discussion: The two first axles are condition for the third one, which is most important, since it permits the collective construction of ethical competence, able to add the individual characteristics of every professional in a common good which is necessary to the logics of the primary care organization through team work and sharing management. The multi professional meetings can promote the construction of the ethical competence, mainly if they are organized as time for permanent education, that incorporate the learning and reflecting critically on the professional practice to develop competences and to improve the performance of the activities. Conclusion: For the integral, responsible and sharing practice of health, it is necessary that professionals act as a team in the search of the same objectives, constructing collectively the ethical competence for a better care of users. In this sense, it is important to reserve time of the team meeting for the construction of this competence, although empirical studies are needed to measure its effectiveness.