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This study investigated how a standard could become reality-based in a workplace where certain types of deviations are not permitted, such as a radiopharmaceutical production unit. Compliance with standards is necessary to ensure the safety of individuals who manufacture such substances as well as the security of patients receiving treatment. In this qualitative case study, an ergonomic analysis of work (also known as activity analysis) was performed, with noncompliance recorded in internal audits as a starting point: the lack of double-checking in radiopharmaceutical synthesis cassette assembly. Field observations and self-confrontation interviews with workers from a production unit were conducted to analyze the activities. Although a double-check did not occur, the radiopharmaceutical synthesis operator apparently developed another risk control strategy, focusing his attention to the equipment assembly details, which necessitated continuous control and verification actions to ensure that there were no problems at this stage of production. A multilevel approach was used to demonstrate how the safety and quality of production processes based on standard compliance only become effective and adherent to the activity after resolving various conflicts at work, including control systems (external and internal audits), work collectives, the contradiction of the activity itself, and the discussion of singular situations arising daily. This study contributes to the discussion on workplace safety considering standardization and advances the discussion on changing perspectives regarding rule compliance.

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In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like 'Family Health Strategy,' 'Expanded Family Health Center,' and 'Psychosocial Care Centers' but a lack of 'Beds in General Hospitals' destinated to mental health care, 'Unified Electronic Medical Records' and 'Mental Health Training Activities for Professionals.' In the process dimension, adequate implementation of actions such as 'Multidisciplinary and Joint Care,' 'Assistance to Common Mental Disorders by Primary Health Care,' 'Management of Psychiatric Crises in Psychosocial Care Centers,' 'Offer of Health Promotion Actions,' and 'Discussion of Cases by Mental Health Teams' point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of 'Psychosocial Rehabilitation Actions,' 'Productive Inclusion,' 'User Protagonism,' 'Network Integration,' and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.

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BACKGROUND: Health promotion is an important strategy for companies as it helps identify risks at work and the health needs of workers. Nursing, as a profession committed to promoting decent work, plays an important role in this strategy. OBJECTIVE: This manuscript aims to discuss the experience of the Nursing Service in the construction of knowledge about work, to support actions in favor of health promotion. METHODS: This is a discussion article in the field of occupational health conducted at a Research Center in the nuclear area. RESULTS: Based on actions centered on guidelines on lifestyles and scheduling visits to the workplace, with the Internal Public Health Commission, limitations were identified that allowed us to discuss and understand the role of nurses as occupational health professionals. CONCLUSION: Knowing the work and understanding it in its specificities and limitations of the production process has allowed to expand the possibilities of action with workers to transform working conditions and promote health.

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Resumo Trata-se de um estudo metodológico para desenvolvimento e validação do Instrumento Multidimensional para Avaliação da Implantação da RAPS (IMAI-RAPS) em Minas Gerais (MG)/Brasil. O estudo foi executado em três etapas: estudo de avaliabilidade, desenvolvimento do IMAI-RAPS, aplicação da Técnica Delphi para validação de conteúdo e aparência das questões. Foram realizados a análise de documentos oficiais, revisão da literatura e um engajamento estruturado com membros do programa para esclarecer sua operacionalização e focalizar os aspectos centrais a serem avaliados. Um modelo teórico-lógico da RAPS foi construído de acordo com a tríade donabediana: estrutura, processo e resultado e organizado em: Unidades Mínimas (Assistência à Saúde Mental e Reabilitação Psicossocial), Conectividade (Articulação da Rede), Integração (Governança e Gestão do Cuidado), Normatividade (Política de Saúde Mental e Participação e Controle Social), Subjetividade e Estrutura (Serviços, Sistema Logístico e Educação em Saúde). Desse modelo derivou-se o IMAI-RAPS que foi validado por 44 experts da área indicando a abordagem de questões relevantes, úteis e viáveis para avaliação da estrutura e processo de implantação do programa em MG. A utilização da Técnica Delphi possibilitou que os produtos desenvolvidos fossem balizados por estudiosos ou profissionais da RAPS de diversas regiões do país aumentando o poder analítico da ferramenta.

Abstract This is a methodological study for the development and validation of the Multidimensional Instrument for Evaluating of the Implementation of Psychosocial Care Network (IMAI-RAPS) in Minas Gerais (MG)/Brazil. The study was carried out in three stages: evaluability study, development of the IMAIRAPS, application of the Delphi Technique for content and appearance validation of the questions. The analysis of official documents, literature review and a structured engagement with program members were carried out to clarify its operationalization and focus on the central aspects to be evaluated. A theoreticallogical model of RAPS was built according to the Donabedian triad: structure, process and result and organized into: Minimum Units (Mental Health Care and Psychosocial Rehabilitation), Connectivity (Network Articulation), Integration (Governance and Management of the Care), Normativity (Mental Health Policy and Participation and Social Control), Subjectivity and Structure (Services, Logistics System and Health Education). The IMAI-RAPS was derived from this model, which was validated by 44 experts in the field, indicating the approach of relevant, useful and viable questions for evaluating the structure and process of implementing the program in MG. The use of the Delphi Technique made it possible for the developed products to be marked out by Psychosocial Care Network scholars or professionals from different regions of the country, increasing the analytical power of the tool.

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The present study aims at analyzing the regionalization of the services carried out by the Psychosocial Care Network (RAPS in Portuguese) in the state of Minas Gerais (MG) in Brazil, yielding indicators that may enhance the SUS strategic management towards the strengthening of the psychosocial care provided by the state. It is a cross-sectional study, based on the data collected in May 2019 from government websites, considering the state's Macro-Regions and Health Regions as units of analysis. Indicators of service coverage in relation to the population in accordance to normative parameters determined by the Ministry of Health for a better understanding of the effective coverage were produced, and a general indicator (iRAPS) of the supply of services in this network in Minas Gerais state was validated. The outcomes allow a detailed analysis of the structural aspect of the RAPS in MG and unveil the development of a robust network. However, important regional heterogeneities were noticed and also a lack of services aiming at specific populations providing assistance 24 hours a day, which weakens the proper access to RAPS in several parts of the state. Higher values of iRAPS were found in health regions with low socioeconomic development and low general offer of health services, a fact that differs from the national scenario, which may imply state policy investments aiming at offering RAPS within the state hinterland areas.

Objetivou-se analisar a regionalização dos serviços da Rede de Atenção Psicossocial (RAPS) em Minas Gerais (MG), Brasil, gerando indicadores que possam potencializar a gestão estratégica do SUS no fortalecimento da atenção psicossocial do estado. É um estudo transversal, realizado a partir de dados coletados em maio de 2019 em sites governamentais, tendo as Macrorregiões e Regiões de Saúde do estado como unidades de análise. Foram produzidos indicadores da cobertura de serviços em relação à população, de acordo com parâmetros normativos estipulados pelo Ministério da Saúde, para melhor compreensão da cobertura efetivada e validou-se um indicador geral (iRAPS) da oferta dos serviços dessa rede em MG. Os resultados encontrados possibilitam uma análise detalhada do aspecto estrutural da RAPS em MG e demonstram a implantação de uma rede robusta. Entretanto, percebem-se importantes heterogeneidades regionais e também uma carência de serviços voltados para populações específicas e com funcionamento 24 horas, o que fragiliza o adequado acesso à RAPS em diversos territórios do estado. Foram encontrados maiores valores do iRAPS nas regiões de saúde com baixo desenvolvimento socioeconômico e baixa oferta geral de serviços de saúde, fato que difere do cenário nacional.

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Resumo Objetivou-se analisar a regionalização dos serviços da Rede de Atenção Psicossocial (RAPS) em Minas Gerais (MG), Brasil, gerando indicadores que possam potencializar a gestão estratégica do SUS no fortalecimento da atenção psicossocial do estado. É um estudo transversal, realizado a partir de dados coletados em maio de 2019 em sites governamentais, tendo as Macrorregiões e Regiões de Saúde do estado como unidades de análise. Foram produzidos indicadores da cobertura de serviços em relação à população, de acordo com parâmetros normativos estipulados pelo Ministério da Saúde, para melhor compreensão da cobertura efetivada e validou-se um indicador geral (iRAPS) da oferta dos serviços dessa rede em MG. Os resultados encontrados possibilitam uma análise detalhada do aspecto estrutural da RAPS em MG e demonstram a implantação de uma rede robusta. Entretanto, percebem-se importantes heterogeneidades regionais e também uma carência de serviços voltados para populações específicas e com funcionamento 24 horas, o que fragiliza o adequado acesso à RAPS em diversos territórios do estado. Foram encontrados maiores valores do iRAPS nas regiões de saúde com baixo desenvolvimento socioeconômico e baixa oferta geral de serviços de saúde, fato que difere do cenário nacional.

Abstract The present study aims at analyzing the regionalization of the services carried out by the Psychosocial Care Network (RAPS in Portuguese) in the state of Minas Gerais (MG) in Brazil, yielding indicators that may enhance the SUS strategic management towards the strengthening of the psychosocial care provided by the state. It is a cross-sectional study, based on the data collected in May 2019 from government websites, considering the state's Macro-Regions and Health Regions as units of analysis. Indicators of service coverage in relation to the population in accordance to normative parameters determined by the Ministry of Health for a better understanding of the effective coverage were produced, and a general indicator (iRAPS) of the supply of services in this network in Minas Gerais state was validated. The outcomes allow a detailed analysis of the structural aspect of the RAPS in MG and unveil the development of a robust network. However, important regional heterogeneities were noticed and also a lack of services aiming at specific populations providing assistance 24 hours a day, which weakens the proper access to RAPS in several parts of the state. Higher values of iRAPS were found in health regions with low socioeconomic development and low general offer of health services, a fact that differs from the national scenario, which may imply state policy investments aiming at offering RAPS within the state hinterland areas.

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O modelo da Atenção Psicossocial trouxe novas formas de organização do trabalho em saúde mental. O objetivo desse estudo foi compreender a dinâmica de trabalho em equipe multiprofissional desenvolvido nos serviços de Betim/MG. O referencial metodológico sebaseou na pesquisa qualitativa. Foram realizadas entrevistas narrativas e grupo focal. Sob a orientação da hermenêutica-dialética, foram construídas três categorias de análise: construção do processo de trabalho -aspectos históricos e atuais; trabalho emequipe e repercussões nas profissões; desafios do trabalho. O trabalho na Saúde Mental tem sido desenvolvido por equipes multidisciplinares, numa proposta de organização interprofissional. Os trabalhadores puderam reconstruir lugares identificatórios distintos de suas categorias específicas. Embora reconheçam que o trabalho em equipe e os dispositivos de reflexão coletiva são essenciais para sustentação do modelo, há desafios que comprometem o cuidado e provocam sofrimento no trabalhador, indicando a necessidade de investimento em Educação Permanente em Saúde.

The Psychosocial Care model brought new forms of work organization in mental health. The aim of this study was to understand the dynamics of multiprofessional teamwork developed at Betim / MG services. The methodological framework was based on qualitative research. Narrative interviews and focus group were conducted. Under the guidance of dialectical hermeneutics, three categories of analysis were constructed: construction of the work process -historical and current aspects; teamwork and repercussions on the professions; job challenges. The work in mental health has been developed by multidisciplinary teams, in a proposal of interprofessional organization. Workers were able to reconstruct identifiable places distinct from their specific categories. Although they recognize that teamwork and collective reflection devices are essential to support the model, there are challenges that compromise care and cause suffering in workers, indicating the need for investment in Permanent Health Education. (AU)

El modelo de Atención Psicosocial trajo nuevas formas de organización del trabajo en salud mental. El objetivo de este estudio fue comprender la dinámica del trabajo en equipo multiprofesional desarrollado en los servicios de Betim / MG. El marco metodológico se basó en la investigación cualitativa. Se realizaron entrevistas narrativas y grupos focales. Bajo la guía de la hermenéutica dialéctica, se construyeron tres categorías de análisis: construcción del proceso de trabajo: aspectos históricos y actuales; trabajo en equipo y repercusiones en las profesiones; retos laborales. El trabajo en salud mental ha sido desarrollado por equipos multidisciplinarios, en una propuesta de organización interprofesional. Los trabajadores pudieron reconstruir lugares identificables distintos de sus categorías específicas. Aunque reconocen que el trabajo en equipo y los dispositivos de reflexión colectiva son esenciales para respaldar el modelo, existen desafíos que comprometen la atención y causan sufrimiento a los trabajadores, lo que indica la necesidad de invertir en Educación Permanente en Salud. (AU)

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Resumo Realizou-se pesquisa qualitativa com o objetivo de compreender as repercussões psicossociais da pandemia do SARS-CoV-2 na população atingida pelo rompimento da Barragem de Fundão, em 2015, pertencente à mineradora Samarco e suas mantenedoras - VALE e BHP Billiton - em Mariana (MG). Foram utilizadas as técnicas de observação participante e grupos focais. As narrativas de profissionais de saúde e pessoas atingidas foram analisadas através da Análise de Conteúdo, a partir dos fatores socioculturais, simbólicos e políticos encontrados nesse contexto de sobreposição de desastre da mineração e pandemia. Os resultados mostram que a vivência dos atingidos durante a pandemia apresenta singularidades, tais como a intensificação da ruptura de laços sociais e comunitários, que já era identificada desde o rompimento. O luto durante a pandemia também é potencializado pelo luto coletivo já vivenciado desde a tragédia. Há uma intensificação do sofrimento diante da falta de informação e da prorrogação da entrega do reassentamento. É possível identificar a pandemia como mais um ponto de sofrimento para essa população vulnerabilizada.

Abstract Qualitative research was developed with the aim of understanding the psychosocial repercussions of the SARS-CoV-2 pandemic on the population affected by the collapse of the Fundão Dam in Mariana (MG), in 2015, belonging to the Samarco mining company and its maintainers VALE and BHP Billiton. Participant observation techniques and focus groups were used. The narratives of health professionals and affected people were analyzed through Content Analysis, from the sociocultural, symbolic and political factors found in this context of overlapping mining disaster and pandemic. The results show that the experience of those affected during the pandemic presents singularities such as the intensification of the rupture of social and community ties that had already been identified since the disaster. Grief during the pandemic is also enhanced by the collective grief already experienced since the tragedy. There is an intensification of suffering due to the lack of information and the postponement of the resettlement delivery. It is possible to identify the pandemic as another point of suffering for this vulnerable population.

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Resumo Introdução Durante as três décadas do Sistema Único de Saúde (SUS), a tríade universalidade/integralidade/igualdade esteve complementada pela garantia de acesso, que, apesar de importantes avanços, também registrou a manutenção de desafios e, até, retrocessos. Objetivo Compreender os aspectos imbricados com o acesso à rede de atenção à saúde. Método Entrevistas e grupos focais foram realizados com 32 profissionais de saúde, incluindo gestores, de um município da Região Metropolitana de Belo Horizonte caracterizado por marcada vulnerabilidade social e econômica. As dimensões teóricas "estrutural", "operacional" e "relacional" guiaram a análise e interpretação da narrativa dos profissionais. Resultados Os resultados demonstraram que a dimensão estrutural assumiu centralidade na narrativa dos profissionais de saúde como determinantes para o acesso, relacionada não apenas ao financiamento, mas também a questões afetas à operacionalização e organização dos serviços de saúde, como rotatividade dos profissionais e planejamento territorial. Conclusão Muitas dessas questões não são passíveis de intervenções, pelo menos de forma direta e em curto prazo pelos profissionais de saúde, incluindo gestores. No entanto, reconhecer e refletir sobre sua influência no acesso aos serviços da rede de saúde municipal pode ser um produtivo caminho no sentido de articulação, proposição e implementação de estratégias.

Abstract Background During the three decades of the Unified Health System (SUS), the triad of universality/integrality/equality was complemented by the guarantee of access, which despite important advances, also registered the maintenance of challenges and even setbacks. Objective To understand the factors that influenced access to public health services. Method Interviews and focus groups were realized with 32 health professionals including managers from a municipality in the metropolitan region of Belo Horizonte characterized by the marked social and economic vulnerability. The theoretical structural, operational, and relational dimensions guided the analysis and interpretation of the professionals' narrative. Results The results showed that the structural dimension assumed a central role in the narrative of health professionals as determinants of access related not only to financing but also to questions related to the operability and organization of health services such as professional rotation and territorial planning. Conclusion Many of these issues are not amenable to interventions at least directly and in short terms by health professionals including managers, however, recognizing and reflecting on their influence on access to municipal health network services can be a productive path towards articulation, proposition, and implementation's strategies.

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Resumo A criação dos serviços substitutivos ao manicômio trouxe inúmeros desafios, entre eles, a formação de seus trabalhadores. Frente a esse desafio foi necessário a formação em ato, nos próprios serviços. O presente estudo busca compreender esse fenômeno, a partir da trajetória dos trabalhadores de Saúde Mental do município de Betim, Minas Gerais. O referencial metodológico se baseou na pesquisa qualitativa orientada pela hermenêutica-dialética. Os instrumentos de coleta de dados foram entrevistas narrativas e grupo focal. Compreendemos que os trabalhadores aprenderam a trabalhar na atenção psicossocial dentro dos próprios serviços, a partir da equipe multiprofissional e dos seguintes dispositivos: reuniões, fóruns, oficinas. Foram atores ativos, promovendo seminários e encontros diversos; bem como tiveram, em certos momentos, supervisões clínico-institucionais. A integração ensino-serviço também favoreceu a Educação Permanente dos trabalhadores. No entanto, nos últimos anos, tem havido dificuldades para sustentar tal formação.

Abstract The creation of services to replace asylums has brought numerous challenges, including the training of its workers. Faced with this challenge, it was necessary training in the services themselves. The present study seeks to understand this phenomenon, from the trajectory of Mental Health workers in the city of Betim, Minas Gerais. The methodological framework was based on qualitative research guided by dialectical hermeneutics. The data collection instruments were narrative interviews and focus group. We understand that workers learned to work in psychosocial care within their own services, from the multiprofessional team and the following devices: meetings, forums, workshops. They were active actors, promoting seminars and various meetings; as well as having, at times, clinical and institutional supervision. The teaching-service integration also favored the permanent education of the workers. However, in recent years there have been difficulties in sustaining such training.

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