Supervisão exercida pelo enfermeiro na estratégia saúde da família: uma análise sob a perspectiva das relações de poder

Abstract

The base of this investigation is the supervision carried out by nurses from the perspective of power relations in the work context of the Family Health (FH) team, which consists of a favorable place for changes in health practices in Primary Health Care (PHC), due to the performance of the FH teams, which provide care, respecting the way of life of people and their families, depending on the location and communities. The supervision carried out by the nurse in the context of the work process of the FH team collaborates in the transformation of the required health practices, when we consider that the work of the nurse as a social practice has been assuming a relevant role due to the ability to recognize the complex and varied health needs of the users and families, making it possible to act in a contextualized way, in addition to stimulating interactive and reflective intra-team processes for comprehensive health care. Therefore, this study aimed to analyze the supervision of nurses from the perspective of power relations in family health, with a focus on nursing and community health agents, in a city of the countryside of São Paulo. This is an exploratory, descriptive and interpretative research with a qualitative approach. Data were collected through semi-structured interviews with 46 FH workers and were analyzed under the framework of the work process in health and nursing; the concept of supervision; of the interprofessional work approach and its attributes in the FH and of the power category, in the Foucauldian perspective, based on the thematic content analysis. The analysis of the results allowed the construction of five thematic categories: ‘the supervision of the nurse in the perspective of control in the relations of disciplinary power in Family Health’; ‘the duality of supervision exercised by nurses in Family Health between Oppressive Power and Positive Power’; ‘the challenges for the supervision of nurses in the FH and possibilities for reframing the supervision conducted by nurses in the FH’; ‘challenges for the supervision of nurses in the SF and possibilities for reframing the supervision carried out by nurses in the SF’. The results showed that the supervision carried out by nurses in the FH has a predominance of strict control addressed in the dimension of Foucauldian disciplinary power studied. However, the power identified in supervision presented other outcomes, considering that it (power) is a producer of things, which not only controls and oppresses, but also has positive effects in the construction of healthy work environments, with appreciation of interactions, establishment of trust, strengthening of teamwork and support for workers, aspects that result in the promotion of psychological safety in the FH. There were multiple challenges for supervision in the FH, such as: the intensification of the pace of work in the FH, insufficient support from central management to conduct supervision and fear of being accused of moral harassment in the exercise of supervision. Supervision in the educational approach in health was evidenced in the nurses' work process, although it presented weaknesses to be overcome, considering the role that it has in the transformation of health practices. Even with these obstacles, possibilities for redefining supervision were identified, with advances towards strengthening interprofessional work in the FH. Keywords: Nursing Supervision. Family Health. Health Team. Interprofessional Relations. Job. Power (psychology).