RESUMO
In this paper we study the working conditions of Community Health Workers in performing house calls within low-income, violent communities in order to understand the challenges in delivering primary care in developing countries. We conducted field studies in two primary healthcare clinics and telephone surveys for 5 months in 2017 within systematic sample of 1690 community health workers based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. A number of 759 interviews were completed, approximately 50% of the sample, 86% men and 14% women. Most participants are 30-39 years old (35%), followed by 27% of 40-49 years old participants. Results show that exposure to territorial violence and environmental or health-related diseases significantly affects CHWs. Moreover, CHWs have to develop a significant set of skills to cope with aspects of the territory, and those skills are not present in their training. As community health workers work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.
Assuntos
Agentes Comunitários de Saúde , Atenção à Saúde/organização & administração , Áreas de Pobreza , Atenção Primária à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Brasil , Países em Desenvolvimento , Feminino , Visita Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Carga de TrabalhoRESUMO
Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.
Assuntos
Agentes Comunitários de Saúde/psicologia , Atenção Primária à Saúde/organização & administração , Serviços Urbanos de Saúde/organização & administração , Violência/estatística & dados numéricos , Adulto , Brasil , Países em Desenvolvimento , Feminino , Visita Domiciliar , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
Emergency response organizations need to be resilient to cope with escalating events resulting from dynamic, unexpected, or complex situations. In Brazil, the Firefighter Corps are military hierarchal organizations with a culture based on fixed structures, well defined norms and procedures. These push against innovations which are necessary to be resilient. This research describes how firefighter captains in the 30-35-year age range managed an emergency response escalation in light of standard operating procedures (SOPs) during a training exercise. The study used ethnographic methods to find and discuss gaps between the instructions and the activities carried out during the exercise, highlighting the differences between work as done (WAD) and work as imagined (WAI), as it was instantiated in the SOP prescriptions. The aim was to produce reflections on WAI and WAD as a way to raise awareness of the need for a cultural change toward resilience in firefighter organizations. This was achieved through firefighter engagement with a comprehensive visualization of the analysis results which afforded easy interaction between the experts, the data, and the researchers.
Assuntos
Bombeiros/psicologia , Trabalho/psicologia , Adulto , Antropologia Cultural , Brasil , Humanos , Imaginação , Masculino , Resiliência PsicológicaRESUMO
BACKGROUND: Air transportation of personnel to offshore oil platforms is one of the major hazards of this kind of endeavor. Pilot performance is a key factor in the safety of the transportation system. OBJECTIVE: This study seeks to identify the ergonomic factors present in pilots' activities that may in some way compromise or enhance their performance, the constraints and affordances which they are subject to; and where possible to link these to their associated risk factors. METHODS: Methodology adopted in this project studies work in its context. It is a merging of Activity Analysis (Guerin et al. 2001) of European tradition with Cognitive Task Analysis (CTA - www.ctaresource.com) articulated with the recent approaches to cognitive systems engineering developed by Professors David Woods and Erik Hollnagel. Fifty-five hours of field interviews provided the input for analysis. RESULTS: Sixteen ergonomic constraints were identified, some cognitive, some physical, all considered relevant by the research subjects and expert advisers. CONCLUSIONS: Although the safety record of the personnel transportation system studied is considered acceptable, there is low hanging fruit to be picked which can help improve the system's safety.
Assuntos
Aeronaves , Saúde Ocupacional , Indústria de Petróleo e Gás , Segurança , Ergonomia , Humanos , Oceanos e Mares , Pilotos/psicologia , Pesquisa Qualitativa , Resiliência PsicológicaRESUMO
The current work presents results from a cognitive task analysis (CTA) of a nuclear disaster simulation. Audio-visual records were collected from an emergency room team composed of individuals from 26 different agencies as they responded to multiple scenarios in a simulated nuclear disaster. This simulation was part of a national emergency response training activity for a nuclear power plant located in a developing country. The objectives of this paper are to describe sources of resilience and brittleness in these activities, identify cues of potential improvements for future emergency simulations, and leveraging the resilience of the emergency response system in case of a real disaster. Multiple CTA techniques were used to gain a better understanding of the cognitive dimensions of the activity and to identify team coordination and crisis management patterns that emerged from the simulation exercises.
Assuntos
Planejamento em Desastres , Processos Grupais , Liberação Nociva de Radioativos , Resiliência Psicológica , Brasil , Emergências/psicologia , HumanosRESUMO
In this article we present a model of some functions and activities of the Brazilian Air traffic Control System (ATS) in the period in which occurred a mid-air collision between flight GLO1907, a commercial aircraft Boeing 737-800, and flight N600XL, an executive jet EMBRAER E-145, to investigate key resilience characteristics of the ATM. Modeling in some detail activities during the collision and related them to overall behavior and antecedents that stress the organization uncover some drift into failure mechanisms that erode safety defenses provided by the Air Navigation Service Provider (ANSP), enabling a mid-air collision to be happen.
Assuntos
Acidentes Aeronáuticos , Aviação/organização & administração , Anedotas como Assunto , Brasil , Tomada de Decisões , Modelos TeóricosRESUMO
Work in organizations requires a minimum level of consensus on the understanding of the practices performed. To adopt technological devices to support the activities in environments where work is complex, characterized by the interdependence among a large number of variables, understanding about how work is done not only takes an even greater importance, but also becomes a more difficult task. Therefore, this study aims to present a method for modeling of work in complex systems, which allows improving the knowledge about the way activities are performed where these activities do not simply happen by performing procedures. Uniting techniques of Cognitive Task Analysis with the concept of Work Process, this work seeks to provide a method capable of providing a detailed and accurate vision of how people perform their tasks, in order to apply information systems for supporting work in organizations.