Nursing research and the qualification of health care: some considerations

Detalhes bibliográficos
Autor(a) principal: Fortuna, Cinira Magali
Data de Publicação: 2012
Outros Autores: Mishima, Silvana Martins
Tipo de documento: Artigo
Idioma: por
eng
spa
Título da fonte: Revista Eletrônica de Enfermagem
Texto Completo: https://revistas.ufg.br/fen/article/view/13408
Resumo: There has been a significant increase in the number of research groups in Brazil(1), with a subsequent increase in nursing research and the number of publications of scientific journals, as well as the qualification of nursing researchers and journals. This increase in research and publications has translated into higher bibliometric indexes(2-3), it being worthwhile to highlight that this movement follows the increase in the number of Brazilian nursing graduate courses. Nevertheless, a question should be asked: what has been the impact of increased production on the quality of health care services? We purposefully did not state nursing care specifically, as we consider that health research is committed to the protection and improvement of quality of life, and does not focus exclusively on the professional fields in which it is developed, but overcomes the borders of knowledge. Furthermore, we consider the premise that nursing is a social practice inevitably connected to other disciplines and fields of knowledge. In other words, quality nursing does not exist apart from quality health care and from being ethically committed to the lives of people. We believe it is important to reflect regarding the intrinsic “space” between a given research work and its impact on care, namely the Brazilian National Unified Health System (SUS), because we defend that quality health care is an undeniable right of every citizen, and is not an item of merchandise to be accessed according to one’s social and economic position in the production process. Scientific research is an institution, just as health, language, and even nursing are institutions, among others, with a more apparent or explicit part, accepted in its manifestation in addition to other unspoken, implicit compositions, which are components just the same(4). From this perspective, society is a tapestry of institutions that fabricate our way of being, loving, and being in life, while it is also fabricated by us, the subjects in the course of its history. It is from this conceptual grounding that we invite our fellow health workers, researchers and faculty to join us and reflect on what we have produced, who we have produced it for, and why have we produced it. Our implied analysis(5), a questioning look at the way institutions occur within ourselves, how they construct us and how we place ourselves within them, encourages us to immediately analyze the effects of the invitation to write the present editorial. It certainly filled us with joy, permeated with the idea of our work being acknowledged, but also produced an effect stemming from the affective bonds that cannot be separated from the research process, but that we insist on denying and separating from science: the manifestation of the scientific institution within us. Research is linked to the production of knowledge, which, on the other hand, is connected to graduate programs within the university and to members of the faculty/research group, who are also education professionals whogather other researchers/workers. In the present globalized capitalist society, we are guided by one premise: there is an inseparable bond between teaching and research. That premise brings about consequences to both the practice of teaching and the development of research(6). What evaluation measures should currently be considered to assess the work of the faculty? In general, the measures used are any production capable of being seen in terms of figures, such as the number of articles published, the number of graduates one has advised, class hours taught, and so forth. Many are the consequences, which often include the overload of a faculty that lacks time to reflect. Nóvoa(6) points out that, in university education, the emergence of the need to prepare analytical professionals coincidently occurs with a draining of the faculty’s time to reflect(6). Is research possible without reflection? Is it possible to keep track of graduate and undergraduate students’ learning in their strenuous education process and still engage in research, given this lack of time? To what extent have research efforts been focused on addressing the process of learning and teaching, of learning to discover new possibilities to change the current reality? These questions emerge and challenge us to cast a second look upon the production of the teaching-research dyad. Another aspect regarding institutions is that there is a relationship which exists between macro-political and micro-political aspects. Effects occur by the evaluation systems of journals, graduate programs and peer reviews, which also affects their dissemination and publication. What effects have been produced on nursing and health research by the indicators used to evaluate scientific production, translated as impact factors that permit comparison across journals of various disciplines, measures indicating the number of citations of each researcher, and RFP (requests for proposals) that offer funds for specific themes and research designs? Thus, it appears that the intrinsic relationship between nursing/health research and the quality of the health care service is becoming diluted, and the final question is asked: for what purpose do we produce “science”? Precisely what science are we developing in health and nursing? Perhaps we are living a production process that “hides” the objectives of keeping our job of ranking people, universities and services following the logic of consumption and individualism, a process that naturalizes the idea that a researcher is a lone individual researcher capable of developing him or herself through his or her own efforts, when the reality is that no scientific production begins in itself, but through previous and concurrent works/investigations/efforts that weave the tapestry of our studies. Researchers(7) state that “scientific production within the academic sphere continues separately from services, having little effect on the creation of public health policies”. Therefore, how can we repurpose our ethical-esthetical commitment of producing research with quality health care being the ultimate expression? Knowing that there are no ready-made answers and aware of the strength of what has already been instituted, our challenge is to procure other processes, create new devices and break the hard surface of institutions, beginning with scratches that may be imperceptible but are capable of making way for other movements. One possible movement may be the search for partnerships between workers and clients in conducting research that would answer the everyday challenges of healthcare services, evidence-based interventions and scientific knowledge produced in a delicate and intricate knowledge network of different fields of knowledge(8). We propose a collective invention effort: build projects and research that produce knowledge and change practices while creating life in places where it has been, with all its preciousness, repeatedly eroded.     REFERENCES 1. Erdmann AL, Lanzoni GMM. Características dos grupos de pesquisa da enfermagem brasileira certificados pelo CNPq de 2005 a 2007. Esc. Anna Nery [Internet]. 2008 [cited 2012 dec 31];12(2):316-22. Available from: http://dx.doi.org/10.1590/S1414-81452008000200018. 2. Marziale MHP, Mendes IAC. O fator de impacto das publicações científicas. Rev Lat Am Enfermagem [Internet]. 2002 [cited 2012 dec 31];10(4):466-7. Available from: http://dx.doi.org/10.1590/S0104-11692002000400001. 3. Erdmann AL, Fernandes JD. A classificação dos periódicos científicos da área da Enfermagem. Acta paul. enferm. [Internet]. 2009 [cited 2012 dec 31];22(5):v-i. Available from: http://dx.doi.org/10.1590/S0103-21002009000500001. 4. Baremblitt G. Compêndio de Análise Institucional e outras correntes. Teoria e Prática. 5th ed. Belo Horizonte: Instituto Felix Guatarri; 2002. 5. Monceau G. Implicação, sobreimplicação e implicação profissional. Fractal, Rev. Psicol. [Internet]. 2008 [cited 2012 dec 31];20(1):19-26. Available from: http://dx.doi.org/10.1590/S1984-02922008000100007. 6. Universidade de Vigo Televisión [Internet]. Vigo: Universidade de Vigo (BR) [cited 2012 dec 31]. Mediateca. II Congreso Internacional de Docencia Universitaria (II CIDU 2011). Conferencia de António Nóvoa. Available from: http://tv.uvigo.es/video/44043. 7. Cabral IE, Tyrrel MAR. Pesquisa em enfermagem nas Américas. Rev Bras Enferm [Internet]. 2010 [cited 2012 dec 31];63(1):104-10. Available from: http://dx.doi.org/10.1590/S0034-71672010000100017. 8. Fortuna CM, Mishima SM, Matumoto S, Pereira MJB, Ogata MN. A pesquisa e a articulação ensino-serviço na consolidação do Sistema Único de Saúde. Rev Esc Enferm USP [Internet]. 2011 [cited 2012 dec 31];45(spe2):1696-700. Available from: http://dx.doi.org/10.1590/S0080-62342011000800010.
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spelling Nursing research and the qualification of health care: some considerationsLa investigación en enfermería y la calificación de la atención: algunas reflexionesA pesquisa de enfermagem e a qualificação da assistência: algumas reflexõesThere has been a significant increase in the number of research groups in Brazil(1), with a subsequent increase in nursing research and the number of publications of scientific journals, as well as the qualification of nursing researchers and journals. This increase in research and publications has translated into higher bibliometric indexes(2-3), it being worthwhile to highlight that this movement follows the increase in the number of Brazilian nursing graduate courses. Nevertheless, a question should be asked: what has been the impact of increased production on the quality of health care services? We purposefully did not state nursing care specifically, as we consider that health research is committed to the protection and improvement of quality of life, and does not focus exclusively on the professional fields in which it is developed, but overcomes the borders of knowledge. Furthermore, we consider the premise that nursing is a social practice inevitably connected to other disciplines and fields of knowledge. In other words, quality nursing does not exist apart from quality health care and from being ethically committed to the lives of people. We believe it is important to reflect regarding the intrinsic “space” between a given research work and its impact on care, namely the Brazilian National Unified Health System (SUS), because we defend that quality health care is an undeniable right of every citizen, and is not an item of merchandise to be accessed according to one’s social and economic position in the production process. Scientific research is an institution, just as health, language, and even nursing are institutions, among others, with a more apparent or explicit part, accepted in its manifestation in addition to other unspoken, implicit compositions, which are components just the same(4). From this perspective, society is a tapestry of institutions that fabricate our way of being, loving, and being in life, while it is also fabricated by us, the subjects in the course of its history. It is from this conceptual grounding that we invite our fellow health workers, researchers and faculty to join us and reflect on what we have produced, who we have produced it for, and why have we produced it. Our implied analysis(5), a questioning look at the way institutions occur within ourselves, how they construct us and how we place ourselves within them, encourages us to immediately analyze the effects of the invitation to write the present editorial. It certainly filled us with joy, permeated with the idea of our work being acknowledged, but also produced an effect stemming from the affective bonds that cannot be separated from the research process, but that we insist on denying and separating from science: the manifestation of the scientific institution within us. Research is linked to the production of knowledge, which, on the other hand, is connected to graduate programs within the university and to members of the faculty/research group, who are also education professionals whogather other researchers/workers. In the present globalized capitalist society, we are guided by one premise: there is an inseparable bond between teaching and research. That premise brings about consequences to both the practice of teaching and the development of research(6). What evaluation measures should currently be considered to assess the work of the faculty? In general, the measures used are any production capable of being seen in terms of figures, such as the number of articles published, the number of graduates one has advised, class hours taught, and so forth. Many are the consequences, which often include the overload of a faculty that lacks time to reflect. Nóvoa(6) points out that, in university education, the emergence of the need to prepare analytical professionals coincidently occurs with a draining of the faculty’s time to reflect(6). Is research possible without reflection? Is it possible to keep track of graduate and undergraduate students’ learning in their strenuous education process and still engage in research, given this lack of time? To what extent have research efforts been focused on addressing the process of learning and teaching, of learning to discover new possibilities to change the current reality? These questions emerge and challenge us to cast a second look upon the production of the teaching-research dyad. Another aspect regarding institutions is that there is a relationship which exists between macro-political and micro-political aspects. Effects occur by the evaluation systems of journals, graduate programs and peer reviews, which also affects their dissemination and publication. What effects have been produced on nursing and health research by the indicators used to evaluate scientific production, translated as impact factors that permit comparison across journals of various disciplines, measures indicating the number of citations of each researcher, and RFP (requests for proposals) that offer funds for specific themes and research designs? Thus, it appears that the intrinsic relationship between nursing/health research and the quality of the health care service is becoming diluted, and the final question is asked: for what purpose do we produce “science”? Precisely what science are we developing in health and nursing? Perhaps we are living a production process that “hides” the objectives of keeping our job of ranking people, universities and services following the logic of consumption and individualism, a process that naturalizes the idea that a researcher is a lone individual researcher capable of developing him or herself through his or her own efforts, when the reality is that no scientific production begins in itself, but through previous and concurrent works/investigations/efforts that weave the tapestry of our studies. Researchers(7) state that “scientific production within the academic sphere continues separately from services, having little effect on the creation of public health policies”. Therefore, how can we repurpose our ethical-esthetical commitment of producing research with quality health care being the ultimate expression? Knowing that there are no ready-made answers and aware of the strength of what has already been instituted, our challenge is to procure other processes, create new devices and break the hard surface of institutions, beginning with scratches that may be imperceptible but are capable of making way for other movements. One possible movement may be the search for partnerships between workers and clients in conducting research that would answer the everyday challenges of healthcare services, evidence-based interventions and scientific knowledge produced in a delicate and intricate knowledge network of different fields of knowledge(8). We propose a collective invention effort: build projects and research that produce knowledge and change practices while creating life in places where it has been, with all its preciousness, repeatedly eroded.     REFERENCES 1. Erdmann AL, Lanzoni GMM. Características dos grupos de pesquisa da enfermagem brasileira certificados pelo CNPq de 2005 a 2007. Esc. Anna Nery [Internet]. 2008 [cited 2012 dec 31];12(2):316-22. Available from: http://dx.doi.org/10.1590/S1414-81452008000200018. 2. Marziale MHP, Mendes IAC. O fator de impacto das publicações científicas. Rev Lat Am Enfermagem [Internet]. 2002 [cited 2012 dec 31];10(4):466-7. Available from: http://dx.doi.org/10.1590/S0104-11692002000400001. 3. Erdmann AL, Fernandes JD. A classificação dos periódicos científicos da área da Enfermagem. Acta paul. enferm. [Internet]. 2009 [cited 2012 dec 31];22(5):v-i. Available from: http://dx.doi.org/10.1590/S0103-21002009000500001. 4. Baremblitt G. Compêndio de Análise Institucional e outras correntes. Teoria e Prática. 5th ed. Belo Horizonte: Instituto Felix Guatarri; 2002. 5. Monceau G. Implicação, sobreimplicação e implicação profissional. Fractal, Rev. Psicol. [Internet]. 2008 [cited 2012 dec 31];20(1):19-26. Available from: http://dx.doi.org/10.1590/S1984-02922008000100007. 6. Universidade de Vigo Televisión [Internet]. Vigo: Universidade de Vigo (BR) [cited 2012 dec 31]. Mediateca. II Congreso Internacional de Docencia Universitaria (II CIDU 2011). Conferencia de António Nóvoa. Available from: http://tv.uvigo.es/video/44043. 7. Cabral IE, Tyrrel MAR. Pesquisa em enfermagem nas Américas. Rev Bras Enferm [Internet]. 2010 [cited 2012 dec 31];63(1):104-10. Available from: http://dx.doi.org/10.1590/S0034-71672010000100017. 8. Fortuna CM, Mishima SM, Matumoto S, Pereira MJB, Ogata MN. A pesquisa e a articulação ensino-serviço na consolidação do Sistema Único de Saúde. Rev Esc Enferm USP [Internet]. 2011 [cited 2012 dec 31];45(spe2):1696-700. Available from: http://dx.doi.org/10.1590/S0080-62342011000800010.Hemos experimentado en Brasil un crecimiento significativo de los grupos de investigación(1), habiéndose incrementado las investigaciones de enfermería y, en consecuencia, aumentando la divulgación en periódicos científicos, así como la calificación de los investigadores y de las publicaciones del área. Esta mejora se ha traducido en la elevación de los índices bibliométricos(2-3), siendo válido destacar que este movimiento acompaña el incremento de la posgraduación en enfermería en el país. No obstante, debe imponerse un cuestionamiento: ¿Cuál ha sido el impacto de esta producción en la calidad de la atención prestada a los usuarios de los servicios de salud? Intencionalmente, no ponemos el foco sólo en la atención de enfermería, por considerar que la investigación en el campo de la salud, comprometida con la defensa y la calificación de la vida, no se dirige sólo a las disciplinas profesionales que las desarrollan, sino que sobrepasan fronteras de conocimiento. En adición, tenemos como premisa a la enfermería, en cuanto se trata de una práctica social necesariamente articulada a otros trabajos y campos de conocimiento. Dicho de otra forma, no hay enfermería de calidad apartada del trabajo en salud de calidad y éticamente comprometida con la vida de las personas. Nos parece importante reflexionar sobre el “espacio”, intersticio entre una investigación y su impacto en la atención brindada, especialmente, en el Sistema Único de Salud, pues defendemos la atención de calidad en la salud como derecho inalienable de todo ciudadano, y no como una mercadería a la cual se tiene acceso de acuerdo a la posición social y económica de cada sujeto, en el proceso de producción. La investigación científica, así como la salud, el lenguaje y, por qué no, la enfermería, entre tantas otras, son instituciones que poseen una parte más aparente, explícita, expresa, aceptada en sus manifestaciones; y otras composiciones implícitas, tácitas que igualmente las constituyen(4). En tal perspectiva, la sociedad es un entretejido de instituciones que inciden en nuestro modo de ser, amar, estar vivos, pero que también son construidas por nosotros, por los sujetos, en su devenir histórico. Desde ese territorio conceptual es que llamamos a nuestros colegas, trabajadores de la salud, investigadores, docentes, a pensar con nosotros: ¿Qué hemos producido? ¿Para quién? ¿Para qué? Nuestro análisis de implicación(5), visión reflexiva para el modo en que las instituciones están en nosotros, cómo ellas nos modelan y qué posición ocupamos en ellas, nos hace, desde el inicio, analizar los efectos de la invitación a elaborar esta editorial. Ciertamente, fue motivo de gran alegría, teñida por la idea del reconocimiento del trabajo, mas también efecto de lazos afectivos que no se separan de los procesos de investigación, pero que insistimos en negar y dejar fuera de la ciencia: manifestación de la institución científica en nosotros. La investigación está ligada a la producción de conocimientos, que, por otro lado, se entrega vinculada a los programas de posgraduación en el contexto universitario, a un docente / grupo de investigación, que también es un trabajador de la enseñanza o que aglutina a otros investigadores / trabajadores. En la sociedad actual de capitalismo globalmente integrado, nos guía una premisa: existe un vínculo no disociable entre enseñanza e investigación. Esa premisa trae consecuencias, tanto para la práctica de la enseñanza como para el desarrollo de la investigación(6). ¿Cuáles son en la actualidad, las medidas de evaluación del trabajo de un docente? En general, son mediciones que se ajusten a coeficientes tales como número de artículos publicados, número de orientaciones concluidas, número de horas de clase, etcétera. Una de las consecuencias es la sobrecarta de profesores que ni han tenido tiempo para reflexionar. Nóvoa(6) llama nuestra atención acerca de que cuando el imperativo de la formación de profesionales reflexivos se adentra en la formación universitaria, existe una coincidente pérdida del tiempo del profesor para la reflexión(6). ¿Es posible investigar sin reflexionar? ¿Es posible acompañar el tiempo de aprendizaje de los estudiantes de graduación y posgraduación en su arduo proceso de aprender a investigar sin tiempo? ¿En qué medida los esfuerzos investigativos se han volcado al proceso de aprender y enseñar, de aprender a aprender nuevas posibilidades de intervenir en la realidad? Son preguntas que se presentan y desafían a una visión diferenciada para el producto del binomio enseñanza-investigación. Otro aspecto de las instituciones es que existe una inmanencia entre aspectos macropolíticos y micropolíticos. Hay efectos de los sistemas de evaluación de los periódicos, de los programas de posgraduación, de las evaluaciones de las investigaciones efectuadas por colegas, así como sobre su divulgación y publicación. Los indicadores utilizados en la métrica de la evaluación de la producción científica, traducida en factores de impacto que permiten la comparación entre periódicos científicos de variada naturaleza, las mediciones que indican el volumen de citas de cada investigador en la producción científica, los avisos de prensa que ponen en disponibilidad recursos financieros para temas y diseños específicos de investigaciones, ¿qué efectos acaban produciendo en la práctica de investigar en enfermería, en salud? De este modo, nos parece que la intrínseca relación entre la investigación de la enfermería y de la salud para la calidad de atención prestada se va diluyendo, y resta de cierta forma la pregunta: ¿atendiendo cuál finalidad es que producimos “ciencia”? ¿Qué ciencia es esta que estamos construyendo en el campo de la salud, en el campo de la enfermería? Tal vez estemos en un proceso productivo que “esconde” los objetivos de mantenimiento de nuestro trabajo, de calificar personas, universidades y servicios, en la lógica del consumo y del individualismo. Un proceso que encuentra natural la idea de que un investigador es investigador individualmente y consigue desarrollarse por sus esfuerzos, cuando en verdad no existe producción científica que comience a partir de sí misma, pero sí existen trabajos / investigaciones / esfuerzos anteriores y concomitantes que entretejen nuestras investigaciones. Los investigadores(7) afirman que “la producción científica inserta en el marco académico continúa alejada de los servicios, ejerciendo poca influencia en la formulación de políticas públicas de salud”. Entonces, ¿cómo volver a aproximarnos a nuestro compromiso ético-estético de producir investigaciones que tengan como fin último la calificación de la atención? Sin respuestas listas y conscientes de la fuerza de lo instituido, nuestro desafío es el de diligenciar otros procesos, inventar nuevos dispositivos, agrietar las superficies duras de las instituciones, ranuras al principio imperceptibles, pero capaces de hacer pasar otros movimientos. Un posible movimiento puede estar en la búsqueda de asociaciones con trabajadores y usuarios, para el pactado de investigaciones que respondan a desafíos cotidianos de los servicios de salud, intervenciones sustentadas en evidencias científicas, en conocimientos científicos producidos en una delicada e intrincada red de saberes de diferentes áreas del conocimiento(8). Proponemos un esfuerzo colectivo de invención: construir proyectos e investigaciones que, al mismo tiempo, generen conocimientos y transformen las prácticas, y que por sobre todo, creen vida allí donde ella, en su preciosidad, reiteradamente se desvanece. REFERENCIAS 1. Erdmann AL, Lanzoni GMM. Características dos grupos de pesquisa da enfermagem brasileira certificados pelo CNPq de 2005 a 2007. Esc. Anna Nery [Internet]. 2008 [cited 2012 dec 31];12(2):316-22. Available from: http://dx.doi.org/10.1590/S1414-81452008000200018. 2. Marziale MHP, Mendes IAC. O fator de impacto das publicações científicas. Rev Lat Am Enfermagem [Internet]. 2002 [cited 2012 dec 31];10(4):466-7. Available from: http://dx.doi.org/10.1590/S0104-11692002000400001. 3. Erdmann AL, Fernandes JD. A classificação dos periódicos científicos da área da Enfermagem. Acta paul. enferm. [Internet]. 2009 [cited 2012 dec 31];22(5):v-i. Available from: http://dx.doi.org/10.1590/S0103-21002009000500001. 4. Baremblitt G. Compêndio de Análise Institucional e outras correntes. Teoria e Prática. 5th ed. Belo Horizonte: Instituto Felix Guatarri; 2002. 5. Monceau G. Implicação, sobreimplicação e implicação profissional. Fractal, Rev. Psicol. [Internet]. 2008 [cited 2012 dec 31];20(1):19-26. Available from: http://dx.doi.org/10.1590/S1984-02922008000100007. 6. Universidade de Vigo Televisión [Internet]. Vigo: Universidade de Vigo (BR) [cited 2012 dec 31]. Mediateca. II Congreso Internacional de Docencia Universitaria (II CIDU 2011). Conferencia de António Nóvoa. Available from: http://tv.uvigo.es/video/44043. 7. Cabral IE, Tyrrel MAR. Pesquisa em enfermagem nas Américas. Rev Bras Enferm [Internet]. 2010 [cited 2012 dec 31];63(1):104-10. Available from: http://dx.doi.org/10.1590/S0034-71672010000100017. 8. Fortuna CM, Mishima SM, Matumoto S, Pereira MJB, Ogata MN. A pesquisa e a articulação ensino-serviço na consolidação do Sistema Único de Saúde. Rev Esc Enferm USP [Internet]. 2011 [cited 2012 dec 31];45(spe2):1696-700. Available from: http://dx.doi.org/10.1590/S0080-62342011000800010.Temos vivenciado no Brasil um crescimento significativo dos grupos de pesquisa(1), com incremento nas investigações de enfermagem e, consequentemente, um aumento da divulgação em periódicos científicos, bem como a qualificação dos pesquisadores e dos periódicos da área. Essa melhora tem sido traduzida na elevação dos índices bibliométricos(2-3), cabendo destacar que esse movimento acompanha o incremento da pós-graduação em enfermagem no país. No entanto, uma questão deve ser feita: qual tem sido o impacto dessa produção na qualidade da atenção prestada aos usuários dos serviços de saúde? Propositadamente não especificamos assistência de enfermagem por considerarmos que a pesquisa no campo da saúde, comprometida com a defesa e a qualificação da vida, não se dirige somente aos campos profissionais que desenvolvem, uma vez que ultrapassam fronteiras de conhecimentos. Adicionalmente, temos como premissa a enfermagem, enquanto prática social, necessariamente articulada a outros trabalhos e campos dos saberes. Dito de outra forma, não há enfermagem de qualidade apartada do trabalho em saúde de qualidade e éticamente comprometida com a vida das pessoas. Parece-nos importante refletir no ?espaço?, interstício, entre uma investigação e respectivo impacto na atenção prestada, especialmente, no Sistema Único de Saúde, já que defendemos a assistência de qualidade na saúde como direito inalienável de todo cidadão, e não como mercadoria a ser acessada conforme a posição social e econômica de cada sujeito no processo de produção. A pesquisa científica, assim como a saúde, a linguagem e, por que não, a enfermagem, entre outras, são instituições que possuem uma parte mais aparente, dita, explícita, aceita em suas manifestações, e outras composições implícitas, não ditas, que igualmente as constituem(4). Nessa perspectiva, a sociedade é um tecido de instituições que nos fabricam em nosso jeito de ser, amar, estar na vida, porém, que também são fabricadas por nós, sujeitos em seu devir histórico. Dentro desse território conceitual é que chamamos nossos colegas, trabalhadores de saúde, pesquisadores, docentes, a pensarem conosco: O que temos produzido? Para quem? Para quê? Nossa análise de implicação(5), o olhar reflexivo para o modo como as instituições estão em nós e nos fabricam, e de que maneira nos colocamos nessas instituições, fez-nos, de partida, analisar os efeitos do convite para elaborar este editorial. Certamente foi motivo de grande alegria permeado pela ideia de reconhecimento do trabalho, mas foi também efeito de laços afetivos, inseparáveis dos processos investigativos, que insistimos em negar e deixar de fora da ciência:  manifestação da instituição científica em nós. A pesquisa está atrelada à produção de conhecimento, que por outro lado se vincula aos programas de pós-graduação no interior da universidade, a um docente/grupo de pesquisa, que também é um trabalhador do ensino ou que aglutina outros pesquisadores/trabalhadores. Na atual sociedade, de capitalismo mundialmente integrado, uma premissa nos guia: há um vínculo indissociável entre ensino e pesquisa. Essa premissa traz consequências tanto para a prática do ensino como para o desenvolvimento da investigação(6). Quais são as medidas de avaliação do trabalho de um docente, atualmente? Em geral, são produções que caibam em coeficientes como número de artigos publicados, número de orientações concluídas, número de horas-aulas etc. Uma das consequências tem sido a sobrecarga de professores que, atualmente, tem tido pouco tempo para reflexão. Nóvoa(6) nos chama a atenção para o seguinte fato: enquanto o imperativo da formação de profissionais reflexivos adentra a formação universitária, há, coincidentemente, um esvaziamento do tempo do professor para refletir(6). É possível pesquisar sem refletir? É possível, sem tempo, acompanhar o tempo de aprendizagem dos estudantes de graduação e pós-graduação em seu árduo processo de aprender a pesquisar sem tempo? Em que medida os esforços de pesquisa têm se voltado ao processo de ensino-aprendizagem, de aprender a aprender novas possibilidades de intervir na realidade? São perguntas que se fazem presentes e que desafiam um olhar diferenciado para o produto da díade ensino-pesquisa. Outra dimensão das instituições é a imanência existente entre aspectos macropolíticos e micropolíticos. Há efeitos dos sistemas de avaliação dos periódicos, dos programas de pós-graduação e das avaliações por pares sobre as pesquisas e, também, sobre as respectivas divulgação e publicação. Que efeitos produzem os indicadores utilizados na métrica da avaliação da produção científica – traduzida em fatores de impacto que permitem a comparação entre periódicos de ciências de várias naturezas –, as medições que indicam o volume de citações de cada pesquisador na produção científica e os editais que disponibilizam recursos financeiros para temas e desenhos específicos de investigações, na prática de investigativa em enfermagem e em saúde? Parece-nos que a intrínseca relação entre a pesquisa da enfermagem e da saúde, para a qualidade de assistência prestada, vai se diluindo e resta, de certa forma, as seguintes questões: produzimos “ciência” para atender a qual finalidade? Que ciência é esta que estamos construindo no campo da saúde e no campo da enfermagem? Talvez estejamos num processo produtivo que “esconde” os objetivos de manutenção de nosso trabalho, de ranquear pessoas, universidades e serviços, na lógica do consumo e do individualismo. Um processo que naturaliza a ideia de que um pesquisador é pesquisador individualmente e consegue desenvolver-se por seus esforços, quando na verdade não há produção científica que comece em si mesma, e sim trabalhos/investigações/esforços anteriores e concomitantes que tecem uma rede de pesquisas. Pesquisadores(7) afirmam que “a produção científica inserida na esfera acadêmica continua afastada dos serviços, exercendo pouca influência na formulação de políticas públicas de saúde”. Então, como nos reaproximar de nosso compromisso ético-estético de produzir pesquisas que tenham como finalidade última a qualificação da atenção? Sem respostas prontas e cientes da força do instituído, nosso desafio é o de agenciar outros processos, inventar novos dispositivos, produzir rachaduras na superfície dura das instituições, ranhuras de início imperceptíveis, mas capazes proporcionarem outros movimentos. Um possível movimento pode estar na busca de parcerias com trabalhadores e usuários para a pactuação de pesquisas que respondam a desafios cotidianos dos serviços de saúde, intervenções sustentadas em evidências e conhecimentos científicos produzidos em uma delicada e intrincada rede de saberes de diferentes áreas(8). Propomos um esforço coletivo de invenção: construir projetos e pesquisas que, ao mesmo tempo, produzam conhecimentos, transformem as práticas e, sobretudo, criem vida onde está, em sua preciosidade, reiteradamente se esvai.     REFERÊNCIAS 1. Erdmann AL, Lanzoni GMM. Características dos grupos de pesquisa da enfermagem brasileira certificados pelo CNPq de 2005 a 2007. Esc. Anna Nery [Internet]. 2008 [cited 2012 dec 31];12(2):316-22. Available from: http://dx.doi.org/10.1590/S1414-81452008000200018. 2. Marziale MHP, Mendes IAC. O fator de impacto das publicações científicas. Rev Lat Am Enfermagem [Internet]. 2002 [cited 2012 dec 31];10(4):466-7. Available from: http://dx.doi.org/10.1590/S0104-11692002000400001. 3. Erdmann AL, Fernandes JD. A classificação dos periódicos científicos da área da Enfermagem. Acta paul. enferm. [Internet]. 2009 [cited 2012 dec 31];22(5):v-i. Available from: http://dx.doi.org/10.1590/S0103-21002009000500001. 4. Baremblitt G. Compêndio de Análise Institucional e outras correntes. Teoria e Prática. 5th ed. Belo Horizonte: Instituto Felix Guatarri; 2002. 5. Monceau G. Implicação, sobreimplicação e implicação profissional. Fractal, Rev. Psicol. [Internet]. 2008 [cited 2012 dec 31];20(1):19-26. Available from: http://dx.doi.org/10.1590/S1984-02922008000100007. 6. Universidade de Vigo Televisión [Internet]. Vigo: Universidade de Vigo (BR) [cited 2012 dec 31]. Mediateca. II Congreso Internacional de Docencia Universitaria (II CIDU 2011). Conferencia de António Nóvoa. Available from: http://tv.uvigo.es/video/44043. 7. Cabral IE, Tyrrel MAR. Pesquisa em enfermagem nas Américas. Rev Bras Enferm [Internet]. 2010 [cited 2012 dec 31];63(1):104-10. Available from: http://dx.doi.org/10.1590/S0034-71672010000100017. 8. Fortuna CM, Mishima SM, Matumoto S, Pereira MJB, Ogata MN. A pesquisa e a articulação ensino-serviço na consolidação do Sistema Único de Saúde. Rev Esc Enferm USP [Internet]. 2011 [cited 2012 dec 31];45(spe2):1696-700. Available from: http://dx.doi.org/10.1590/S0080-62342011000800010.Faculdade de Enfermagem da UFG2012-12-31info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionArtigo Não Avaliado por Paresapplication/pdfapplication/pdfapplication/pdfhttps://revistas.ufg.br/fen/article/view/1340810.5216/ree.v14i4.13408Revista Eletrônica de Enfermagem; Vol. 14 No. 4 (2012); 740-8Revista Eletrônica de Enfermagem; v. 14 n. 4 (2012); 740-81518-1944reponame:Revista Eletrônica de Enfermageminstname:Universidade Federal de Goiás (UFG)instacron:UFGporengspahttps://revistas.ufg.br/fen/article/view/13408/13335https://revistas.ufg.br/fen/article/view/13408/13336https://revistas.ufg.br/fen/article/view/13408/13337Fortuna, Cinira MagaliMishima, Silvana Martinsinfo:eu-repo/semantics/openAccess2020-08-11T00:30:36Zoai:ojs.revistas.ufg.br:article/13408Revistahttps://revistas.ufg.br/fenPUBhttps://revistas.ufg.br/fen/oairee.fen@ufg.br1518-19441518-1944opendoar:2020-08-11T00:30:36Revista Eletrônica de Enfermagem - Universidade Federal de Goiás (UFG)false
dc.title.none.fl_str_mv Nursing research and the qualification of health care: some considerations
La investigación en enfermería y la calificación de la atención: algunas reflexiones
A pesquisa de enfermagem e a qualificação da assistência: algumas reflexões
title Nursing research and the qualification of health care: some considerations
spellingShingle Nursing research and the qualification of health care: some considerations
Fortuna, Cinira Magali
title_short Nursing research and the qualification of health care: some considerations
title_full Nursing research and the qualification of health care: some considerations
title_fullStr Nursing research and the qualification of health care: some considerations
title_full_unstemmed Nursing research and the qualification of health care: some considerations
title_sort Nursing research and the qualification of health care: some considerations
author Fortuna, Cinira Magali
author_facet Fortuna, Cinira Magali
Mishima, Silvana Martins
author_role author
author2 Mishima, Silvana Martins
author2_role author
dc.contributor.author.fl_str_mv Fortuna, Cinira Magali
Mishima, Silvana Martins
description There has been a significant increase in the number of research groups in Brazil(1), with a subsequent increase in nursing research and the number of publications of scientific journals, as well as the qualification of nursing researchers and journals. This increase in research and publications has translated into higher bibliometric indexes(2-3), it being worthwhile to highlight that this movement follows the increase in the number of Brazilian nursing graduate courses. Nevertheless, a question should be asked: what has been the impact of increased production on the quality of health care services? We purposefully did not state nursing care specifically, as we consider that health research is committed to the protection and improvement of quality of life, and does not focus exclusively on the professional fields in which it is developed, but overcomes the borders of knowledge. Furthermore, we consider the premise that nursing is a social practice inevitably connected to other disciplines and fields of knowledge. In other words, quality nursing does not exist apart from quality health care and from being ethically committed to the lives of people. We believe it is important to reflect regarding the intrinsic “space” between a given research work and its impact on care, namely the Brazilian National Unified Health System (SUS), because we defend that quality health care is an undeniable right of every citizen, and is not an item of merchandise to be accessed according to one’s social and economic position in the production process. Scientific research is an institution, just as health, language, and even nursing are institutions, among others, with a more apparent or explicit part, accepted in its manifestation in addition to other unspoken, implicit compositions, which are components just the same(4). From this perspective, society is a tapestry of institutions that fabricate our way of being, loving, and being in life, while it is also fabricated by us, the subjects in the course of its history. It is from this conceptual grounding that we invite our fellow health workers, researchers and faculty to join us and reflect on what we have produced, who we have produced it for, and why have we produced it. Our implied analysis(5), a questioning look at the way institutions occur within ourselves, how they construct us and how we place ourselves within them, encourages us to immediately analyze the effects of the invitation to write the present editorial. It certainly filled us with joy, permeated with the idea of our work being acknowledged, but also produced an effect stemming from the affective bonds that cannot be separated from the research process, but that we insist on denying and separating from science: the manifestation of the scientific institution within us. Research is linked to the production of knowledge, which, on the other hand, is connected to graduate programs within the university and to members of the faculty/research group, who are also education professionals whogather other researchers/workers. In the present globalized capitalist society, we are guided by one premise: there is an inseparable bond between teaching and research. That premise brings about consequences to both the practice of teaching and the development of research(6). What evaluation measures should currently be considered to assess the work of the faculty? In general, the measures used are any production capable of being seen in terms of figures, such as the number of articles published, the number of graduates one has advised, class hours taught, and so forth. Many are the consequences, which often include the overload of a faculty that lacks time to reflect. Nóvoa(6) points out that, in university education, the emergence of the need to prepare analytical professionals coincidently occurs with a draining of the faculty’s time to reflect(6). Is research possible without reflection? Is it possible to keep track of graduate and undergraduate students’ learning in their strenuous education process and still engage in research, given this lack of time? To what extent have research efforts been focused on addressing the process of learning and teaching, of learning to discover new possibilities to change the current reality? These questions emerge and challenge us to cast a second look upon the production of the teaching-research dyad. Another aspect regarding institutions is that there is a relationship which exists between macro-political and micro-political aspects. Effects occur by the evaluation systems of journals, graduate programs and peer reviews, which also affects their dissemination and publication. What effects have been produced on nursing and health research by the indicators used to evaluate scientific production, translated as impact factors that permit comparison across journals of various disciplines, measures indicating the number of citations of each researcher, and RFP (requests for proposals) that offer funds for specific themes and research designs? Thus, it appears that the intrinsic relationship between nursing/health research and the quality of the health care service is becoming diluted, and the final question is asked: for what purpose do we produce “science”? Precisely what science are we developing in health and nursing? Perhaps we are living a production process that “hides” the objectives of keeping our job of ranking people, universities and services following the logic of consumption and individualism, a process that naturalizes the idea that a researcher is a lone individual researcher capable of developing him or herself through his or her own efforts, when the reality is that no scientific production begins in itself, but through previous and concurrent works/investigations/efforts that weave the tapestry of our studies. Researchers(7) state that “scientific production within the academic sphere continues separately from services, having little effect on the creation of public health policies”. Therefore, how can we repurpose our ethical-esthetical commitment of producing research with quality health care being the ultimate expression? Knowing that there are no ready-made answers and aware of the strength of what has already been instituted, our challenge is to procure other processes, create new devices and break the hard surface of institutions, beginning with scratches that may be imperceptible but are capable of making way for other movements. One possible movement may be the search for partnerships between workers and clients in conducting research that would answer the everyday challenges of healthcare services, evidence-based interventions and scientific knowledge produced in a delicate and intricate knowledge network of different fields of knowledge(8). We propose a collective invention effort: build projects and research that produce knowledge and change practices while creating life in places where it has been, with all its preciousness, repeatedly eroded.     REFERENCES 1. Erdmann AL, Lanzoni GMM. Características dos grupos de pesquisa da enfermagem brasileira certificados pelo CNPq de 2005 a 2007. Esc. Anna Nery [Internet]. 2008 [cited 2012 dec 31];12(2):316-22. Available from: http://dx.doi.org/10.1590/S1414-81452008000200018. 2. Marziale MHP, Mendes IAC. O fator de impacto das publicações científicas. Rev Lat Am Enfermagem [Internet]. 2002 [cited 2012 dec 31];10(4):466-7. Available from: http://dx.doi.org/10.1590/S0104-11692002000400001. 3. Erdmann AL, Fernandes JD. A classificação dos periódicos científicos da área da Enfermagem. Acta paul. enferm. [Internet]. 2009 [cited 2012 dec 31];22(5):v-i. Available from: http://dx.doi.org/10.1590/S0103-21002009000500001. 4. Baremblitt G. Compêndio de Análise Institucional e outras correntes. Teoria e Prática. 5th ed. Belo Horizonte: Instituto Felix Guatarri; 2002. 5. Monceau G. Implicação, sobreimplicação e implicação profissional. Fractal, Rev. Psicol. [Internet]. 2008 [cited 2012 dec 31];20(1):19-26. Available from: http://dx.doi.org/10.1590/S1984-02922008000100007. 6. Universidade de Vigo Televisión [Internet]. Vigo: Universidade de Vigo (BR) [cited 2012 dec 31]. Mediateca. II Congreso Internacional de Docencia Universitaria (II CIDU 2011). Conferencia de António Nóvoa. Available from: http://tv.uvigo.es/video/44043. 7. Cabral IE, Tyrrel MAR. Pesquisa em enfermagem nas Américas. Rev Bras Enferm [Internet]. 2010 [cited 2012 dec 31];63(1):104-10. Available from: http://dx.doi.org/10.1590/S0034-71672010000100017. 8. Fortuna CM, Mishima SM, Matumoto S, Pereira MJB, Ogata MN. A pesquisa e a articulação ensino-serviço na consolidação do Sistema Único de Saúde. Rev Esc Enferm USP [Internet]. 2011 [cited 2012 dec 31];45(spe2):1696-700. Available from: http://dx.doi.org/10.1590/S0080-62342011000800010.
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