A produção do cuidado na atenção domiciliar: Relações de poder e estratégias de resistência

Abstract

The demographic and epidemiological transition pose challenges to the field of health, as they demand the production of continuous, intensive, integral and humanized care. Several strategies to meet this new profile has been built and, among these, we highlight the Home Care services (SAD). It is understood that the production of care in AD is permeated by power relations and proposes to this study to investigate them. The goal is to analyze power relations that are established practices in Home Care, comprising the operation of the strategies used in this process. This is qualitative study, data were obtained in carrying out 109 visits to two teams of home care in the city of Contagem, Minas Gerais. During the visits were carried out observations on the production of care at the time of hospital admission and at SAD, in home care, readmission and readmission and post-obito visits. These visits enabled the monitoring of 14 cases of patients. Complementarily interviews were conducted with 5 patients / carers and 10 professionals. Data were analyzed from the perspective of discourse analysis directed by Michel Foucault's framework. The results indicate the majority presence of a caregiver with parental bond and female. These relations involved in the production of care in the home are characterized by involvement, empathy, bonds and acolhimentos but also reveal the disciplining, control and regulation affecting care in home care. The professionals work in an integrated manner with a view to meet the health needs of patients and caregivers. They are attentive and seek to guide the actions according to the context of life of families. However, their practices represent the power of technical-scientific and normative-organizational discourse own mode of operating actions in the public health system. Users and carers in turn also vie for the production of care revealing strategic and tactical resistance to rules and regulations imposed by the service. However, the inventive possibility and are restricted in most cases prevails subordination and obedience to the logic advocated. The production of care in home care reveals the disciplinarian, normative power, but also underlies the full speech, with humanized, proximal, creative actions. This space also takes place religious discourse establishing a regime of truth that restricts the choices and possibilities. It is concluded that there are moments of production and interdiction of care that make up two planes simultaneously from the effects of power relations in home care.