The nursing work in the production of health care in the clinical model

Abstract

The subject of this research study is the technological and social organization of health work in hospital, considering the position of nursing practice within production of care. The aim is to analyze the work process at a University Hospital to apprehend the configuration of practices, knowledges, social relations and technologies that are operated by agents in intervention on the body of an ill person. Using a dialectical approach, empirical data were collected by direct observation of the work process in a medical in-patient unit and by semi-structured interviews with professionals. It was found that the production of care is developed based on collective work, that is structured by the division in parts and fragmentation of the actions of the different agents, in order to produce a diagnosis and therapy. The agents articulate their actions around the medical act which takes up a central position in the production of care. The importance of broadening the clinical model to contemplate the social and subjective dimension of the health/disease process is pointed out in a therapeutical project shared by different health care team professionals. It is proposed to change the work process associated with the construction of new management models in health care institutions.