PROFESSI ON AL ROLES OF A HEALTH TEAM: A VI EW OF I TS COMPON EN TS
Sandr a Regina da Cost a Saar1 Mar ia Au x iliador a Tr ev izan2
Saar SRC, Tr evizan MA. Pr ofessional r oles of a healt h t eam : a view of it s com ponent s. Rev Lat ino- am Enfer m agem
2 0 0 7 j an eir o- f ev er eir o; 1 5 ( 1 ) : 1 0 6 - 1 2 .
Based on t he Theor y of Roles, t his st udy aim ed t o ex am ine healt h t eam pr ofessionals’ v iew s on t he
r ole play ed by t heir colleagues. We int er v iew ed 39 healt h pr ofessionals: 01 nut r it ionist , 02 psy chologist s, 02
n u r ses, 0 3 p h y siot h er ap ist s, 0 4 p h ar m acist s, 1 0 d en t ist s an d 1 7 p h y sician s. Th e r esu lt s sh ow ed t h at t h e
par t icipan t s con sider ed t h at t eam w or k sh ar es r espon sibilit y , w h ich r eliev es st r ess an d is a w ay of lear n in g;
t hey also indicat e t hat expect at ions r egar ding t he pr ofessionals’ r ole ar e not ver y clear and t hat m ost par t icipant s
h av e lit t le k n ow ledge abou t t h eir colleagu es’ pr ofession al r ole. Th e m ost clear ly descr ibed pr ofession al r oles
ar e t hose of phy sicians, nur ses and phar m acist s. The m ost obscur e is t he psy chologist ’s r ole.
DESCRI PTORS: pat ient car e t eam ; pr ofessional r ole; healt h
LOS ROLES PROFESI ONALES DE UN EQUI PO DE SALUD: LA VI SI ÓN DE SUS I NTEGRANTES
Est e est udio, basado en la Teor ía de Roles, t uvo com o obj et ivo est udiar la visión que los pr ofesionales
de un equipo de salud t ienen con r elación al r ol de sus com pañer os de equipo. Ent r evist am os a 39 pr ofesionales
de salud: 01 nut r icionist a, 02 psicólogos, 02 enfer m er as, 03 fisiot er apeut as, 04 far m acéut icos, 10 dent ist as y
1 7 m édicos. Los r esult ados m ost r ar on que, al com par t ir el t r abaj o, los par t icipant es div iden r esponsabilidad,
dism inuyen el st r ess; así com o lo consider an una for m a de apr endizaj e; las expect at ivas en r elación a los r oles
pr ofesionales no son clar as y la m ayor ía conoce m uy poco el r ol pr ofesional del equipo. Los r oles pr ofesionales
d escr it os m ás clar am en t e son los d e m éd ico, en f er m er o y f ar m acéu t ico. El m en os esp ecif icad o es el d el
p sicólog o.
DESCRI PTORES: gr upo de at ención al pacient e; papel pr ofesional; salud
PAPÉI S PROFI SSI ONAI S DE UMA EQUI PE DE SAÚDE: VI SÃO DE SEUS I NTEGRANTES
Fundam ent ado na t eor ia de papéis, est e est udo buscou invest igar a visão que os pr ofissionais de um a
equipe de saúde t êm a r espeit o do papel desem penhado por seus com panheir os de equipe. Ent r ev ist ou- se 39
pr of ission ais de saú de: 1 n u t r icion ist a, 2 psicólogos, 2 en f er m eir os, 3 f isiot er apeu t as, 4 f ar m acêu t icos, 1 0
den t ist as, e 1 7 m édicos. Os r esult ados indicar am que os in for m ant es con sider am que o t r abalho em equipe
divide a r esponsabilidade, aliviando o est r esse; é um a for m a de apr endizado; indicam t am bém que as expect at ivas
qu an t o aos papéis pr ofission ais n ão são clar as e qu e a m aior ia dos in for m an t es t em pou co con h ecim en t o a
r espeit o do papel pr ofissional dos com panheir os de equipe. Os papéis pr ofissionais descr it os com m ais clar eza
for am os de m édico, enfer m eir o e far m acêut ico. O m ais obscur o é o do psicólogo.
DESCRI TORES: equipe de assist ência ao pacient e; papel pr ofissional; saúde
1 RN, Brazilian Ar m y Reser ve Officer, PhD in Nur sing, e- m ail: saar @enf.ufm g.br ; 2 RN, Full Pr ofessor, Univer sit y of São Paulo at Ribeir ão Pr et o College of
Nur sing, WHO Collabor at ing Cent r e for Nur sing Resear ch Developm ent , CNPq Resear cher 1A
I NTRODUCTI ON
T
his paper is based on dat a obt ained t hr ough an em pir ical r esear ch , car r ied ou t in t h e fr am ew or kof a n u r sin g d oct or al d isser t at ion p r esen t ed at t h e
Ribeir ão Pr et o College of Nur sing, w hich inv est igat ed
t h e sp ecif icit y of n u r ses. Du r in g d at a collect ion , in
or der t o av oid ask in g in f or m an t s dir ect ly abou t t h e
specif icit y of n u r ses, w e ask ed t h em t o t alk a lit t le
about t heir pr ofessional ex per ience and ex pect at ions
a b o u t t h e p e r f o r m a n c e o f o t h e r h e a l t h t e a m
pr ofessionals. We found t hat som e of t he infor m ant s
f a ced d i f f i cu l t i es t o d escr i b e t h e a t t r i b u t i o n s a n d
com pet ences of t heir w or k colleagues. This at t r act ed
our at t ent ion and m ade us elaborat e t his paper.
I n t h e a t t em p t t o h i st o r i ca l l y r eco v er t h e
or igins of t he healt h t eam as w e k now it t oday, w e
look ed b ack in t im e an d m an ag ed t o ou t lin e t h r ee
“ healt h t eam ” m odels( 1), w hich w er e act iv e fr om t he 1 8t h ce n t u r y o n w a r d s. Ea ch o f t h e m h a d d i st i n ct char act er ist ics, but t he t hr ee had som et hing sim ilar :
t heir concer n w it h t he populat ion’s healt h condit ion.
The aut hor does not m ent ion t he t er m “ healt h
t eam ” but , in describing t he for m at ion st eps of social
m edicine, he allow s us t o pict ur e a t eam t hat w or k s
f or t h e b en ef it of or in t h e n am e of h ealt h . Th ese
t h r ee m odels ar e:
a) St at e Medicine, developed in Ger m any at t he st ar t
of t he 18t h cent ury, in w hich a “ healt h t eam ” consist ed of: physicians, cent ral adm inist r at ive organizat ion t hat
su p er v i sed a n d g u i d ed m ed i ca l w o r k a n d m ed i ca l
em ploy ees appoin t ed by t h e gov er n m en t ;
b) Ur ban Medicine, developed in Fr ance at t he end of
t he 18t h cent ur y, in w hich a “ healt h t eam ” included: ph y sician s, ch em ist s an d ph y sicist s;
c) Wor k f or ce Medicin e, dev eloped in En glan d in t h e
secon d t h ir d of t h e 1 9t h cen t u r y, in w h ich a h ealt h t eam w as con st it u t ed by : ph y sician s w h o t ook car e
o f t h e p o o r, p h y si ci a n s w h o t o o k ca r e o f g en er a l
pr oblem s lik e epidem ics an d pr iv at e ph y sician s w h o
t ook car e of w hoev er could pay t heir ser v ices.
I n t he 18t h cent ury, w hen t he hospit al em erged as a place of cur e and no longer as a place for dying,
an d w h en t h e h osp it al sp ace w as m ed icalized an d
d iscip lin ed , w e can w it n ess t h e ap p ear an ce of t h e
“ healt h t eam ” w e are m ore fam iliar w it h. This “ healt h
t eam ” is present in t he rit ual of m edical visit s, w hich
is follow ed b y t h e en t ir e h ospit al h ier ar chy, t h at is:
a ssi st a n t s, st u d e n t s, n u r se s a n d o t h e r s. We w i l l
consider t hat t he healt h t eam w as const it ut ed on t he
basis of t his event( 1).
The above “ healt h t eam ” m odels display lit t le
sim ilar it y w it h t h e h ealt h t eam s w e live w it h t oday.
We ar e accust om ed t o see a healt h t eam const it ut ed
by : ph y sician s, n u r ses, ot h er n u r sin g pr of ession als,
psy chologist s, nut r it ionist s, dent ist s, phy siot her apist s,
p h a r m a c i s t s a n d s o c i a l w o r k e r s . Th i s g r o u p i s
c o m m o n l y c a l l e d t h e m u l t i p r o f e s s i o n a l o r
in t er disciplin ar y h ealt h t eam .
This m ult iprofessional charact er is considered
as a st rat egy t hat guides and allows for int egral care
d e l i v e r y. I t i s m i s t a k e n l y m i x e d u p w i t h
int erdisciplinarity. The form er indicat es t he j uxt aposit ion
of different disciplines, in which each professional act s
a c c o r d i n g t o h i s / h e r s p e c i a l i s t k n o w l e d g e ; t h e
t her apeut ic pr ocess is fr agm ent ed. The lat t er im plies
int eract ion bet w een t w o or m ore disciplines, reflect ed
in t he int egrat ion of key concept s, in epist em ology and
in t eaching and r esear ch or ganizat ion( 2- 3).
The first m ult iprofessional st udies appeared in
t he 1930’s and 40’s and were relat ed t o m ent al healt h.
I n t he 1960’s, a quant it at ive increase occurred in t he
healt h w ork force. These fact s derived from a m ent al
h ea l t h ca r e h u m a n i za t i o n p r o p o sa l , t h e i n cr ea sed
dem and for healt h ser v ices and t he incor por at ion of
increasingly com plex t echnologies( 2- 3).
To elaborat e t his paper, w e depar t ed fr om a
n u m b er of p r em i ses, w h i ch w er e: i n d i v i d u al s p l ay
count less roles in t he social syst em t hey are insert ed
in, including pr ofessional r oles; t he r oles indiv iduals
per for m ar e out lined accor ding t o t he r oles played by
t h e ot h er p er son s p r esen t in t h e r esp ect iv e social
syst em ; t he definit ion of t he sit uat ion r epr esent ed by
a cer t ain par t icipant const it ut es an int egr al par t of a
r ep r esen t at ion t h at is f ed an d m ain t ain ed t h r ou g h
cooper at ion w it h m or e t han one t eam par t icipant ; each
par t icipant in t his gr oup or t eam has t o giv e his/ her
defin it ion of t h e r ole ( s) h e per for m s; t h e t eam is a
gr oup of indiv iduals w ho cooper at e in t he r ealizat ion
of a par t icular r out ine, of a t ask; t her e exist s a bond
of m ut ual dependence t hat links m em ber s of t he sam e
t eam w it h one anot her( 4- 5).
I n v iew of t hese pr em ises, w e at t em pt ed t o
ex am in e h ealt h t eam p r of ession als’ v iew ab ou t t h e
r ole per for m ed by t heir t eam colleagues.
METHODOLOGY
To ca r r y o u t t h i s st u d y, w e f o l l o w e d t h e
p r ecep t s o f q u a l i t a t i v e r esea r ch a n d a d o p t ed t h e
Th e e m p i r i ca l r e se a r ch w a s r e a l i ze d a t a
m ilit ary hospit al locat ed in t he St at e of Minas Gerais,
Br a zi l . Th i s sm a l l h o sp i t a l o f f e r s m e d i ca l cl i n i cs,
s u r g i c a l c l i n i c s , n u r s i n g , d e n t i s t r y, p s y c h o l o g y,
p h ar m acy, p hy siot h er ap y, lab or at or y an d n u t r it ion ,
as w ell as suppor t and adm inist r at iv e ser v ices.
Dat a collect ion only st ar t ed aft er t he pr oj ect
had been appr oved by t he Resear ch Et hics Com m it t ee
at t h e Rib eir ão Pr et o Colleg e of Nu r sin g , an d af t er
t he boar d of t he m ilit ar y or ganizat ion and infor m ant s
had giv en t heir consent .
We i n t e r v i e w e d t h i r t y - n i n e h e a l t h
pr ofession als, dist r ibu t ed as follow s: 0 1 n u t r it ion ist ,
02 psy chologist s, 02 nur ses, 03 phy siot her apist s, 04
p h a r m a c i s t s , 1 0 d e n t i s t s a n d 1 7 p h y s i c i a n s
( appr ox im at ely 80% of t he healt h pr ofessionals w ho
w or k at t he hospit al) . I nt er v iew s w er e r ecor ded w it h
t h e in for m an t s’ con sen t an d, aft er t r an scr ipt ion , w e
pr oceeded w it h dat a analy sis. I n or der t o guar ant ee
t he infor m ant s’ anony m it y, t hey w er e ident ified w it h
a n a l p h a n u m e r i c a l c o d e t h a t c o n s i s t e d o f t h e
p r of ession ’s f ir st let t er s, f ollow ed b y t h e in t er v iew
or der num ber. To dist inguish bet w een phar m acist s and
phy siot her apist s, t he fir st t hr ee let t er s w er e used t o
designat e t he lat t er ( PHY) .
DATA PRESENTATI ON
Dat a an aly sis allow ed u s t o con st r u ct t h ee
a n a l y t i c c a t e g o r i e s . Th e s e a r e : t e a m w o r k ,
p e r c e p t i o n o f p r o f e s s i o n a l r o l e s a n d
m u l t i p r o f e ssi o n a l t eam , w it h t w o su b cat eg or ies:
h o w it is co n sid e r e d a n d e x p e ct a t io n s.
Te a m w o r k
Team w ork is considered essent ial but difficult .
I t is seen as a w ay of sh ar in g r esp on sib ilit ies an d
ach iev in g t h e p at ien t ’s h ealt h r ecov er y f ast er. Th is
v iew is j u st if ied b y t h e f act t h at each p r of ession al
perceives t he sit uat ion different ly, and t hat t he “ union”
of differ ent per cept ions facilit at es t he com pr ehension
of t he w hole, m aking it possible t o pict ur e t he pat ient
as a w h ole. I t r eq u ir es in t er p lay in or d er t o av oid
b l u n d er s an d ( r e) w o r k . Team w o r k i s co n si d er ed a
sou r ce of lear n in g, becau se it per m it s con t act w it h
ot her ex per iences t hr ough pr ofessional dialogue and
ca se d i scu ssi o n s. Th i s ca n b e i l l u st r a t e d b y t h e
follow in g st at em en t .
I n t eam work you expand your knowledge, you can solve
doubt s, [ ...] w hen you w or k w it h people fr om ot her ar eas you
im pr ove your diagnosis, your abilit y t o see t he pat ient as a w hole
is bet t er .
Per cept ion of pr of ession al r oles
All inform ant s pict ured different iat ed roles for
healt h t eam m em ber s. They alleged t hat t his definit ion
is dif f icu lt w h en t h e n u m ber of st af f is in su f f icien t .
D i f f e r e n t r e a s o n s w e r e a p p o i n t e d f o r t h i s
differ ent iat ion, condensed in: ex ist ence of hier ar chy,
ex ist en ce of law s r eg u lat in g t h e p r of ession als an d
im p ossib ilit y t o k n ow ev er y t h in g ab ou t ev er y t h in g ,
giv in g r ise t o com plem en t ar y r oles. Th e in for m an t s’
st at em en t s d i sp l ay ed t h at p h y si ci an s d i scr i m i n at e
again st / disqu alif y ot h er pr of ession als.
That ’s how I see it , perhaps it m ay even be ant i- et hical
t o be t alking like t his, I see a ver y lar ge discr im inat ion by t he
physician against t he r est of t he w hit e- coat , t hat is, healt h st aff.
Th e ph ar m acist ’s r ole
Ph ar m aci st s’ r o l e w as cl ear l y d el i m i t ed i n
t hr ee act iv it y ar eas: m anagem ent , biochem ist r y and
p h ar m acy in it self. Ph y sician s, n u r ses an d d en t ist s
show gr eat er expect at ions in t er m s of or ient at ion and
c l a r i f i c a t i o n s a b o u t c o l l a t e r a l e f f e c t s a n d d r u g
int er act ions. The second m ost w ant ed act ivit y r efer r ed
t o biochem ist r y, j ust ified by t hese pr ofessionals’ help
in clin ical diagn osis. Man agem en t w as ch ar act er ized
by r esponsibilit y, gr ant ed by t he infor m ant s; and by
t he acquisit ion, cont r ol and dist r ibut ion of dr ugs and
m edical- hospit al m at er ial. Anot her ar ea indicat ed as
b e l o n g i n g t o p h a r m a c i s t s ’ c o m p e t e n c e w a s t h e
Ho sp i t a l I n f e ct i o n Co n t r o l Co m m i ssi o n , h o w e v e r,
w it hout ex plaining t he act iv it ies t hey w ould per for m .
I t sh ou ld b e m en t ion ed t h at on e of t h e in f or m an t s
b eliev ed t h e p h ar m acist w as n ot n ecessar y in t h e
h ealt h t eam . Accor din g t o h im , it is t h e bioch em ist
w ho play s an essent ial r ole.
I r eally don ’t see t h e n eed f or a ph ar m acist in a
m ult idisciplinar y t eam . I believ e it ’s t he r ole of a biochem ist
t hat ’s im por t ant , t o be able t o help us by suppor t ing som e
addit ional t est s. As t o t he phar m acist , I can’t see an im por t ant
r ole for him , no.
So m e i n f o r m a n t s a f f i r m e d t h a t , a l t h o u g h
t h ey m an aged t o pict u r ed ph ar m acist s’ act iv it ies in
t he phar m acy and t he labor at or y, t heir r ole w as not
Th e ph y sician ’s r ole
Ph y sician s w er e seen as p r of ession als w h o
serve as t he pat ient ’s “ ent ry door ”, t hat is, t hey receive
pat ien t s, r each t h e clin ical diagn osis, elabor at e t h e
t h e r a p e u t i c p l a n a n d r e f e r t h e m a s n e ce ssa r y.
I n f o r m a n t s e st a b l i sh e d cl i n i ca l d i a g n o si s a s t h e
phy sician’s m ain r ole. Som e disagr eem ent s appear ed
in t erm s of t reat m ent . Most inform ant s considered t hat
t his is t he physician’s responsibility, but t hat it is execut ed
j oin t ly w it h ot h er pr of ession als. Ot h er pr of ession als
co n si d e r e d t r e a t m e n t a s a co m p l e m e n t a r y a ct i o n
per f or m ed by dif f er en t pr of ession als, in w h ich each
bears his/ her own responsibilit y.
Ph y s i c i a n s w e r e a l s o c o n s i d e r e d a s
coordinat ors of healt h t eam act ions, being responsible
f or gu idin g an d su per v isin g t h e ot h er pr of ession als’
w or k . They w er e defined as: pr ofessionals w it h lit t le
v i s i o n , p r e j u d i c e d , r e s i s t a n t a g a i n s t t e a m w o r k ,
cent r alizing, and “ t he alm ight y ”
Look, t he doct or is t r ained t o be w ho he is. [ ...] older
doct or s ar e ver y r esist ant against t eam w or k, [ ...] People w ho
gr aduat ed som e t im e ago ar e ver y pr ej udiced. [ ...] They r eally
feel super ior .
The dent ist ’s r ole
The im age const ruct ed of dent ist s is not clear.
They are perceived as “ people who t reat t eet h” and as
professionals who are t echnically capable of diagnosing
and treating oral pathologies with system ic repercussions.
Therefore, they are responsible for im portant differential
diagnoses, am ong w hich or al cancer w as m ent ioned
rather frequently. References to their participation in the
health team range from insignificant and dispensable to
fundam ental and essential. Most inform ants consider that
dent ist s’ w ork belongs in out pat ient clinics, separat ed
from the health team .
I t seem s t o m e t hat t he dent ist is v er y m uch int o
qu est ion s ch ar act er ist ic of den t ist r y . I t seem s t o be a v er y
char act er ist ic sect or , I see lit t le ar t iculat ion w it h ot her healt h
pr of ession als.
I n f or m an t s ex p r essed a ch an g e p r ocess in
den t ist s’ act iv it ies, der iv in g f r om t h e Fam ily Healt h
Pr ogram st rat egy w hich, in a w ay, has cont r ibut ed t o
int egr at e t hese pr ofessionals in t he t eam .
Th e psy ch ologist ’s r ole
Psychologist s were considered im port ant in t he
healt h t eam but t heir act ivit ies were not clearly defined.
As t h e n a m e i t se l f sa y s, t h e m o r e su b j e ct i v e ,
psychological par t and he is m or e gener alist , he does not only
focus on one aspect , he sees t he pat ient as a w hole, I t hink.
Most in f or m an t s ex p r ess t h at p sy ch olog ist s
a r e r e s p o n s i b l e f o r g i v i n g e m o t i o n a l s u p p o r t t o
p a t i en t s, f a m i l i es a n d t ea m s. On l y o n e i n f o r m a n t
r ef er r ed t o t h e psy ch ologist ’s act iv it ies as som eon e
w h o i s c a p a b l e o f d i a g n o s i n g , e s t a b l i s h i n g a n d
co n d u ct i n g a t h e r a p e u t i c p l a n . W h e n d e scr i b i n g
p sy ch o l o g i st s‘ r o l e , so m e i n f o r m a n t s m e n t i o n e d
act ions relat ed t o solving pat ient s’ and t heir respect ive
f a m i l i e s ’ s o c i o e c o n o m i c p r o b l e m s , i g n o r i n g t h e
ex ist en ce of social w or k er s.
… t heir r ole st ands out in t hat t hey have w or ked in
psychological suppor t , social assist ance, or ient at ion.
Th e ph y siot h er apist ’s r ole
Re h a b i l i t a t i o n w a s t h e m o s t m e n t i o n e d
act iv it y. This w as div ided int o m ot or, r espir at or y and
social r ehabilit at ion; t he lat t er r efer s t o t he pat ient ’s
reint egrat ion int o t he social environm ent ( s) he belongs
t o. Som e infor m ant s indicat ed t hat phy siot her apist s’
r ole w as t o help m edical w or k .
I t hink it is a cooper at ive r ole. [ ...] But w e do w or k as
assist an t s, y es.
Ot her s per ceiv ed t hem as pr ofessionals w ho
a r e c a p a b l e o f p r o m o t i n g h e a l t h , e s t a b l i s h i n g
diagnoses and t r eat ing diseases t hat involve differ ent
or g an ic sy st em s an d lim it in d iv id u als in t h eir d aily
a ct i o n s. Tw o i n f o r m a n t s r ef er r ed t o t h e f a ct t h a t
ph y siot h er apist s in gen er al pr efer ou t pat ien t clin ical
w ork and int eract lit t le w it h t he healt h t eam .
The nut r it ionist ’s r ole
Discou r se ev iden ced t h at n u t r it ion ist s’ m ain
f u n ct ion is t o h elp w it h pat ien t s’ an d pr of ession als’
diet . Ot her descr ipt ions of t heir r ole w er e nut r it ional
assessm en t an d f ood ed u cat ion . Th e n u t r it ion ist is
consider ed t o be a pr ofessional w ho depends on t he
phy sician t o act and helps in t his pr ofessional’s w or k
Or ient at ions about diet , suggest ions about w hat diet
t o prescribe. [ ...] When he so t o say prescribes a diet , t he physician
has t o appr ove it fir st .
N u t r i t i o n i s t s a r e s e e n a s n o t v e r y
par t icipat ive, but im por t ant for t he healt h t eam . Tw o
infor m ant s m ent ioned t hat , besides clinical nut r it ion,
nut r it ionist s play an im por t ant r ole in t he food indust r y.
p r of ession al cap ab le of elab or at in g h ealt h y m en u s
t h a t a r e a d e q u a t e t o p a t i e n t s’ i n d i v i d u a l n e e d s,
w it hout placing a bur den on t he hospit al or dom est ic
b u d g et .
The nur se’s r ole
I n f o r m a n t s ’ v i e w s i n t h i s r e s p e c t w e r e
m u l t i p l e . Th e y a t t r i b u t e a d m i n i st r a t i v e , ca r e a n d
edu cat ion al act ion s t o n u r ses. Th e m ost m en t ion ed
n u r s i n g r o l e w a s a d m i n i s t r a t i v e . A d m i n i s t r a t i v e
funct ions w er e subdivided in t hr ee act ivit y ar eas: w or k
pr ocess, in st it u t ion al en v ir on m en t an d h ealt h t eam .
Descr ibed act ion s r ef er r ed t o r esou r ce pr ov ision f or
h ealt h act s t o t ak e p lace, eq u ip m en t m ain t en an ce,
c a r e u n i t o r g a n i z a t i o n a n d c l e a n i n g , b e s i d e s
in t er act ion s w it h all h ealt h t eam m em ber s, w h et h er
by pr oviding w hat is necessar y for pat ient car e or by
giv in g in f or m at ion .
I n for m an t s ou t lin ed t w o w ay s for n u r ses t o
act in pat ien t car e, ex pr essin g t h at n u r ses act bot h
d i r e c t l y, e x e m p l i f i e d b y m o r e c o m p l e x i n v a s i v e
pr ocedu r es, an d in dir ect ly, m en t ion in g car e deliv er y
su p er v ision .
Wi t h r esp ect t o ed u cat i o n , t h e i n f o r m an t s
ex p r essed t h at n u r ses ar e r esp on sib le f or t r ain in g
ot her nur sing t eam m em ber s, giving t echnical advice,
t r a n sm i t t i n g t h e n ecessa r y k n o w l ed g e t o p er f o r m
p r o ce d u r e s a n d t r a i n i n g t h e m f o r se r v i ce a n d i n
ser v i ce.
Th e m u lt ipr of ession al t eam
How it is consider ed
We h av e m en t ion ed b ef or e t h at in f or m an t s
co n si d er t ea m w o r k a s i m p o r t a n t a n d a so u r ce o f
lear n in g. Based on t h eir st at em en t s, w e pict u r e t h e
t eam as a “ puzzle”, in w hich all pieces fit in “ perfect ly”
and t he end pr oduct show s a com plex w hole.
I n f or m an t s r ef er r ed t o t h e f act t h at n ot all
pr ofessionals k now t he r ole, funct ion or com pet ence
of t heir t eam colleagues. They m ent ioned a st r uggle
for pow er an d fear of losin g pr ofession al space an d
st at us, as w ell as t he exist ence of professional “ feuds”
t h at ar e h ar d t o pen et r at e. Accor din g t o t h em , t h is
d if f icu lt y d er iv es f r om t h e lack of d ialog u e am on g
professionals, w hich im pairs int errelat ions am ong t eam
m em ber s. They j ust ify t hese fact s by t he lack of an
adequat e place t o hold m eet ings or encount er s.
Pa r t i ci p a n t s i n d i ca t e d g r e a t e r d i st a n ci n g
bet w een phy sicians and ot her healt h t eam m em ber s,
s a y i n g t h a t t h e s e p r o f e s s i o n a l s c o m m o n l y p u t
t h e m s e l v e s o n a p e d e s t a l , w h i c h m a k e s a n y
a p p r o x i m a t i o n d i f f i c u l t . Th e y h e l d u n i v e r s i t i e s
r e s p o n s i b l e f o r t h e l a c k o f k n o w l e d g e a b o u t
pr of ession al r oles an d t h e r edu ced in t er play am on g
t eam m em ber s as, du r in g t h eir edu cat ion , n o j oin t /
int egrat ed act ivit ies w ere prom ot ed. Professionals also
m ent ioned t hat , w hen an uncom m on sit uat ion occur s,
o u t si d e w o r k r o u t i n e s, t h a t i s, w h e n “ so m e t h i n g
w r on g ” h app en s, t h e r espon sibilit y f or t h e ev en t is
shov eled on fr om one t eam m em ber t o anot her.
Ex p ect at ion s
The int er v iew ed pr ofessionals r ev ealed t heir
desir e t o have a bet t er definit ion of w or k goals and a
b et t er in t er p lay am on g t eam m em b er s. Th ey w an t
each pr ofessional t o do his/ her par t and t hat all t eam
m e m b e r s b e c o m e c a p a b l e o f l i s t e n i n g t o a n d
r espect ing t he ot her s.
They t hink t hat , w hen one k now s w ell w hat
o n e d o e s a n d w h a t t h e o t h e r p e r s o n d o e s ,
per f or m an ce is bet t er, t h u s im pr ov in g pat ien t car e.
They affir m t hat daily cont act am ong t eam m em ber s
t en d s t o i m p r o v e i n t er r el a t i o n s a n d d ecr ea se t h e
ov er load and st r ess of and inside w or k .
Discou r se r ev ealed t h at som e pr of ession als
d e p e n d o n t h e p h y s i c i a n f o r d e c i s i o n m a k i n g .
Physicians, in t urn, posit ion t hem selves as t he cent er
of decision m aking and at t r act t he super vision of ot her
p r of ession als’ w or k .
DATA DI SCUSSI ON
Som e aut hor s( 7- 12) have st udied t he t hem e of t h i s p a p e r. On e o f t h e m( 7 ) sp e ci f i ca l l y l o o k e d a t m u lt ipr ofession al car e for h y per t en siv e pat ien t s an d
appoint ed a clear definit ion of each professional’s role,
g i v e n t h e s p e c i f i c i t y c h a r a c t e r i s t i c o f e a c h a n d
i n d i ca t i n g t h a t so m e a ct i o n s w i t h i n t h e t ea m a r e
obv ious. I n our st udy, w e found t he opposit e. Healt h
t eam m em ber s had lit t le know ledge about t heir t eam
colleagues’ pr ofessional r oles. This fact evidences t he
a b s e n c e o f c l e a r e x p e c t a t i o n s a b o u t w h a t e a c h
pr ofessional should/ can do in t his t eam , and t he lack
o f c l a r i t y a b o u t h o w o n e p r o f e s s i o n a l c o u l d
Th e r el at i o n sh i p am o n g t eam m em b er s i s
dir ect ly r elat ed t o t he inst it ut ion t hey w or k in and t o
t h e t y pe of t ask it aim s t o per f or m( 8 ). Th is r elat ion “ d ef in es” t h e ob j ect iv es an d ob st acles t h e t eam is
con fr on t ed w it h . Th e t eam w e ex am in ed is in ser t ed
in a m ilit ar y or ganizat ion. We infer t hat t he cont ex t
shar ed by t hese inst it ut ions ( hier ar chy, pr ior it izat ion
o f m i l i t a r y a c t i v i t i e s ) m a y h a v e i n f l u e n c e d t h e
collect ed dat a, alt hough all int er v iew ees w er e act iv e
in ot her healt h or ganizat ions as w ell.
I t w a s e v i d e n c e d t h a t , a m o n g
m ult idisciplinar y t eam pr ofessionals, phy sicians hav e
t he m ost clear ly defined r ole, follow ed by nur ses and
pharm acist s. Psychologist s’ r ole is t he m ost “ obscur e”.
I n for m an t s m en t ion ed t h eir su ppor t t o pat ien t s an d
fam ilies during hospit alizat ion, as w ell as t o t he t eam .
How ev er, t h eir st at em en t s did n ot ex plain h ow t h is
suppor t occur s and w hat it m eans.
Alt hough nursing was t he profession wit h t he
secon d b est d elim it ed r ole, n u r ses’ sp ecif ic r ole is
su r r ou n ded by a ser ies of ex pect at ion s. Par t icu lar ly
physicians expect t hat t hey dedicat e t hem selves m ore
to care but affirm that they are essential in adm inistration.
We found t hat , alt hough t hey ar e consider ed
as healt h t eam m em ber s, dent ist s, phy siot her apist s,
nut r it ionist s and psychologist s w er e appoint ed as ver y
dist ant fr om t he t eam , because t hey m ost ly dev elop
t heir w ork at out pat ient clinical level. This fact m akes
us t hink t hat , accor ding t o t he infor m ant s, t eam w or k
is rest rict ed t o daily hospit al w ork. Only t hr ee of t hem
looked beyond hospit als. This sit uat ion evidences and
r e i n f o r c e s a h o s p i t a l - c o n c e n t r a t e d h e a l t h c a r e
pr act ice, cent er ed on a biological- cur at ive t her apeut ic
int er v ent ion m odel( 3 ).
FI NAL CONSI DERATI ONS
No w a d a y s, i n t e r d i sci p l i n a r i t y i s d i scu sse d
an d appoin t ed as a cu r e- all for “ failu r es t o m eet in
t h e cu r r en t w or ld ”. How ev er, d at a f r om t h is st u d y
m a k e u s i n q u i r e a b o u t h o w t o d e v e l o p
in t er disciplin ar it y if daily w or k is m ar k ed by lack of
k n ow ledge abou t w h at disciplin es ar e an d h ow t h ey
c o m p l e m e n t o n e a n o t h e r. H o w c a n w e p r a c t i c e
in t er disciplin ar it y if w e ign or e each t eam m em ber ’s
p r of ession al r ole?
We a g r e e t h a t “ i n t e r d i sci p l i n a r i t y i s o n l y
su cce ssf u l a s a f o r m o f k n o w l e d g e a n d sci e n t i f i c
pr act ice t o t he ex t ent t hat t he using discipline ( and,
t o t h e sa m e ex t en t t h e su b j ect w h o p r a ct i ces i t )
a s s u m e s t h e u s e d d i s c i p l i n e a n d s t r i c t l y m o v e s
t hr ough it s pr oblem ”( 13).
I n t h is sen se, in t er d iscip lin ar it y r ep r esen t s
a n y a c t i v i t y d e v e l o p e d a n d e x p e r i e n c e d f r o m
d i f f e r e n t f o c i , i n t e g r a t i n g v a r i o u s c o n t e n t s a n d
co n v er g i n g t h em t o w ar d s a cer t ai n g o al . I n o t h er
w o r d s , i t c o v e r s a p h e n o m e n o n t h a t m u s t b e
analy zed fr om t he per spect iv e of sev er al k now ledge
ar eas, so t h at t h e d if f er en t p r of ession als in v olv ed
can pict ur e it as a w hole( 14).
We f ou n d t h at , on ce ag ain , t h e d ich ot om y
b et w een t h eo r y a n d p r a ct i ce w a s ev i d en ced . Th e
acad em i c d i sco u r se i s i n t er d i sci p l i n ar y b u t , i n t h e
p r act ical w or ld , it is d iscip lin ar it y t h at r eig n s ( t h e
“ feuds” of specialt ies pr evail) . I n t his st udy, w e found
t h at it is t h e acad em y it self, t h r ou g h it s ed u cat ion
pr ocess, w hich per pet uat es disciplinar y pr act ice. Joint
act iv it ies ar e lit t le ex p lor ed an d , w h en t h ey occu r,
t h e y d o n o t a l l o w p a r t i c i p a n t s t o p e r c e i v e t h e
i m p o r t a n c e o f t h e p r o f e s s i o n a l r o l e s d i f f e r e n t
m em ber s play and how t hey ar e connect ed w it h t heir
ow n p r of ession al r ole.
Ou r a p p r o a c h t o h e a l t h t e a m m e m b e r s ’
v iew of t h eir colleagu es w as f ast , r est r ict ed t o on e
s i n g l e p r a c t i c e s i t e a n d , t h e r e f o r e , l i m i t e d . We
b e l i e v e s i m i l a r s t u d i e s w i t h a l a r g e r n u m b e r o f
i n f o r m a n t s s h o u l d b e d e v e l o p e d . T h e s e c o u l d
su p p or t t h e con st r u ct i on of a h eal t h p r act i ce t h at
t r u l y i n v ol v es t eam w or k .
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