Quem Decide o Que é Ciência: Poder Profissional e Saúde. Paradigmas, poder e resistência à mudança nos sistemas de saúde
Palavras-chave:
Modelos teóricos, Modelo biomédico, Poder, Sistemas de saúde, Atenção centrada na pessoa, Salutogénese (DeCS)Resumo
Este artigo analisa criticamente como os paradigmas científicos dominantes nos sistemas de saúde definem quais conhecimentos são considerados legítimos e quem detém a autoridade epistemológica. A partir da teoria das mudanças de paradigma, argumenta-se que o positivismo biomédico se consolidou como um dogma que dificulta a integração de abordagens centradas no cuidado, na participação e na comunidade. Essa hegemonia contribui para a fragmentação, a desumanização e a limitada capacidade de resposta dos sistemas de saúde a necessidades complexas. Defende-se que a resistência à mudança paradigmática está mais relacionada a dinâmicas de poder profissional do que à ausência de evidência, sendo necessária a ampliação do modelo científico por razões de integridade científica e responsabilidade social.
Referências
Antonovsky, A. (1979). Health, stress, and coping. Jossey-Bass.
Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M. & Griffiths, P. (2018). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 8(1), e019189, 1-8. https://doi.org/10.1136/bmjopen-2017-019189
Baduge, M. S. D. S. P., Garth, B., Boyd, L., Ward, K., Joseph, K., Proimos, J. & Teede, H. J. (2024). Barriers to advancing women nurses in healthcare leadership: A review. eClinical Medicine Part of The Lancet Discovery Science, 67, 102354. https://doi.org/10.1016/j.eclinm.2023.102354
Bolton, D., & Gillett, G. (2019). The biopsychosocial model of health and disease: New philosophical and scientific developments. Palgrave Macmillan.
Bourdieu, P. (2004). Science of science and reflexivity. University of Chicago Press. Coulter, A. & Oldham, J. (2016). Person-centred care: What is it and how do we get there? Future Hospital Journal, 3(2), 114–116. https://doi.org/10.7861/futurehosp.3-2-114
Dall’Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J. & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies, 134, 104311. https://doi.org/10.1016/j.ijnurstu.2022.104311
de Londras, F., Cleeve, A., Rodriguez, M. I., Farrel, A., Furgalska, M. & Lavelanet, A. (2023). The impact of ‘conscientious objection’ on abortion-related care: Evidence and implications. Health Policy, 129, 104716, 1-12. https://doi.org/10.1016/j.healthpol.2023.104716
Doyle, C., Lennox, L. & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 3(1), e001570, 1-18. https://doi.org/10.1136/bmjopen-2012-001570
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
Eriksson, M. & Lindström, B. (2008). A salutogenic interpretation of the Ottawa Charter. Health Promotion International, 23(2), 190–199. https://doi.org/10.1093/heapro/dan014
Freidson, E. (2001). Professionalism: The third logic. University of Chicago Press. Gabbay, J. & Le May, A. (2011). Practice-based evidence for healthcare: Clinical mindlines. Routledge.
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P. & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581–629. https://doi.org/10.1111/j.0887-378X.2004.00325.x
Imam, A., Obiesie, S., Aluvaala, J., Maina, J. M., Gathara, D. & English, M. (2022). Identifying gaps in global evidence for nurse staffing and patient care outcomes research in low/middle-income countries: an umbrella review. BMJ Open, 12(10), e064050, 1-12. https://doi.org/10.1136/bmjopen-2022-064050
Kickbusch, I. & Gleicher, D. (2012). Governance for health in the 21st century. World Health Organization Regional Office for Europe.
Krawutschke, R., Pastrana, T. & Schmitz, D. (2024). Conscientious objection and barriers to abortion within a specific regional context - an expert interview study. BMC Med Ethics, 25, 14, 1-9. https://doi.org/10.1186/s12910-024-01007-1
Kringos, D. S., Boerma, W. G. W., Hutchinson, A. & Saltman, R. B. (Eds.). (2015). Building primary care in a changing Europe. World Health Organization-European Observatory on Health Systems and Policies.
Kuhn, T. S. (1962). The structure of scientific revolutions. University of Chicago Press.
Marmot, M. (2015). The health gap: The challenge of an unequal world. The Lancet, 386(10011), 2442–2444. https://doi.org/10.1016/S0140-6736(15)00150-6
Marmot, M., Atkinson, T., Allen, J., Black , C., Broadfoot , P., Cumberlege , J., Diamond , I., Gilmore , I., Ham , C., Meacher, M. & Mulgan, G. (2010). Fair society, healthy lives. The Marmot Review. Strategic review of health inequalities in england post-2010. The Marmot Review. https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf
Martínez-Riera, J. R. et al. (2020). Enfermería comunitaria y promoción de la salud. Enfermería Clínica,30(3), 175–182
Maslach, C. & Leiter, M. P. (2016). Understanding burnout: recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311
Mittelmark, M. B., Sagy, S., Eriksson, M., Bauer, G. F., Pelikan, J. M., Lindström, B. & Espnes, G. A. (Eds.). (2017). The handbook of salutogenesis. Springer.
Noble, H. & Smith, J. (2025). Ensuring validity and reliability in qualitative research. Evidence-Based Nursing, 28(4), 206–208. https://doi.org/10.1136/ebnurs-2024-104232
O’Mara-Eves, A., Brunton, G., Oliver, S., Kavanagh, J., Jamal, F. & Thomas, J. (2015). The effectiveness of community engagement in public health interventions for disadvantaged groups: a meta-analysis. BMC Public Health, 15, 129, 1-23. https://doi.org/10.1186/s12889-015-1352-y
Pyo, J., Lee, W., Choi, E. Y., Jang, S. G. & Ock, M.(2023). Qualitative research in healthcare: Necessity and Characteristics. Journal of Preventive Medicine & Public Health, 56(1), 12-20. https://doi.org/10.3961/jpmph.22.451
Rifkin, S. B. (2014). Examining the links between community participation and health outcomes. Health Policy and Planning, 29(Suppl 2), ii98–ii106. https://doi.org/10.1093/heapol/czu076
Royal College of Nursing. (2020). Gender and nursing as a profession: Valuing nurses and paying them their worth. RCN.
Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H. & Lu, M. (2018). How to practice person-centred care: A conceptual framework. BMJ, 360, k252. https://doi.org/10.1136/bmj.k252
Solar, O. & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion. Paper 2 (Policy and Practice). World Health Organization. https://www.who.int/publications/i/item/9789241500852
Starfield, B., Shi, L. & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83(3), 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x
Tronto, J. C. (1993). Moral boundaries: A political argument for an ethic of care. Routledge. Willis, E., Carryer, J., Harvey, C., Pearson, M. & Henderson, J. (2017). Austerity, new public management and missed nursing care. Journal of Advanced Nursing, 73(12), 3102–3110. https://doi.org/10.1111/jan.13380
World Health Organization. (1986). Ottawa charter for health promotion. The 1st International Conference on Health Promotion, Ottawa. https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference
World Health Organization. (2016). Framework on integrated, people-centred health services [Reporte del secretariado]. https://apps.who.int/gb/ebwha/pdf_files/wha69/a69_39-en.pdf
World Health Organization, Regional Office for Europe. (2017). Enhancing the role of community health nursing for universal health coverage (Human Resources for Health Observer Series No. 18). WHO Regional Office for Europe.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2026 Los derechos morales pertenecen al autor, los derechos patrimoniales a la Benemérita Universidad Autónoma de Puebla.
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Los derechos morales pertenecen al autor, los derechos patrimoniales a la Benemérita Universidad Autónoma de Puebla.
